Background and Purpose
Patients presenting with an intracerebral hemorrhage (ICH) generally have an initial
noncontrast computed tomography (NCCT) of the brain. Computed tomography angiography
(CTA) can help identify secondary causes of ICH and detect a “spot sign.” We hypothesized
that performing an urgent CTA in the setting of a presumed primary ICH has only limited
utility and did not alter urgent management.
Methods
This was a retrospective study of consecutive patients presenting with a primary ICH
identified from the Duke University Stroke Registry from 2010 to 2013 who had an ICH
detected on an initial NCCT. Patients with hemorrhages related to tumor, hemorrhagic
conversion of an ischemic stroke, and known secondary causes were excluded. CTA within
the first 10 hours of presentation was considered “urgent.”
Results
Of 246 patients meeting the inclusion criteria, 53% had an urgent CTA. Those who underwent
a CTA were younger (61 ± 1 versus 70 ± 1 years, P < .0001) and more commonly had deep bleeds (50% versus 45%, P = .048). CTA identified 12 aneurysms (10 incidental) and 2 arteriovenous malformations;
87% were normal. Urgent CTA was associated with a change in management in 3 cases
(2.2%); each had historic or other findings suggestive of a secondary cause of hemorrhage
and none led to urgent treatment changes.
Conclusions
In the absence of features suggesting a secondary cause, the results of an urgent
CTA did not alter the urgent management of a consecutive series of patients with ICH.
CTAs may be safely delayed until after the acute period in these patients.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prediction of haematoma growth and outcome in patients with intracerebral haemorrhage using the CT-angiography spot sign (PREDICT).Lancet Neurol. 2012; 11: 307-314
- Prospective validation of the computed tomographic angiography spot sign score for intracerebral hemorrhage.Stroke. 2013; 44: 3097-3102
- Accuracy of the spot sign on computed tomography angiography as a predictor of haematoma enlargement after acute spontaneous intracerebral haemorrhage: a systematic review.Cerebrovasc Dis. 2014; 37: 268-2762
- Guidelines for the management of spontaneous intracerebral hemorrhage.Stroke. 2010; 41: 2108-2129
- Advanced CT imaging in the evaluation of hemorrhagic stroke.Neuroimaging Clin N Am. 2011; 21: 197-213
- The Spot Sign and Tranexamic Acid on Preventing ICH Growth—AUStralasia Trial (STOP-AUST): protocol of a phase II randomized, placebo-controlled, double-blind, multicenter trial.Intern J Stroke. 2014; 9: 519-524
Article info
Publication history
Published online: November 25, 2016
Accepted:
October 1,
2016
Received in revised form:
September 13,
2016
Received:
August 20,
2016
Footnotes
All authors contributed to the design, data collection, analysis, preparation, and critical revision of this article. L.B.G. takes responsibility for the integrity of the work as a whole, from inception to publication.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.10.001
Copyright
Published by Elsevier Inc. on behalf of National Stroke Association.
