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Angiography in non-traumatic brain haematoma. An analysis of 100 cases
P D Griffiths1, C J Beveridge, A Gholkar
1Academic Department of Radiology, University of Sheffield, UK.
Insights
This study analyzed intracerebral hematoma (ICH) CT scans to identify features that might avoid the need for angiography. Certain temporal lobe hematoma characteristics, especially with subarachnoid hemorrhage, strongly suggest vascular abnormalities.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Intracerebral hematoma (ICH) is a critical condition often requiring prompt diagnosis.
- Conventional angiography is a standard diagnostic tool for identifying the underlying cause of ICH.
- Identifying specific CT features could potentially streamline diagnosis and avoid unnecessary invasive procedures.
Purpose of the Study:
- To investigate the anatomical characteristics of intracerebral hematoma (ICH) on CT scans.
- To determine if specific CT findings can predict the need for angiography in non-traumatic ICH cases.
- To correlate CT findings with angiographic results in patients with ICH.
Main Methods:
- Prospective study of 100 patients with non-traumatic ICH.
- All patients underwent CT and conventional angiography within 4 days of symptom onset.
- Exclusion criteria included history of trauma or known pre-existing brain abnormalities.
Main Results:
- Angiography revealed ruptured aneurysms or arteriovenous malformations (AVMs) in 49% of cases (22 aneurysms, 27 AVMs).
- Vascular abnormalities were more common in patients under 40 and those with associated subarachnoid or intraventricular hemorrhage.
- Temporal lobe ICH, particularly extending into the Sylvian fissure or with subarachnoid hemorrhage, showed >90% association with structural abnormalities.
Conclusions:
- Specific CT features of ICH can be highly suggestive of underlying vascular abnormalities like AVMs or aneurysms.
- Negative initial angiography in suggestive cases warrants follow-up with repeat angiography or MR imaging.
- CT findings alone, even with hypertension history, cannot definitively exclude all treatable vascular abnormalities.
Purpose:
The primary purpose of this project was to study the anatomical characteristics of intracerebral haematoma (ICH) in order to determine features that may negate the need for angiography in some patients.
Material And Methods:
The study was prospective and designed to investigate the underlying cause of non-traumatic ICH in 100 cases assessed by conventional angiography. Patients were excluded if there was a history of trauma or known pre-existing brain abnormality. All patients were examined with CT and angiography within 4 days of the ictus.
Results:
Ruptured aneurysms or arteriovenous malformations (AVMs) were diagnosed on the initial angiogram in 49% of cases: 27 AVMs and 22 aneurysms. One case of superior sagittal sinus thrombosis was also detected. Vascular abnormalities were found most frequently in the under-40 age group and in cases in which subarachnoid haemorrhage, intraventricular haemorrhage or extracerebral haematoma accompanied the ICH. The temporal lobe was the most frequent anatomical location (37%). When a temporal lobe haematoma extended into the Sylvian fissure from the inferior pole of the temporal lobe or when it was associated with subarachnoid haemorrhage, structural abnormalities were found in over 90% of cases.
Conclusions:
There are groups of patients with ICH in whom the CT features are highly suggestive of AVM or aneurysm rupture. If the initial angiography is negative in these cases, careful follow up by repeat angiography and/or MR imaging is essential. However, potentially treatable abnormalities cannot be excluded with certainty by the distribution of the haematoma on CT alone, even if there is a history of pre-existing hypertension.