Intracerebral hemorrhage other imaging findings

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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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