Angiographic Examination of Spontaneous Putaminal Hemorrhage

Abstract

Background: This study was carried out to examine indications for angiographic evaluation in the case of spontaneous putaminal hemorrhage. Methods: Angiographic examinations were performed on 62 consecutive adults with spontaneous putaminal hemorrhage without remarkable subarachnoid hemorrhage. Most patients were evaluated using conventional catheter angiography except for hypertensive patients over the age of 60 who underwent a magnetic resonance angiogram or a computed tomography angiogram. Computed tomography and clinical factors such as age and hypertension were correlated with the angiographic findings. Results:Nine of the 62 patients (15%) exhibited angiographic abnormalities, including middle cerebral artery aneurysm (n = 1), arteriovenous malformations (n = 3), moyamoya disease (n = 2), and the moyamoya phenomenon associated with a proximal middle cerebral artery occlusion (n = 3). The angiographic yield was significantly higher (1) among patients at or below the median age of 55 compared with those above (9/33, 27%, versus 0/29, 0%; p < 0.01), and (2) among patients without hypertension compared with those with hypertension (5/9, 56%, versus 4/53, 8%; p < 0.01). Conclusions: Although our data could be biased due to the patient selection procedure, they suggest that angiographic evaluation is highly useful for spontaneous putaminal hemorrhage regardless of volume and shape of the hematomas, excepting hypertensive patients over 55 years of age.

Radiological Investigation of Spontaneous Intracerebral Hemorrhage

“…15,16,19 Three nonrandomized studies described the yield of strategies of delaying IADSA 3,22 or of IADSA or CT/MRA for putaminal hemorrhage. 23 The 5 remaining studies compared 1 investigation for the identification of ICH cause against another, without blinding the readers. 24 -28 Critical Appraisal Generalizability of some studies was limited by their inclusion of a few patients with pure subdural, 4,21 pure subarachnoid, 16,20,21 or pure intraventricular [3][4][5]17,18,21 hemorrhage.…”

“…The proportions of cohorts investigated ranged from 23% undergoing MRI after hospital admission 19 to 65% undergoing immediate or delayed IADSA after hospital admission. 3 Participants were often further selected for investigation by age, 18 the location of their ICH, 13,22,23,25 or whether the ICH extended into intraventricular, subdural, or subarachnoid compartments. 12 Only 4 studies standardized timing of the investigation.…”

“…3,22,23 One study identified consecutive admissions with ICH and compared 2 prespecified approaches to IADSA timing 3 : the prevalence of underlying abnormalities ranged from 24%, when an underlying abnormality had not been suspected and IADSA was postponed until 3 months after ICH, to 75%, when it had and IADSA was done in the acute phase and, if negative, repeated 3 months thereafter. A study of repeat IADSA for the investigation of subcortical lobar ICH when the initial IADSA had been negative yielded an 18% AVM detection rate.…”

“…22 A study of 62 patients with putaminal ICH, by CT/MRA to investigate hypertensive patients age Ͼ60 years and by IADSA for everyone else, with follow-up MRA if the initial investigation was negative, found 9 patients (15%) with an angiographic abnormality; the yield was higher in normotensive patients and in those age Յ55 years. 23 …”

Cerebral Hemodynamics and Oxygen Metabolism in Patients with Moyamoya Syndrome Associated with Atherosclerotic Steno-Occlusive Arterial Lesions

“…In the present study, we visually checked all the ROI settings via the viewer window and eliminated apparently inappropriate ROI from the analysis. Fourthly, although we have suggested that cerebral hemodynamic compromise may be responsible for the development of moyamoya-like vessels, hereditary factors may also be involved in this angiogenesis because the incidence of moyamoya disease is comparatively higher in the Japanese [13] and Koreans [14], and markedly lower in Caucasians. Further studies are needed to elucidate the effects of racial differences and genetic factors on the development of moyamoya-like vessels.…”