Search Results (460)

Introduction: Transnasal penetrating intracranial injuries represent an exceptionally rare form of traumatic brain injury, characterized by high mortality and a substantial risk of severe neurosurgical and infectious complications. Self-inflicted injuries involving the penetration of a foreign body through the nasal cavity into the brain are exceedingly uncommon and require prompt diagnosis and a multidisciplinary treatment approach. Objective: This study aimed to present a rare clinical case of transnasal penetration of a foreign body (a ballpoint pen refill) into the brain parenchyma during a suicide attempt, and to describe the diagnostic and therapeutic approach. Case Report: A 46-year-old woman with an acute psychotic disorder was admitted following a suicide attempt involving the insertion of a ballpoint pen refill through the right nasal cavity. Computed tomography revealed a retained intracranial foreign body embedded within the brain parenchyma, traversing the cribriform plate and associated with pneumocephalus. The foreign body was successfully removed via an endoscopic endonasal approach. Owing to the cerebrospinal fluid leak that developed after removal of the foreign body, reconstruction of the anterior skull base defect was performed using fascia lata and tissue adhesive. The postoperative course was uneventful, with no neurological complications and gradual resolution of the intracerebral hemorrhagic changes and pneumocephalus. The patient was discharged without neurological deficits and was referred for psychiatric treatment with a diagnosis of catatonia accompanied by episodes of psychomotor agitation. Conclusions: Transnasal penetrating brain injuries are rare but potentially fatal. Early radiological diagnosis, meticulous preoperative planning, and an endoscopic endonasal approach enable safe removal of the foreign body and reliable reconstruction of the anterior skull base defect. Multidisciplinary collaboration among neurosurgeons, otorhinolaryngologists, radiologists, and psychiatrists is essential for achieving favorable outcomes in these patients. Full article

Choriocarcinoma is a highly malignant trophoblastic tumour characterised by the secretion of human chorionic gonadotropin (β-hCG). Depending on its origin, choriocarcinoma is divided into gestational (GCC) or nongestational (NGCC). The prognosis is poor due to its high malignancy and possible hemorrhagic metastasis to distant organs. In the present case, a 40-year-old woman presented to the ophthalmology clinic with intermittent visual disturbances and a headache. An MRI of the head revealed a small, round area of contrast enhancement, suggesting a vascular malformation. A month later, the patient presented to the emergency department after syncope. A head CT scan revealed two large intracerebral hematomas, which were evacuated by craniotomy. However, there were recurrences of intracranial bleeding, some of which were reoperated. During hospitalisation, chest X-ray and CT scans revealed a mass in the right middle lobe of the lung. Successive subcapsular hematomas were detected in both liver lobes; the patient underwent two laparotomies. A gynaecological examination and transvaginal ultrasonography excluded the possibility of pregnancy despite the elevated levels of βhCG. Histopathological examination of the liver tissue confirmed the presence of metastatic foci of choriocarcinoma. The patient received cycles of chemotherapy. After chemotherapy, βhCG decreased. Full article

Background: Systemic inflammation plays a critical role in secondary brain injury after spontaneous intracerebral hemorrhage (ICH). The pan-immune-inflammation value (PIV) has recently emerged as a novel composite inflammatory biomarker; however, its prognostic significance in critically ill ICH patients remains unclear. Methods: This retrospective cohort study included 111 consecutive adult patients admitted to the intensive care unit (ICU) with spontaneous ICH between January 2020 and December 2024. PIV, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and conventional clinical predictors were evaluated at ICU admission. The primary outcome was 28-day mortality, while the mechanical ventilation (MV) requirement was assessed as a secondary outcome. Receiver operating characteristic (ROC) analysis and logistic regression models were used to evaluate prognostic performance. Results: MV was required in 78 patients (70.3%), and 41 patients (36.9%) died within 28 days. Patients requiring MV had significantly higher PIVs than non-ventilated patients (p = 0.013), whereas PIVs did not differ significantly between survivors and non-survivors (p = 0.539). For predicting MV requirement, GCS score demonstrated the highest discriminative performance (AUC = 0.922), followed by ICH score (AUC = 0.874), procalcitonin (AUC = 0.861), and NLR (AUC = 0.832), whereas PIV showed modest discrimination (AUC = 0.650). For 28-day mortality, procalcitonin achieved the highest AUC (0.800), while PIV showed poor predictive performance (AUC = 0.535). In multivariable analysis, NLR and procalcitonin remained independently associated with both MV requirement and 28-day mortality. PIV was not included in the final multivariable models because of its overlap with NLR; moreover, it did not provide meaningful incremental prognostic value when added to the reference models. Conclusions: In this single-center cohort of ICU-admitted patients with spontaneous ICH, PIV did not add meaningful prognostic value beyond established clinical and inflammatory predictors. These findings do not support the routine use of PIV for early risk stratification in this specific population; simpler markers, particularly NLR and procalcitonin, may be preferred when interpreted alongside established clinical severity measures. Full article

