A Ruptured Berry aneursym caused a large intraventricular hemorrhage involving the lateral and third ventricles. Intraventricular hemorrhages of this size are usually fatal either due to the pressure wave of the blood hitting the floor of the fourth ventricle where many of the cardiovascular and respiratory centers lie or by acute cerebral edema and herniation. Other causes include blood dyscrasias or rupture of vascular malformations. Hypertensive hemorrhages are often due to hypertensive lipohyalinosis of of small arteries with formation of small Charcot-Bouchard aneurysms.
Blood dyscrasias cause bleeding due to inability of the blood to clot.
Hemorrhages from vascular malformations are caused by trauma or hypertension further damaging an abnormal blood vessel wall. They may also rupture into the ventricle which may cause death or may be helpful in decompression. Blood dyscrasias such as leukemias often produce many small petechial or larger hemorrhages. Vascular malformations may rupture due to hypertension, trauma or abnormalities of the blood vessel wall. The walls of a large hemorrhage thought to be due to hypertension should be examined for abnormal vessels.