Computerized Tomography in Intracranial Hemorrhage

Weisberg, Leon A.

doi:10.1001/archneur.1979.00500430052007

Cited by 122 publications

(49 citation statements)

References 8 publications

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“…The role played by hypertension may vary in relation to the site of hemorrhage. The frequency of hypertension varies from 43% to 81% 3O " 35 among patients with basal ganglionic hemorrhage and from 31% to 45% 30 -37 among patients with lobar hemorrhage. According to the same studies, other risk factors such as diabetes or cardiopathies (other than hypertensive cardiopathy) are irrelevant.…”

Section: Discussionmentioning

confidence: 99%

Leukoaraiosis, intracerebral hemorrhage, and arterial hypertension.

Inzitari

Giordano

Ancona

et al. 1990

Stroke

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To investigate whether the observed association of leukoaraiosis with intracerebral hemorrhage is direct or mediated by risk factors, we compared 116 patients with intracerebral hemorrhage confirmed by computed tomography and 155 controls without intracerebral hemorrhage, evaluating the prevalence of leukoaraiosis and vascular risk factors. Leukoaraiosis was observed in 21 (18%) of the 116 patients and in 12 (8%) of the 155 controls (p<0.01). Only two (6%) of the 31 patients with lobar hemorrhage had leukoaraiosis on computed tomograms, compared with 17 (24%) of the 71 patients with basal ganglionic hemorrhage (p<0.05). Leukoaraiosis was significantly correlated with intracerebral hemorrhage after controlling for age and sex by using multiple logistic regression analysis, while the correlation disappeared after controlling for hypertension. Our results indicate that leukoaraiosis is not an independent risk factor for intracerebral hemorrhage. (Stroke 1990;21:1419-1423) T he term "leukoaraiosis" was introduced byHachinski et al 1 to describe computed tomographic (CT) images of symmetric patchy or diffuse areas of low density in the hemispheric white matter. Although leukoaraiosis has been reported in association with intracerebral hemorrhage (ICH), 2 it is not yet clear whether leukoaraiosis itself is a risk factor for ICH or whether this association is related to the presence of shared vascular risk factors. It is known that leukoaraiosis shares with ICH arterial hypertension as a possible risk factor 34 and that the parenchymal vasculopathy (hypertensive or amyloid) present in ICH has also been reported in leukoaraiosis. 3 We sought to determine whether vascular risk factors, in particular arterial hypertension, explain the presence of leukoaraiosis on cranial CT scans of patients with ICH. Subjects and MethodsAll cranial CT scans were carried out by the Careggi Hospital Neuroradiology Service, the only city emergency neuroradiology service during the study period. From January 1,1985, to December 31, 1986, a CT diagnosis of spontaneous ICH was made Received December 15, 1989; accepted June 22, 1990. in 172 patients aged >40 years. Of these 172 patients, 41 were excluded from the study because of the presence of movement artifacts, large lesions with a mass effect, previous neurosurgery, or other aspects interfering with a proper evaluation of leukoaraiosis on CT pictures and a further 15 were excluded because of insufficient data on the risk factors to be evaluated. This selection produced the 116 patients with ICH involved in this study. We randomly selected 224 from among 7,304 cranial CT studies with no evidence of ICH performed during the same period in patients aged >40 years. Among these 224 patients, the 155 who met the criteria for proper definition of study variables were chosen as controls. They presented with transient ischemic attack or ischemic stroke (31), trauma (28), cerebral neoplasms (28), nonvascular or vascular dementia (18), epilepsy (11), headache (10), vertigo or syncope (8), depressi...

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Section: Discussionmentioning

confidence: 99%

Leukoaraiosis, intracerebral hemorrhage, and arterial hypertension.

Inzitari

Giordano

Ancona

et al. 1990

Stroke

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“…Numerous recent studies have clarified the clinical presentations, locations and acute prognostic features. [1][2][3] The acute mortality from such bleeds has been found to be lower than estimated in the pre-CT era. Even in the past, however, very little has been written on the ultimate outcome of survivors of an acute ICH.…”

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confidence: 95%

Long-term prognosis of hypertensive intracerebral hemorrhage.

Douglas¹,

Haerer²

1982

Stroke

121

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The diagnosis of intracerebral hemorrhage (ICH) has become precise with the advent of computerized tomography (CT). Little, however, is known concerning the long-term prognosis. Seventy consecutive patients with primary intracerebral hemorrhage (all known etiologies except hypertension excluded) proven by CT scan were studied. Follow up, averaging 2 1/2 years, was successful in all cases. The status of alertness, EKG, and clinical impression on admission were significant prognostic factors. As expected, mortality increased with size of the hematoma and ventricular rupture. Acute in hospital mortality was 40%. Another 17% died during the long-term follow up, but none of them from cerebrovascular disease. Ninety-two percent of the survivors were ambulatory at follow up. Hypertensive intracerebral hemorrhages, unlike aneurysms, rarely, if ever, rebleed. Patients are not likely to have a second bleed in another location. Hypertensive intracerebral hemorrhage is more common in blacks, especially young adult males with severe hypertension, but overall mortality is lower than thought prior to the CT scan. Most survivors can achieve independence and deserve aggression rehabilitation efforts.

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“…2 3 Nearly all of the early studies describing the computed tomography (CT) features and clinical presentation of ICH were from single tertiary care centre case series, perhaps biased toward more severe cases. [4][5][6] Population based studies, which account for all cases in a community independent of referral status, provide a more accurate estimate of the true spectrum of disease.…”

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Presentation of intracerebral haemorrhage in a community

Zahuranec

Gonzales

Brown³

et al. 2005

Journal of Neurology, Neurosurgery & Psychiatry

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Background: Studies on intracerebral haemorrhage (ICH) from tertiary care centres may not be an accurate representation of the true spectrum of disease presentation. Objective: To describe the clinical and imaging presentation of ICH in a community devoid of the referral bias of an academic medical centre; and to investigate factors associated with lower Glasgow coma scale (GCS) score at presentation, as GCS is crucial to early clinical decision making. Methods: The study formed part of the BASIC project (Brain Attack Surveillance in Corpus Christi), a population based stroke surveillance study in a bi-ethnic Texas community. Cases of first non-traumatic ICH were identified from years 2000 to 2003, using active and passive surveillance. Clinical data were collected from medical records by trained abstractors, and all computed tomography (CT) scans were reviewed by a study physician. Multivariable linear regression was used to identify clinical and CT predictors of a lower GCS score. Results: 260 cases of non-traumatic ICH were identified. Median ICH volume was 11 ml (interquartile range 3 to 36) with hydrocephalus noted in 45%. Median initial GCS score was 12.5 (7 to 15). Hydrocephalus score (p = 0.0014), ambient cistern effacement (p = 0.0002), ICH volume (p = 0.014), and female sex (p = 0.024) were independently associated with lower GCS score at presentation, adjusting for other variables. Conclusions: ICH has a wide range of severity at presentation. Hydrocephalus is a potentially reversible cause of a lower GCS score. Since early withdrawal of care decisions are often based on initial GCS, recognition of the important influence of hydrocephalus on GCS is warranted before withdrawal of care decisions are made.

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Computerized Tomography in Intracranial Hemorrhage

Cited by 122 publications

References 8 publications

Leukoaraiosis, intracerebral hemorrhage, and arterial hypertension.

Leukoaraiosis, intracerebral hemorrhage, and arterial hypertension.

Long-term prognosis of hypertensive intracerebral hemorrhage.

Presentation of intracerebral haemorrhage in a community

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