SMASH U Classification of ICH

A simple and practical clinical classification for the etiology of intracerebral hemorrhage from Helsinki University Central Hospital.

SMASH U stands for:

  • (S) structural vascular lesions – including cavernomas and AVMs – 5%
  • (M) medication – 14%
  • (A) amyloid angiopathy – 20%
  • (S) systemic disease (liver cirrhosis, thrombocytopenia, others) – 5%
  • (H) hypertension – 35%
  • (U) undetermined – 21%

*patients with structural lesions have smallest hemorrhages and best prognosis; anticoagulation-related ICH were largest and most often fatal.



Stroke. 2012 Oct;43(10):2592-7. Epub 2012 Aug 2.  SMASH-U: a proposal for etiologic classification of intracerebral hemorrhage.  Meretoja A., et al.

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