Spontaneous intracranial hematomas: role of dynamic CT and angiography

Chandra, Naval; Khandelwal, N.; Bapuraj, J. R.; Mathuriya, S. N.; Vasista, R K; Vk, Kak; Suri, Sudha

doi:10.1111/j.1600-0404.1998.tb07290.x

Cited by 10 publications

(5 citation statements)

References 16 publications

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“…We confirmed 16 patients of vascular abnormalities with additional studies and the findings were compatible. Therefore, 3D-CTA manifested as a highly sensitive modality in our study as reported elsewhere 3,8,23) .…”

Section: Discussionsupporting

confidence: 64%

The Usefulness of 3D-CT Angiography as a Screening Tool for Vascular Abnormalities in Spontaneous ICH Patients

Lee

Kong

Hong

et al. 2007

J Korean Neurosurg Soc

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IntroductionT he term spontaneous intracerebral hemorrhage (ICH) refers to all varieties of bleeding into the cerebral parenchyma in which 'trauma or other exogenous' factors do not play an essential part 24) . It constitutes a major neurosurgical problem. Its incidence varies from 10 to 32% of all cerebrovascular strokes in USA 19) , and from 27.3% to 47.6% in Korea 12,18) .Spontaneous ICH is caused more often by hypertension per se than by vascular abnormality secondarily 2,3) . Clinically, therefore, through investigations to detect any possible associated vascular abnormalities have not been routinely performed on the past. Conventional angiography remains the golden standard for diagnosis of vascular abnormality. But it is invasive, difficult in acutely ill patients, and carries definite risks 1) . Recently three-dimensional computerized tomographic angiography (3D-CTA) has shown to be promise as a highly sensitive and less invasive modality for determining the source of hemorrhage 8,23,29) . In this study, we have tired to screen any associated vascular abnormalities in spontaneous ICH using 3D-CTA.

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Section: Discussionsupporting

confidence: 64%

The Usefulness of 3D-CT Angiography as a Screening Tool for Vascular Abnormalities in Spontaneous ICH Patients

Lee

Kong

Hong

et al. 2007

J Korean Neurosurg Soc

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“…In the present study, hypertensive patients over the age of 60 (n = 21) underwent only CTA or MRA due to the invasive nature of catheter angiography. The diagnostic yield of CTA and MRA for detecting vascular abnormalities in patients with ICHs was not inferior to that of catheter angiography [10, 11]. Nonetheless, it might have led to an underestimation of angiographic abnormalities in the group, although not considerable.…”

Section: Discussionmentioning

confidence: 99%

Angiographic Examination of Spontaneous Putaminal Hemorrhage

Park

Hwang²,

Baik³

et al. 2007

Cerebrovasc Dis

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Background: This study was carried out to examine indications for angiographic evaluation in the case of spontaneous putaminal hemorrhage. Methods: Angiographic examinations were performed on 62 consecutive adults with spontaneous putaminal hemorrhage without remarkable subarachnoid hemorrhage. Most patients were evaluated using conventional catheter angiography except for hypertensive patients over the age of 60 who underwent a magnetic resonance angiogram or a computed tomography angiogram. Computed tomography and clinical factors such as age and hypertension were correlated with the angiographic findings. Results:Nine of the 62 patients (15%) exhibited angiographic abnormalities, including middle cerebral artery aneurysm (n = 1), arteriovenous malformations (n = 3), moyamoya disease (n = 2), and the moyamoya phenomenon associated with a proximal middle cerebral artery occlusion (n = 3). The angiographic yield was significantly higher (1) among patients at or below the median age of 55 compared with those above (9/33, 27%, versus 0/29, 0%; p < 0.01), and (2) among patients without hypertension compared with those with hypertension (5/9, 56%, versus 4/53, 8%; p < 0.01). Conclusions: Although our data could be biased due to the patient selection procedure, they suggest that angiographic evaluation is highly useful for spontaneous putaminal hemorrhage regardless of volume and shape of the hematomas, excepting hypertensive patients over 55 years of age.

