Emergency noninvasive angiography for acute intracerebral hemorrhage

H. Khosravani, S. A. Mayer, A. Demchuk, B. S. Jahromi, D. J. Gladstone, M. Flaherty, J. Broderick, R. I. Aviv*

*Corresponding author for this work

Research output: Contribution to journalReview article

25 Citations (Scopus)

Abstract

SUMMARY: Spontaneous ICH is a devastating condition and is associated with significant mortality in the acute phase due to ongoing hemorrhage and hematoma expansion. A growing body of evidence suggests that there may be considerable utility in performing noninvasive vascular imaging during the acute-to-early phase of ICH. CTA has become widely available and is sensitive and specific for detecting vascular causes of secondary ICH such as aneurysms, arteriovenous malformations, dural arteriovenous fistulas, intracranial dissections, and neoplasm. CT venography can also diagnose dural sinus thrombosis presenting as hemorrhagic infarction. Recent data from stroke populations demonstrate a relatively low risk to patients when contrast is administered in the absence of a known serum creatinine. Detection of acute contrast extravasation within the hematoma ("spot sign") with CT angiography is predictive of subsequent hematoma expansion and is associated with increased morbidity and mortality. Risk stratification based on acute CTA can inform and expedite decision-making regarding intensive care unit admission, blood pressure control, correction of coagulopathy, and neurosurgical consultation. Noninvasive vascular imaging should be considered as an important component of the initial diagnostic work-up for patients presenting with acute ICH.

Original languageEnglish (US)
Pages (from-to)1481-1487
Number of pages7
JournalAmerican Journal of Neuroradiology
Volume34
Issue number8
DOIs
StatePublished - Aug 1 2013

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Cerebral Hemorrhage
Hematoma
Blood Vessels
Angiography
Emergencies
Central Nervous System Vascular Malformations
Intracranial Sinus Thrombosis
Mortality
Phlebography
Arteriovenous Malformations
Brain Neoplasms
Infarction
Aneurysm
Intensive Care Units
Dissection
Creatinine
Decision Making
Referral and Consultation
Stroke
Hemorrhage

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

Khosravani, H., Mayer, S. A., Demchuk, A., Jahromi, B. S., Gladstone, D. J., Flaherty, M., ... Aviv, R. I. (2013). Emergency noninvasive angiography for acute intracerebral hemorrhage. American Journal of Neuroradiology, 34(8), 1481-1487. https://doi.org/10.3174/ajnr.A3296
Khosravani, H. ; Mayer, S. A. ; Demchuk, A. ; Jahromi, B. S. ; Gladstone, D. J. ; Flaherty, M. ; Broderick, J. ; Aviv, R. I. / Emergency noninvasive angiography for acute intracerebral hemorrhage. In: American Journal of Neuroradiology. 2013 ; Vol. 34, No. 8. pp. 1481-1487.
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Khosravani, H, Mayer, SA, Demchuk, A, Jahromi, BS, Gladstone, DJ, Flaherty, M, Broderick, J & Aviv, RI 2013, 'Emergency noninvasive angiography for acute intracerebral hemorrhage', American Journal of Neuroradiology, vol. 34, no. 8, pp. 1481-1487. https://doi.org/10.3174/ajnr.A3296

Emergency noninvasive angiography for acute intracerebral hemorrhage. / Khosravani, H.; Mayer, S. A.; Demchuk, A.; Jahromi, B. S.; Gladstone, D. J.; Flaherty, M.; Broderick, J.; Aviv, R. I.

In: American Journal of Neuroradiology, Vol. 34, No. 8, 01.08.2013, p. 1481-1487.

Research output: Contribution to journalReview article

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AU - Flaherty, M.

AU - Broderick, J.

AU - Aviv, R. I.

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N2 - SUMMARY: Spontaneous ICH is a devastating condition and is associated with significant mortality in the acute phase due to ongoing hemorrhage and hematoma expansion. A growing body of evidence suggests that there may be considerable utility in performing noninvasive vascular imaging during the acute-to-early phase of ICH. CTA has become widely available and is sensitive and specific for detecting vascular causes of secondary ICH such as aneurysms, arteriovenous malformations, dural arteriovenous fistulas, intracranial dissections, and neoplasm. CT venography can also diagnose dural sinus thrombosis presenting as hemorrhagic infarction. Recent data from stroke populations demonstrate a relatively low risk to patients when contrast is administered in the absence of a known serum creatinine. Detection of acute contrast extravasation within the hematoma ("spot sign") with CT angiography is predictive of subsequent hematoma expansion and is associated with increased morbidity and mortality. Risk stratification based on acute CTA can inform and expedite decision-making regarding intensive care unit admission, blood pressure control, correction of coagulopathy, and neurosurgical consultation. Noninvasive vascular imaging should be considered as an important component of the initial diagnostic work-up for patients presenting with acute ICH.

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Khosravani H, Mayer SA, Demchuk A, Jahromi BS, Gladstone DJ, Flaherty M et al. Emergency noninvasive angiography for acute intracerebral hemorrhage. American Journal of Neuroradiology. 2013 Aug 1;34(8):1481-1487. https://doi.org/10.3174/ajnr.A3296