Background/Objectives: Venous thromboembolism (VTE) is a common and potentially preventable complication after hemorrhagic stroke, yet the optimal timing of pharmacologic prophylaxis remains uncertain because of concern for hematoma expansion or rebleeding. Repeat neuroimaging is frequently used to assess hemorrhage stability before initiating deep vein thrombosis (DVT) chemoprophylaxis, although the value of radiographic stability alone remains unclear. This review evaluates the evidence supporting imaging-guided initiation of prophylaxis after intracerebral hemorrhage (ICH) and aneurysmal subarachnoid hemorrhage (aSAH). Methods: A narrative review of the literature was performed focusing on hemorrhage expansion, thrombotic risk, repeat neuroimaging, and timing of pharmacologic prophylaxis in spontaneous ICH and aSAH. Observational studies, limited randomized data, and current guideline recommendations were assessed. Results: In spontaneous ICH, hematoma expansion risk is greatest within the first 24 h, whereas thrombotic risk increases over subsequent days because of immobility and systemic inflammation. Available evidence suggests that early low-dose anticoagulant prophylaxis may be safe in selected patients with stable hemorrhage, although definitions of stability vary and no prospective study has validated repeat imaging as an independent decision trigger. In aSAH, rebleeding risk depends more heavily on aneurysm securement and procedural factors than on imaging appearance alone. Conclusions: Repeat neuroimaging provides important reassurance after hemorrhagic stroke but does not fully capture ongoing biological risks. Current evidence supports a cautious, individualized approach in which radiographic stability informs, but does not independently determine, the timing of pharmacologic VTE prophylaxis. Full article

A 40-year-old man presented with thunderclap headache (TCH) and vomiting post-masturbatory ejaculation. He reported a similar episode with posterior neck pain five days earlier after ejaculation. Unlike his migraine history, these headaches were unusually severe. Upon arrival, physical and neurological examinations were unremarkable except for an elevated blood pressure (154/110 mmHg). Brain MRI/MRA systematically ruled out intracerebral/subarachnoid hemorrhages, aneurysms, cerebral venous thrombosis, and cervical artery dissection, with preserved flow voids on B-PASS, T2, and T2-FLAIR. Notably, MRA demonstrated multiple segmental vasoconstrictions compared to a baseline MRA from five years prior. With an RCVS₂ score of 8, he was diagnosed with reversible cerebral vasoconstriction syndrome (RCVS). Symptoms resolved within 10 days of starting oral verapamil (120 mg/day), and follow-up MRA at one month showed partial improvement. This case highlights RCVS manifesting as a secondary cause sharing features with the proposed headaches associated with sexual activity (HSA) spectrum. RCVS is the predominant secondary cause of HSA (67–90%), often indistinguishable from primary HSA at onset due to the shared presentation of sudden TCH. Its pathophysiology likely involves an orgasm-induced sympathetic surge causing transient dysregulation of cerebral vascular tone. This case emphasizes that thorough neurovascular imaging is important in HSA to differentiate RCVS from primary headaches, ensuring the prompt initiation of calcium channel blockers and the avoidance of triptans. Full article

