Grigore T. Popa University of Medicine and Pharmacy, Iasi, RomaniaBackground. Cases when unexpected death occurs, when the patient is in apparent health or the
event comes during presumably normal activity, especially when it is unwitnessed or when the
victim is found without apparent signs of foul play, may pose a significant challenge to the
coroner in reaching a proper determination of the cause and the manner of death. Spontaneous
intracerebral hemorrhage (ICH) is a bleeding into the parenchyma of the brain and accounts for
approximately 10 % to 20 % of all strokes. ICH is a multi-factorial disease caused by several
interacting and overlapping risk factors and etiologies. When massive ICH, not connected with
head trauma, has occurred, and it is multifocal or not located in one of the typical sites for
hypertensive hemorrhage, one of a multitude of other causes must be suspected. High alcohol
intake increases the risk of all stroke subtypes and of the development of liver diseases and may
induce hypertension, by affecting brain function and producing a series of alcohol-related or
alcohol caused diseases and is associated with changes in the coagulation system. Liver cirrhosis
is a well-known risk factor for ICH, due to impaired coagulation, despite the relatively rare
occurrence of ICH in cirrhotic patients