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“…4,5,[12][13][14][15][16][17][18][19][20][21] Some of these studies contributed to the total of 726 patients with ICH in whom it was possible to calculate the yield of IADSA for finding an aneurysm or arteriovenous malformation (AVM) as the cause of the ICH. [3][4][5]14,17,18,21,25,28 The prevalence of underlying AVMs was 20% (95% CI, 17 to 23) and of aneurysms, 13% (95% CI, 11 to 16; Table 1). Sex of the patients did not appear to influence yield in the individual studies, but the pooled results showed that the yield was relatively low in patients with prestroke hypertension and in those with a deep ICH location ( Table 1).…”

Section: Yield Of 1 Investigationmentioning

confidence: 99%

“…27 The 4 remaining studies compared DSA-MRA against IADSA (11 patients with ICH; no false-positives or false-negatives), 28 3-dimensional CT angiography against IADSA (31 patients with hyperacute ICH; no false-positives or false-negatives), 26 3-dimensional CT angiography against surgical findings (61 patients with massive, acute ICH requiring surgical decompression; sensitivityϭ55%, 95% CI, 38 to 71; specificityϭ97%, 95% CI, 83 to 99; positive predictive valueϭ94%, 95% CI, 74 to 99; and negative predictive valueϭ67%, 95% CI, 53 to 80), 24 and "dynamic" CT angiography against IADSA (44 patients with spontaneous lobar ICH; sensitivityϭ88%, 95% CI, 69 to 96; specificityϭ95%, 95% CI, 76 to 99; positive predictive valueϭ95%, 95% CI, 78 to 99; and negative predictive valueϭ86%, 95% CI, 66 to 95). 25 …”

Section: Diagnostic Utility Of Radiological Techniquesmentioning

confidence: 99%

“…The proportions of cohorts investigated ranged from 23% undergoing MRI after hospital admission 19 to 65% undergoing immediate or delayed IADSA after hospital admission. 3 Participants were often further selected for investigation by age, 18 the location of their ICH, 13,22,23,25 or whether the ICH extended into intraventricular, subdural, or subarachnoid compartments. 12 Only 4 studies standardized timing of the investigation.…”

Section: Systematic Literature Reviewmentioning

confidence: 99%

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Radiological Investigation of Spontaneous Intracerebral Hemorrhage

Cordonnier

Klijn

Beijnum

et al. 2010

Stroke

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Background and Purpose-It is not always clear whether, how, and when to undertake further radiological investigation of spontaneous (nontraumatic) intracerebral hemorrhage (ICH). Methods-We systematically reviewed Ovid MEDLINE and EMBASE databases for studies of the diagnostic utility of radiological investigations of the cause(s) of ICH. We sent a structured survey to neurologists, stroke specialists, neurosurgeons, and neuroradiologists in the United Kingdom, the Netherlands, and France to assess whether, how, and when they would investigate supratentorial ICH. Results-This systematic review detected 20 relevant studies (including 1933 patients), which either quantified the yield of a radiological investigation/imaging strategy (nϭ15) or compared 2 imaging techniques (nϭ5). Six hundred ninety-two (49%) physicians responded to the survey. Further investigation would have been undertaken by the following: 99% of respondents, for younger (38 to 43 years), normotensive adults with lobar or deep ICH; 76%, for older (age 72 to 83 years), normotensive adults with deep ICH; and 31%, for older adults with deep ICH and prestroke hypertension. Younger patient age was the strongest influence on the decision to further investigate ICH (odds ratioϭ16; 95% confidence interval, 13 to 20), followed by the absence of prestroke hypertension (odds ratioϭ5; 95% confidence interval, 4 to 6) and lobar ICH location (odds ratioϭ2; 95% confidence interval, 1 to 2). Conclusions-The

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Spontaneous intracranial hematomas: role of dynamic CT and angiography

Cited by 10 publications

References 16 publications

The Usefulness of 3D-CT Angiography as a Screening Tool for Vascular Abnormalities in Spontaneous ICH Patients

The Usefulness of 3D-CT Angiography as a Screening Tool for Vascular Abnormalities in Spontaneous ICH Patients

Angiographic Examination of Spontaneous Putaminal Hemorrhage

Radiological Investigation of Spontaneous Intracerebral Hemorrhage

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