Objectives: This study investigated the prognostic value of the CNS-LAND score in predicting Intensive Care Unit (ICU) mortality among patients admitted with spontaneous intracerebral hemorrhage (ICH). Methods: In this single-center, retrospective cohort study, 305 adult ICU patients with spontaneous ICH (September 2022–March 2026) were included. The primary endpoint was ICU mortality. Prognostic performance was evaluated using receiver operating characteristic (ROC) curve analysis and the bootstrap-based DeLong method. The independent contribution of CNS-LAND beyond the Glasgow Coma Scale (GCS) was assessed using partial correlation and logistic regression analyses. Results: ICU mortality occurred in 71 of 305 patients (23.3%; median age 66.0 years). CNS-LAND scores were significantly higher in non-survivors than survivors (median 6.0 vs. 3.0, p < 0.001). ROC analysis showed the highest discriminative performance for GCS (AUC: 0.925), followed by Sequential Organ Failure Assessment (SOFA) (AUC: 0.906), Acute Physiology and Chronic Health Evaluation II (APACHE II) (AUC: 0.840), and CNS-LAND (AUC: 0.816; p = 0.467 vs. APACHE II). At a cutoff of ≥5, CNS-LAND yielded 83.1% sensitivity, 70.9% specificity, and a negative predictive value of 93.3%. Spearman analysis revealed near-perfect collinearity between National Institutes of Health Stroke Scale (NIHSS) and GCS (rs = −0.964, p < 0.001). After controlling for GCS, CNS-LAND lost statistical significance (partial rs = −0.051, p = 0.373), and logistic regression confirmed no independent prognostic contribution beyond GCS (LRT: χ² = 0.121, p = 0.728). Conclusions: CNS-LAND demonstrated mortality prediction performance comparable to APACHE II in critically ill ICH patients. However, this apparent performance was almost entirely attributable to the score’s NIHSS component: NIHSS and GCS were near-perfectly collinear (rs = −0.964), and after adjustment for GCS, CNS-LAND was no longer significantly associated with mortality (partial rs = −0.051, p = 0.373; likelihood-ratio test p = 0.728; ΔAUC ≈ 0.000). CNS-LAND therefore provides essentially no independent prognostic information beyond GCS in this population, indicating that its discriminative performance is redundant with, rather than complementary to, standard neurological assessment. This redundancy is rooted in the parallel progression of neurological deficit and consciousness characteristic of severe ICH—a relationship fundamentally distinct from the acute ischemic stroke population in which CNS-LAND was originally derived. Full article

Intracerebral hemorrhage (ICH) is a devastating stroke subtype in which secondary brain injury is driven by oxidative stress, iron overload, ferroptosis, neuroinflammation, blood–brain barrier disruption, and defective hematoma clearance. Nrf2 is a redox-sensitive transcription factor that coordinates antioxidant defense, iron handling, inflammatory regulation, and neurovascular unit protection through downstream effectors such as HO-1, NQO1, GPX4, and SLC7A11. Plant-derived natural compounds have been widely investigated in experimental ICH models; however, increased Nrf2 expression or nuclear translocation alone does not establish Nrf2-dependent neuroprotection. Here, we critically appraise preclinical evidence linking plant-derived natural compounds to Nrf2-centered signaling in ICH and classify the evidence into three levels: causal Nrf2-dependent evidence, Nrf2-associated evidence, and indirect or context-transferred evidence. Representative flavonoids, phenolics, terpenoids, lignans, steroidal lactones, and other bioactive compounds are evaluated with attention to ICH-model relevance, causal pathway validation, pharmacokinetic limitations, brain exposure, and therapeutic window. Current evidence indicates that only a limited subset of compounds has been validated by genetic or pharmacological Nrf2 inhibition, whereas most remain supported by pathway association rather than causality, and preclinical studies rely predominantly on young healthy rodent models with early post-ICH intervention. Notably, no compound currently reaches relatively high translational priority because perihematomal brain exposure, delayed-treatment efficacy, and long-term safety evidence remain largely unavailable. We therefore propose an evidence-based prioritization framework integrating Nrf2 causality, ICH-specific efficacy, brain bioavailability, and translational readiness. This review clarifies the mechanistic boundaries of Nrf2-targeted natural compounds and outlines priorities for rigorous translational research in ICH. Full article

