A new CT-based classification of spontaneous supratentorial intracerebral haematomas

In patients with intracerebral haematoma (ICH) secondary to ruptured aneurysm or arteriovenous malformation (AVM), conservative therapy and follow-up without angiographic evaluation is associated with a risk of recurrent bleeding. It is necessary for a clinician to identify a subgroup of patients with spontaneous supratentorial ICH who are likely to harbour high-flow vascular malformations that require specific treatment - neurosurgical or neuroradiological. A new CT-based classification for supratentorial ICH aimed at a close correlation between ICH localization and occurrence of high-flow vascular malformations diagnosed on angiography is presented.

According to the proposed classification, supratentorial ICHs are divided into deep and cortico-subcortical. The deep group is further subdivided into striatocapsular, lobar ICH and isolated intraventricular haemorrhage and the cortico-subcortical group into paracisternal and convexity ICH. A new classification was used in a consecutive series of 108 patients with spontaneous supratentorial ICH subjected to angiographic evaluation.

Deep ICH in non-hypertensive patients was secondary to AVM rupture in 57.1% (8/14). High-flow vascular malformation was a source of bleeding in 93.6% of patients with paracisternal ICH - aneurysm in most cases (41/47). Convexity ICH was found to be AVM-related in 35.7% of patients (5/14).

Our clinical experience shows that the proposed classification appears to be closely associated with angiographic findings. Its clinical application with consideration of other factors such as age and arterial hypertension may help clinicians to identify high-risk ICH patients for angiographic evaluation and further specific treatment to prevent rebleeding.