Utility of surveillance imaging for spontaneous intracerebral hemorrhage

Management of spontaneous intracerebral hemorrhage involves reversal of coagulopathy, neurological examinations and repeated imaging. Repeated imaging is employed to identify patients prior to neurological deterioration, however, there is no data to support this practice. As such, we strive to identify the utility of surveillance imaging as well as the risks factors that are associated with higher likelihood of developing a clinically significant hematoma progression.

A retrospective chart analysis of 200 consecutive patients was performed on patients with non-traumatic intracerebral hemorrhage. Patients with non-parenchymal hemorrhage, vascular malformations, patients that required surgical intervention based on the initial scan/neurological exam, and trauma were excluded. Patient demographics, blood pressure, presence of a new neurological deficit, progression of hematoma, surgical intervention and mortality were gathered from the chart.

Hematoma progression of greater than 5 mL was seen in 24 patients (12%) on repeat imaging. Large initial hematoma volume, early time from symptom onset to initial imaging, and new neurological deterioration between scans were significantly associated with significant hematoma progression. Of the 24 patients with hematoma progression greater 5 mL, five patients did not develop neurological deterioration. None of these patients required intervention.

Routine imaging in patients with spontaneous intracerebral hemorrhages does not alter clinical management. Rather, careful neurologic monitoring may be safe and more clinically useful in these patients.