Background/Objectives: Spontaneous intracerebral hemorrhage (ICH) is associated with high mortality and disability. We aimed to identify clinical, laboratory, and imaging factors independently associated with 3-month functional outcome across non-contrast computed tomography (NCCT) morphological markers, laboratory biomarkers, and established clinical scoring systems. Methods: This retrospective cohort study included 337 consecutive patients with spontaneous ICH admitted between 2019 and 2022. Admission clinical findings, laboratory parameters, NCCT morphological markers (swirl, blend, black hole, island, hypodensities, and satellite signs), volumetrically segmented hematoma volumes, and prognostic scores (ICH and FUNC scores) were recorded. Poor functional outcome was defined as modified Rankin Scale (mRS) 3–6 at 3 months. Independent predictors were identified using a primary Firth penalized multivariable logistic regression model; discrimination (area under the ROC curve, AUC), calibration, and optimism-corrected performance (1000-resample bootstrap) were assessed, and incremental value over the ICH and FUNC scores was tested with the DeLong method. Results: Poor functional outcome occurred in 60.2% of patients, and 3-month mortality was 36.8%. In the primary penalized model, independent predictors of poor outcome were lower admission Glasgow Coma Scale, larger hematoma volume, NCCT hypodensities, history of hypertension, and lower low-density lipoprotein (LDL) cholesterol. The model showed good discrimination (apparent AUC 0.881; optimism-corrected 0.872) and calibration (slope 0.92) and significantly outperformed the ICH and FUNC scores (DeLong p = 0.009 and p < 0.001, respectively). Several laboratory and treatment variables reached significance only in an unpenalized model and were statistically unstable; these were treated as exploratory. Although swirl, blend, black hole, and island signs were associated with poor outcomes in univariable analysis, they did not remain independent predictors in the final model. The ICH and FUNC scores were significantly associated with poor functional outcome in univariable analysis. Conclusions: Poor 3-month functional outcome after spontaneous ICH is independently associated with neurological severity, hematoma volume, NCCT hypodensities, and selected clinical and laboratory factors. Integrating clinical, volumetric, and CT morphological parameters improved discrimination over established prognostic scores; however, these findings are associative and require prospective, multicenter validation before clinical implementation. Full article

Background: Apixaban and rivaroxaban are commonly used direct oral anticoagulants for venous thromboembolism (VTE), but comparative real-world effectiveness and safety data remain limited. Methods: We conducted a retrospective cohort study using the TriNetX database. Adults with VTE were stratified into apixaban and rivaroxaban treatment groups. Propensity score matching balanced baseline characteristics. Time-to-event outcomes up to 2 years were assessed using Kaplan–Meier analysis and Cox proportional hazards models. Results: Following propensity score matching, well-balanced cohorts (8247) were obtained, with a mean age of 58.3 ± 18.0 versus 57.3 ± 18.1 years. Recurrent VTE rates were broadly comparable at 3 months (22.14% vs. 22.26%; HR 1.02, 95% CI 0.95–1.09; p = 0.6, ARD −0.001, 95% CI: −0.014 to 0.011), with small but statistically significant increases observed with apixaban at 6-month (HR 1.07, 95% CI 1.01–1.13; p = 0.016, ARD 0.009, 95% CI: −0.005 to 0.023), 1-year (HR 1.07, 95% CI 1.01–1.12; p = 0.019, ARD 0.004, 95% CI: −0.010 to 0.019), and 2-year follow-ups (HR 1.08, 95% CI 1.04–1.13; p = 0.000, ARD −0.001, 95% CI: −0.013 to 0.011). All-cause mortality was comparable through 1 year; however, a statistically significant increase was observed at the 2-year follow-up for apixaban (HR 1.20, 95% CI 1.06–1.37; p = 0.005, ARD 0.005, 95% CI: −0.002 to 0.013). Bleeding outcomes were largely comparable in the overall cohort, with no statistically significant differences in composite major bleeding (2-year ARD: −0.004, 95% CI: −0.012–0.004), major bleeding (2-year ARD: 0.002, 95% CI: −0.004 to 0.007), gastrointestinal bleeding (2-year ARD: −0.001, 95% CI: −0.004–0.003), or intracerebral hemorrhage (2-year ARD: 0.000, 95% CI: −0.002–0.003) across follow-up periods. A statistically significant reduction in non-major bleeding with regard to apixaban was observed at the 6-month follow-up only (HR 0.79, 95% CI 0.63–0.98; p = 0.033) (2-year ARD: −0.004, 95% CI: −0.010–0.002). Subgroup analyses revealed important heterogeneity: among patients with obesity, composite major bleeding was significantly lower with respect to apixaban at the 2-year follow-up (HR 0.39, 95% CI 0.20–0.76; p = 0.004), whereas among patients with cancer, composite major bleeding was significantly higher with apixaban at the 1-year (HR 1.31, 95% CI 1.02–1.70; p = 0.037) and 2-year follow-ups (HR 1.32, 95% CI 1.04–1.68; p = 0.023). Conclusions: In this real-world propensity-matched analysis, apixaban and rivaroxaban demonstrated broadly comparable effectiveness and safety for VTE treatment, with largely similar bleeding outcomes in the overall cohort. Small but statistically significant increases in recurrent VTE and 2-year mortality with apixaban, alongside subgroup-specific bleeding differences, underscore the importance of individualized treatment selection based on patient-specific risk factors. Full article

