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Intracerebral hemorrhage other imaging findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Other imaging findings in diagnosis of intracerebral hemorrhage may include CT angiography (CTA), CT venography (CTV), MR angiography (MRA), MR venography (MRV), and ctheter angiogram.[1][2]

Other imaging findings

CTA/CTV

  • CT angiography (CTA) may identify patients at high risk of intracerebral hemorrhage (ICH) expansion based upon the presence of contrast extravasation within the hematoma.[1][3]
  • CTA/CTV are reasonably sensitive at identifying secondary causes of hemorrhage, including:[4]
    • Arteriovenous malformations (AVM)
    • Tumors
    • Moyamoya
    • Cerebral vein thrombosis
  • A CT venogram should be performed if neuroimaging suggest cerebral vein thrombosis (abnormal signal in the cerebral sinuses)

MRA/MRV

  • MRA/ MRV are reasonably sensitive at identifying secondary causes of hemorrhage, including:[2]
    • Arteriovenous malformations (AVM)
    • Tumors
    • Moyamoya
    • Cerebral vein thrombosis
  • An MR venogram should be performed if neuroimaging suggest cerebral vein thrombosis (abnormal signal in the cerebral sinuses).

Catheter angiogram

A catheter angiogram may be considered if clinical suspicion is high or noninvasive studies are suggestive of an underlying lesion.[5]

Catheter angiography may indicated in following conditions:[6]

  • Abnormal calcifications
  • Blood in atypical locations (nonhypertensive participants with basal ganglion hematoma)
  • Young patients with no obvious cause

References

  1. ↑ 1.0 1.1 Bartlett ST, Kuo PC, Johnson LB, Lim JW, Schweitzer EJ (1996). “Pancreas transplantation at the University of Maryland”. Clin Transpl: 271–80. PMID 9286577.
  2. ↑ 2.0 2.1 Yoon HK, Shin HJ, Lee M, Byun HS, Na DG, Han BK (2000). “MR angiography of moyamoya disease before and after encephaloduroarteriosynangiosis”. AJR Am J Roentgenol. 174 (1): 195–200. doi:10.2214/ajr.174.1.1740195. PMID 10628478.
  3. ↑ Becker KJ, Baxter AB, Bybee HM, Tirschwell DL, Abouelsaad T, Cohen WA (1999). “Extravasation of radiographic contrast is an independent predictor of death in primary intracerebral hemorrhage”. Stroke. 30 (10): 2025–32. PMID 10512902.
  4. ↑ Mallampalli RK, Walter ME, Peterson MW, Hunninghake GW (1994). “Betamethasone activation of CTP:cholinephosphate cytidylyltransferase in vivo is lipid dependent”. Am J Respir Cell Mol Biol. 10 (1): 48–57. doi:10.1165/ajrcmb.10.1.8292380. PMID 8292380.
  5. ↑ Delgado Almandoz JE, Jagadeesan BD, Moran CJ, Cross DT 3rd, Zipfel GJ, Lee JM, Romero JM, Derdeyn CP. Independent validation of the secondary intracerebral hemorrhage score with catheter angiog- raphy and findings of emergent hematoma evacuation. Neurosurgery. 2012;70:131–140. doi: 10.1227/NEU.0b013e31822fbf43.
  6. ↑ Aguilar MI, Demaerschalk BM (2007). “Intracerebral hemorrhage”. Semin Neurol. 27 (4): 376–84. doi:10.1055/s-2007-985338. PMID 17701875.


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