PT  - JOURNAL ARTICLE
AU  - H. Khosravani
AU  - S.A. Mayer
AU  - A. Demchuk
AU  - B.S. Jahromi
AU  - D.J. Gladstone
AU  - M. Flaherty
AU  - J. Broderick
AU  - R.I. Aviv
TI  - Emergency Noninvasive Angiography for Acute Intracerebral Hemorrhage
AID  - 10.3174/ajnr.A3296
DP  - 2012 Nov 01
TA  - American Journal of Neuroradiology
4099  - http://www.ajnr.org/content/early/2012/11/01/ajnr.A3296.short
4100  - http://www.ajnr.org/content/early/2012/11/01/ajnr.A3296.full
AB  - 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. Abbreviations AHA/ASAAmerican Heart Association/American Stroke AssociationCAAcerebral amyloid angiopathyCINcontrast-induced nephropathyICHintracerebral hemorrhageSICHspontaneous intracerebral hemorrhage