Intracerebral hemorrhage (ICH) remains one of the most severe forms of stroke and is associated with high mortality, poor functional outcomes, and substantial healthcare burden worldwide. Despite advances in neurocritical care and minimally invasive surgical techniques, the management of ICH remains challenging because of disease heterogeneity, rapid neurological deterioration, and the lack of effective individualized treatment strategies. In recent years, artificial intelligence (AI) has emerged as a promising tool for improving the diagnosis, prognostic evaluation, and precision management of ICH. A systematic literature search was performed in PubMed, Web of Science, and Embase to identify studies on AI applications in ICH, with predefined inclusion criteria focusing on imaging analysis, prognostic prediction, clinical decision support, and minimally invasive surgery. This review summarizes the major clinical applications, limitations, and future directions of AI in ICH, including multimodal foundation models, intelligent surgical assistance, and personalized precision care. Recent studies have demonstrated that AI-based models can significantly improve the accuracy of hematoma segmentation, hematoma expansion prediction, and functional outcome prognostication compared with conventional approaches. Despite encouraging progress, several important barriers continue to limit clinical translation, including data heterogeneity, limited external validation, insufficient interpretability, ethical and regulatory concerns, and challenges in workflow integration. Overall, AI has the potential to transform ICH management from conventional experience-based practice to data-driven, personalized, and precision neurosurgical care. Full article

Computed tomography (CT) scan is a widely used, non-invasive, sensor-based imaging technique that provides critical intracranial information for rapid stroke assessment. Accurate segmentation of intracerebral hemorrhage (ICH) in sensor-derived CT images is vital for clinical decision-making. Effective intelligent analysis of CT images is key to achieving reliable computer-aided diagnosis. However, existing deep learning methods struggle with complex ICH lesions characterized by blurred boundaries, irregular shapes, and large-scale variations. To address these challenges, this paper proposes TransAMGNet, a hybrid U-shaped network with Transformer integration for ICH CT image segmentation. The network is built on a residual U-Net backbone and introduces a Transformer encoder to strengthen global context modeling, thereby improving the representation of complex lesion morphology. Specifically, in the encoding stage, we design an Adaptive Dual-branch Channel Attention Module (ADCAM), which jointly models global and local channel information to enhance the model’s sensitivity to important feature responses. In the skip-connection pathway, we introduce a Multi-scale Feature Enhancement Module (MFEM), which preserves high-resolution spatial details while supplementing multi-scale contextual information to improve shallow-deep feature fusion. During decoding, a Gate-enhanced Dynamic Upsampling Module (GDUM) is constructed to improve the recovery of lesion boundaries and fine-grained structures through the synergy of gated recalibration and content-aware upsampling. The proposed method is systematically evaluated through comparative experiments and ablation studies. Experimental results show that TransAMGNet outperforms competing methods across multiple evaluation metrics, achieving Dice, Recall, IoU, Precision, and HD95 values of 90.47 ± 0.58%, 87.83 ± 3.71%, 81.26 ± 0.78%, 91.13 ± 0.95%, and 32.94 ± 1.1, respectively. The ablation studies further verify the effectiveness of each module. These results demonstrate that TransAMGNet can effectively improve segmentation performance for complex ICH lesions. Full article

Background/Objectives: To evaluate the discriminative value of perilesional microstructural alterations assessed by diffusion tensor imaging (DTI) parameters in differentiating malignant and benign causes of intracerebral hemorrhage. Methods: This retrospective study included patients with intracerebral hemorrhage classified as benign or malignant based on follow-up findings and histopathological diagnosis. Fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), mean diffusivity (MD), lesion-to-normal (L/N) ratios, and perilesional edema index (PEI) were extracted from standardized perilesional regions. Diffusion parameters were compared between groups, and their discriminative performance was assessed using ROC analysis and logistic regression. Results: A total of 41 patients (20 benign, 21 malignant) were included. Malignant cases demonstrated significantly greater PEI and distinct diffusion abnormalities, with markedly higher AD, RD, and MD values, as well as elevated L/N ratios (all p < 0.001). FA was significantly reduced in malignant cases (p = 0.016). Conclusions: Diffusivity metrics—particularly AD, RD, and MD values and their L/N ratios—demonstrated excellent diagnostic performance in differentiating malignant from benign causes of intracerebral hemorrhage, further informed by the PEI, and may support clinical decision-making in diagnostically challenging cases. Full article

