Differential considerations for acute, nontraumatic cerebral hemorrhage include hypertensive hemorrhage, with characteristic locations in the basal ganglia, thalamus, pons, and cerebellum; amyloid angiopathy, which classically demonstrates a lobar distribution and associated foci of blooming or “black dots” on SWI in a subcortical distribution (Fig. 31.3); vascular malformations (Fig. 31.4); venous sinus thrombosis (refer to Chaps. 20 and 47); cocaine or alcohol abuse (refer to Chaps. 2 and 5); primary CNS vasculitis (refer to Chaps. 5, 6, and 10); hemorrhagic neoplasm, for which tumoral enhancement may be minimal; and hemorrhagic conversion of ischemic stroke. The imaging interpreter must combine imaging findings with clinical history, including age of the patient, medical comorbidities, and medication use, in order to arrive at the most probable diagnosis. In patients without a clear etiology of the intracranial hemorrhage on initial evaluation, CTA or MRA should be recommended. Furthermore, underlying lesions may not be apparent in the acute phase of hemorrhage, and follow-up imaging in 2–3 months is often warranted (Fig. 31.5).