Intracerebral hemorrhage Emergency Diagnosis and Assessment: Difference between revisions
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==Overview== | ==Overview== | ||
[[Intracerebral hemorrhage]] is a medical emergency, characterized by high morbidity and mortality, which should be promptly diagnosed and aggressively managed. Hematoma expansion and early deterioration are common within the first few hours after onset. | |||
[[CT]] and [[MRI|magnetic resonance imaging (MRI)]] are both reasonable for initial evaluation.<ref name="pmid17258669">{{cite journal| author=Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM et al.| title=Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. | journal=Lancet | year= 2007 | volume= 369 | issue= 9558 | pages= 293-8 | pmid=17258669 | doi=10.1016/S0140-6736(07)60151-2 | pmc=1859855 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17258669 }} </ref> | |||
==Emergency diagnosis and assessment== | ==Emergency diagnosis and assessment== | ||
[[Intracerebral hemorrhage]] is a medical emergency, characterized by high morbidity and mortality, which should be promptly diagnosed and aggressively managed. Hematoma expansion and early deterioration are common within the first few hours after onset. | |||
*[[CT]] and [[MRI|magnetic resonance imaging (MRI)]] are both reasonable for initial evaluation. CT is very sensitive for identifying acute hemorrhage and is considered the '''gold standard''' | |||
*Gradient echo and T2* susceptibility-weighted MRI are as sensitive as CT for detection of acute hemorrhage and are more sensitive for identification of prior hemorrhage. | |||
==2015 AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage<ref name=ASA/AHA-ICH-Guid> 2015 AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhagehttp://stroke.ahajournals.org/content/early/2015/05/28/STR.0000000000000069 Accessed on November 10, 2016</ref>== | |||
===Emergency Diagnosis and Assessment: Recommendations=== | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.'''A baseline severity score should be performed as part of the initial evaluation of patients with [[intracerebral hemorrhage|intracerebral hemorrhage (ICH)]] ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.'''Rapid neuroimaging with [[CT]] or [[MRI]] is recommended to distinguish [[ischemic stroke]] from [[intracerebral hemorrhage|intracerebral hemorrhage (ICH)]] ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''<nowiki>"</nowiki> | |||
|} | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | |||
|- | |||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''[[CT angiography]], CT venography, contrast-enhanced CT, contrast-enhanced MRI, [[MRA]] and MRV can be useful to evaluate for underlying structural lesions including vascular malformations and [[tumors]] when there is clinical or radiologic suspicion ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
|} | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | |||
|- | |||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.'''[[CT angiography]] and contrast-enhanced CT may be considered to help identify patients at risk for [[hematoma|hematoma expansion]] ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
|} | |||
==References== | ==References== | ||
Latest revision as of 17:47, 29 November 2016
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Intracerebral hemorrhage Microchapters |
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Diagnosis |
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Treatment |
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AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage (2015) |
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AHA/ASA Guideline Recommendation for the Primary Prevention of Stroke (2014) |
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Case Studies |
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Intracerebral hemorrhage Emergency Diagnosis and Assessment On the Web |
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American Roentgen Ray Society Images of Intracerebral hemorrhage Emergency Diagnosis and Assessment |
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FDA on Intracerebral hemorrhage Emergency Diagnosis and Assessment |
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CDC on Intracerebral hemorrhage Emergency Diagnosis and Assessment |
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Intracerebral hemorrhage Emergency Diagnosis and Assessment in the news |
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Risk calculators and risk factors for Intracerebral hemorrhage Emergency Diagnosis and Assessment |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
Intracerebral hemorrhage is a medical emergency, characterized by high morbidity and mortality, which should be promptly diagnosed and aggressively managed. Hematoma expansion and early deterioration are common within the first few hours after onset. CT and magnetic resonance imaging (MRI) are both reasonable for initial evaluation.[1]
Emergency diagnosis and assessment
Intracerebral hemorrhage is a medical emergency, characterized by high morbidity and mortality, which should be promptly diagnosed and aggressively managed. Hematoma expansion and early deterioration are common within the first few hours after onset.
- CT and magnetic resonance imaging (MRI) are both reasonable for initial evaluation. CT is very sensitive for identifying acute hemorrhage and is considered the gold standard
- Gradient echo and T2* susceptibility-weighted MRI are as sensitive as CT for detection of acute hemorrhage and are more sensitive for identification of prior hemorrhage.
2015 AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhage[2]
Emergency Diagnosis and Assessment: Recommendations
| Class I |
| "1.A baseline severity score should be performed as part of the initial evaluation of patients with intracerebral hemorrhage (ICH) (Level of Evidence: B)" |
| "2.Rapid neuroimaging with CT or MRI is recommended to distinguish ischemic stroke from intracerebral hemorrhage (ICH) (Level of Evidence: A)" |
| Class IIa |
| "1.CT angiography, CT venography, contrast-enhanced CT, contrast-enhanced MRI, MRA and MRV can be useful to evaluate for underlying structural lesions including vascular malformations and tumors when there is clinical or radiologic suspicion (Level of Evidence: B)" |
| Class IIb |
| "1.CT angiography and contrast-enhanced CT may be considered to help identify patients at risk for hematoma expansion (Level of Evidence: B)" |
References
- ↑ Chalela JA, Kidwell CS, Nentwich LM, Luby M, Butman JA, Demchuk AM; et al. (2007). "Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison". Lancet. 369 (9558): 293–8. doi:10.1016/S0140-6736(07)60151-2. PMC 1859855. PMID 17258669.
- ↑ 2015 AHA/ASA Guidelines for the Management of Spontaneous Intracerebral Hemorrhagehttp://stroke.ahajournals.org/content/early/2015/05/28/STR.0000000000000069 Accessed on November 10, 2016