Computed tomography angiography (CTA) immediately after diagnosis of intracerebral hematoma (ICH) on noncontrast CT in the emergency room has benefits, which consist of early diagnosis of secondary ICH and prediction of hematoma growth using the spot sign in primary ICH, but CTA also involves possible risks of acute kidney injury (AKI) and adverse reactions. The purpose of this study was to evaluate the benefits and risks of CTA. A total of 1423 consecutive adult patients diagnosed with ICH who were admitted within 3 days of onset between 2010 and 2017 were retrospectively analyzed. Of 1082 patients undergoing CTA, 162 patients (15.0%) showed secondary ICH, and the sensitivity of CTA for secondary ICH was 95.7%. Of 920 patients with primary ICH, a logistic regression model using the spot sign and four other previously reported risk factors (antiplatelet agents, anticoagulants, interval from onset to arrival, hematoma volume) with an area under the curve (AUC) of 0.787 significantly improved model performance to predict hematoma growth compared with a model using the same four factors without the spot sign (AUC: 0.697) (DeLong's test: P = 0.0002). Rates of AKI occurrence were 9.0% and 9.8% in patients with and without CTA, respectively. The odds ratio of AKI in patients with CTA adjusted by reported risk factors was 1.16 (95% confidence interval: 0.72-1.95, P = 0.5548). Emergency CTA following noncontrast CT in patients with ICH could be useful for early diagnosis of secondary ICH and prediction of hematoma growth using the spot sign in primary ICH with little risk.

Epistaxis due to rupture of a nontraumatic internal carotid artery (ICA) aneurysm in the paranasal sinus has rarely been reported. Here, we report a case of double ICA aneurysms located within both the sphenoid and ethmoid sinuses. A 78-year-old woman presented with recurrent massive epistaxis. Magnetic resonance angiogram (MRA) and cerebral angiogram showed two ICA aneurysms: one protruded into the sphenoid sinus and the other protruded into the ethmoid sinus. Intra-aneurysmal coil embolization was performed for both aneurysms. The patient recovered completely, and a follow-up MRA 3 years later showed no recurrence of the aneurysms. Intra-aneurysmal coil embolization is an option of treatment for an ICA aneurysm filling the paranasal sinus.

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