Nontraumatic lobar intracerebral hemorrhage: CT/angiographic correlation

Cerebral angiography in patients with nontraumatic lobar intracerebral hemorrhage may or may not uncover the underlying cause of the disorder. The CT and cerebral angiographic studies of 67 consecutive patients with nontraumatic lobar intracerebral hemorrhage were reviewed to assess the relationship between CT pattern and location of hemorrhage and the frequency of diagnostic angiographic findings. Origins of these hematomas were also determined and correlated with radiographic findings. CT revealed 26 temporal, 18 frontal, 17 parietal, three occipital, and three multiple lobar hematomas. Thirty-three patients had "pure" lobar hematomas, 12 had coexistent intraventricular hemorrhage, 12 had associated subarachnoid hemorrhage, and 10 had both intraventricular and subarachnoid hemorrhage accompanying their lobar hematomas. Angiographic findings were diagnostic in 29 cases (43%). In the presence of accompanying subarachnoid hemorrhage, angiographic findings were diagnostic in 17 (77%) of 22 patients; in its absence, angiography was diagnostic in 12 (27%) of the remaining 45 patients. Diagnostic angiograms were also more frequent in the presence of a frontal or temporal lobar hematoma than with a parietal or occipital lobar hematoma. While CT patterns do influence the frequency of diagnostic angiographic findings, cerebral angiography is recommended in all patients with otherwise unexplained nontraumatic lobar intracerebral hemorrhage.