Radiological Investigation of Spontaneous Intracerebral Hemorrhage

Abstract

Background and Purpose-It is not always clear whether, how, and when to undertake further radiological investigation of spontaneous (nontraumatic) intracerebral hemorrhage (ICH). Methods-We systematically reviewed Ovid MEDLINE and EMBASE databases for studies of the diagnostic utility of radiological investigations of the cause(s) of ICH. We sent a structured survey to neurologists, stroke specialists, neurosurgeons, and neuroradiologists in the United Kingdom, the Netherlands, and France to assess whether, how, and when they would investigate supratentorial ICH. Results-This systematic review detected 20 relevant studies (including 1933 patients), which either quantified the yield of a radiological investigation/imaging strategy (nϭ15) or compared 2 imaging techniques (nϭ5). Six hundred ninety-two (49%) physicians responded to the survey. Further investigation would have been undertaken by the following: 99% of respondents, for younger (38 to 43 years), normotensive adults with lobar or deep ICH; 76%, for older (age 72 to 83 years), normotensive adults with deep ICH; and 31%, for older adults with deep ICH and prestroke hypertension. Younger patient age was the strongest influence on the decision to further investigate ICH (odds ratioϭ16; 95% confidence interval, 13 to 20), followed by the absence of prestroke hypertension (odds ratioϭ5; 95% confidence interval, 4 to 6) and lobar ICH location (odds ratioϭ2; 95% confidence interval, 1 to 2). Conclusions-The

External Validation of the Secondary Intracerebral Hemorrhage Score in The Netherlands

“…The yield of angiographic examinations is known to be higher in normotensive patients and those aged <55 years. 4,7 Indeed, the yield of angiographic examinations was higher in our cohort than in the derivation cohort. A strength of our study is that we were able to study the external validity of the SICH score in a large cohort of patients with ICH on a different continent, with a different approach to performance of angiographic studies in patients with ICH.…”

“…2,3 Computed tomography (CT) angiography enables assessment of vascular pathology in the emergency setting, but it is unclear which patients with ICH should undergo angiographic examinations. 4 The secondary ICH (SICH) score was developed and validated in the United States to identify patients with a high risk of an underlying macrovascular cause on the basis of patient and hemorrhage characteristics (Table I in the online-only Data Supplement). 5 The same investigators performed an external validation study in another US hospital, which indicated that the SICH score is an accurate tool in US settings.…”

Influence of Intracerebral Hemorrhage Location on Incidence, Characteristics, and Outcome

“…1 Approximately four fifths of ICHs with no apparent cause (so-called primary ICH) 2 are usually attributed to small vessel vasculopathies such as arteriolosclerosis or cerebral amyloid angiopathy (CAA). This attribution is usually made on the basis of risk factors, clinical and radiographic features, 3 such as those described by the modified Boston criteria for CAA-related ICH. 4,5 The incidence of lobar primary ICH seems to be increasing, 1,6 possibly because of antithrombotic drugs.…”

Management of acute intracerebral haemorrhage – an update

“…3 This assumption is unreliable as angiographic studies showed that up to 20% of patients with sICH have underlying vascular abnormalities; many of these patients were elderly and hypertensive with deep-seated haematomas. 4 Hence, all patients should be considered for non-invasive vascular imaging (CT angiography or magnetic resonance angiography) and structural imaging (MRI). These should be performed as early as possible to enable early interventions.…”