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'Stroke' is a general term which, though commonly used, is vague; more precise terms are usually used by medical professionals. The term indicates a paralysis of sudden onset that often results from either the obstruction by a clot of a blood vessel in the brain or a hemorrhage around or within the brain. For purposes of understanding the cause of the stroke and for determining the most appropriate treatment, it is important to distinguish whether the cerebrovascular 'accident' was a cerebral infarction resulting from obstructed blood flow or a cerebral hemorrhage. Fifteen cases are discussed which illustrate that primary cerebral hemorrhage may be diagnosed in many cases that begin as cerebral infarctions. CT scans within the first six hours of stroke onset showed signs consistent with infarction, but no evidence of bleeding was apparent. Within 18 hours, a second CT scan revealed hemorrhage in the area, which obscured any signs of infarction. In these cases, the hemorrhage was not a primary cerebral hemorrhage, but bleeding from blood vessels damaged by the infarction. If only the second image were seen, a diagnosis of primary cerebral hemorrhage might be made. Examination of the case records revealed that these 15 patients were far more likely to have risk factors for cerebral infarction than were 200 patients who had been diagnosed with primary cerebral hemorrhage. These risk factors included a history of transient ischemic attacks, which are temporary obstructions of adequate blood flow insufficient to cause the damage of an infarction, and the presence of old infarcts on CT scan that did not cause symptoms. In addition, the patients with the secondary hemorrhages as a result of the infarction were more likely to have some identifiable source of a blood clot, which may have initiated the series of events leading to infarction and hemorrhage. The observations made in these patients suggest that many cases diagnosed as primary cerebral hemorrhage may actually be early hemorrhage secondary to cerebral infarction, also called early spontaneous intra-infarct hematoma. (Consumer Summary produced by Reliance Medical Information, Inc.)