Imaging in young adults with intracerebral hemorrhage

Vascular malformations are a common yet treatable cause of intracerebral hemorrhage (ICH) in the young. The goal of this study was to review the implementation of appropriate secondary angiographic/venographic imaging to identify vascular malformations in young adults with ICH at our specialist neuroscience center.

A retrospective analysis was undertaken of five years of prospectively recorded referral data to the on-call neurosurgery service at the Greater Manchester Neuroscience Centre.

The authors identified 111 ICH patients aged 18-40 over the five-year period, with a wide etiologic spectrum. When assessing the implementation of secondary imaging, they focused on 90 individuals, incorporating those without an identifiable precipitant for their ICH and those with recent recreational drug use and hypertension. Of these 90, 52 (58%) were admitted to the neuroscience center for further management; when excluding three with bilateral fixed and dilated pupils, the remaining 49 all underwent appropriate secondary imaging. Of the 38 subjects not accepted to the neuroscience center, 13 (34%) had bilateral fixed and dilated pupils, 10 (26%) underwent appropriate secondary imaging, and 15 did not - all but two of these 15 were referred outside of normal working hours. The positive yield from secondary imaging was 63%.

Young adults with ICH are more likely to get appropriate imaging to identify vascular malformations in a specialist neuroscience center compared to a non-specialist center. Out of hours care appears to be a significant contributor to this shortfall. This study suggests a need for service redevelopment and specialist neuroscience center input for all cases of young ICH.