Blood-based biomarkers offer a promising “biochemical imaging” approach for acute ischemic stroke (AIS) management, providing objective and accessible tools to complement conventional neuroimaging. This narrative review synthesizes recent advances in biomarkers derived from multiple neurovascular unit (NVU) compartments, including glial fibrillary acidic protein (GFAP), S100 calcium-binding protein B (S100B), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), neuron-specific enolase (NSE), neurofilament light chain (NfL), matrix metalloproteinase-9 (MMP-9), Claudin-5, Occludin, brain-derived neurotrophic factor (BDNF), interleukin-33 (IL-33), tumor necrosis factor-alpha (TNF-alpha), PARK7/DJ-1, glycogen phosphorylase BB (GP-BB), and circulating microRNAs. We focus on their stage-specific clinical utility across three scenarios: (1) ultra-early differentiation between ischemic stroke and intracerebral hemorrhage in prehospital and emergency settings; (2) dynamic prediction and monitoring of hemorrhagic transformation after reperfusion therapies; and (3) assessment of infarct burden, neurorepair potential, and long-term functional outcomes. Despite their promise, clinical translation remains hindered by assay platform heterogeneity, lack of standardized cut-off values, limited cost-effectiveness data, and insufficient prospective validation adjusted for key covariates such as age and renal function. We further discuss multi-marker panel construction, including strategies to address biomarker collinearity and overfitting. Future directions emphasize stage-specific panels, point-of-care testing devices, and artificial intelligence algorithms to advance precision medicine in stroke care. Full article

Herpes simplex virus encephalitis (HSVE) is the most common infectious encephalitis and is associated with high morbidity and mortality when not treated in time. Symptoms include fever, headache, fatigue, neurological deficits such as aphasia and epileptic seizures. While hemorrhagic transformation is a common complication in HSVE, intracerebral hematoma (ICH) as the initial or main presentation is rare. We present two patients with HSVE who displayed a large temporal hematoma as the main finding on cerebral imaging. We further conducted a systematic literature review to identify all published cases of ICH in HSVE. Forty-nine publications met the inclusion criteria, describing a total of 55 patients. In 38 of these, HSVE could be definitely confirmed by brain biopsy, autopsy or PCR. We analyzed these cases according to age, gender, lag from symptom onset to hospital admission, lag from hospital admission to detection of hemorrhage, location of encephalitis and hemorrhage, received treatment and outcome. With a median age of 45 years, this cohort is significantly younger than general HSVE populations described previously. In conclusion, our review shows that, albeit rare, awareness about ICH complicating HSVE is highly relevant as failure to recognize an atypical course of HVSE may result in a delay of effective antiviral treatment, which is related to an unfavorable or even fatal outcome. Full article

Background and Clinical Significance: Cerebral amyloid angiopathy (CAA) is a neurovascular disorder characterized by the deposition of amyloid beta (Aβ) peptides within the walls of small-to-medium-sized cerebral vessels, leading to vascular fragility and an increased risk of lobar intracerebral hemorrhage (ICH), cognitive decline, and recurrent stroke. CAA is an important cause of spontaneous ICH in elderly patients and may be underrecognized, particularly when presenting with acute neurologic symptoms that mimic ischemic stroke. Early identification has significant implications for management, prognosis, and secondary prevention. Case Presentation: An 80-year-old male presented to the emergency department with incoherent speech, rambling, and severe headache concerning for acute stroke. His medical history was notable for a prior cerebrovascular accident, hypertension, diabetes mellitus, benign prostatic hyperplasia, and recent evaluation for dementia-like symptoms. Initial neuroimaging revealed a 3.2 cm intraparenchymal hemorrhage in the left occipital lobe with surrounding edema. Subsequent MRI demonstrated a lobar hemorrhage pattern suggestive of CAA based on imaging findings and clinical context. The patient was admitted to the intensive care unit (ICU) for close neurologic monitoring. He remained hemodynamically stable with no new motor or sensory deficits. Over a three-day hospital course, his speech and visual deficits improved. Blood pressure was carefully controlled, and repeat imaging demonstrated stable hemorrhage without progression. He was diagnosed with probable CAA and discharged home with supportive services. Conclusions: This case highlights the importance of considering cerebral amyloid angiopathy in elderly patients presenting with spontaneous lobar intracerebral hemorrhage and cognitive symptoms. Prompt recognition and appropriate neuroimaging are critical for diagnosis, risk stratification, and guiding management. Full article