Cerebral Hemorrhage as a Cause of Death on Death Certificates

Classification and Documentation

• The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Clinical Data Standards recognizes cerebral hemorrhage as a specific cardiovascular cause of death, classified as "CV: CV hemorrhage" 1
• Cerebral hemorrhage is defined as "death related to hemorrhage such as a nonstroke intracranial hemorrhage (e.g., subdural hematoma), nonprocedural or nontraumatic vascular rupture (e.g., aortic aneurysm), or hemorrhage causing cardiac tamponade" 1
• Cerebral hemorrhage can be further classified as intracerebral hemorrhage, which is "a focal collection of blood within the brain parenchyma or ventricular system that is not caused by trauma" 2
• Hemorrhagic stroke is defined as "rapidly developing clinical signs of neurological dysfunction attributable to a focal collection of blood in the brain parenchyma or ventricular system that is not caused by trauma" 2

Proper Documentation and Best Practices

• The American College of Cardiology recommends that the death certificate should identify cerebral hemorrhage as either the underlying cause or immediate cause of death, depending on the clinical circumstances 3
• The American Heart Association suggests that confirm the diagnosis with appropriate imaging (CT or MRI) whenever possible 4
• The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Clinical Data Standards advises to document the specific type of cerebral hemorrhage (intracerebral, subarachnoid, subdural, etc.) 2, 5
• The American Heart Association recommends including the anatomical location of the hemorrhage when known (lobar, deep, cerebellar, brain stem) 5

Documenting Causes of Death in Intracranial Hemorrhage

Immediate Cause of Death

• Cerebral herniation should be recorded as the immediate cause of death (Part I, line a) when it is the final event leading to demise in a patient with intracranial hemorrhage. 6

Cardiovascular Classification (ACC/AHA)

• The ACC/AHA Task Force classifies cerebral hemorrhage as a distinct cardiovascular cause of death under the category “CV: CV hemorrhage,” encompassing non‑stroke intracranial hemorrhages such as subdural hematoma and non‑procedural, non‑traumatic vascular ruptures. 7

Documentation Standards (American Heart Association / ACC/AHA)

• The ACC/AHA standards require that death certificates specify the hemorrhage compartment (e.g., intraparenchymal, subarachnoid, subdural, etc.) rather than using the generic term “intracranial hemorrhage,” to ensure accurate epidemiologic tracking and public‑health reporting. 7