Diagnostic Evaluation for Nontraumatic Intracerebral Hemorrhage - 22/04/15

Doi : 10.1016/j.ncl.2014.12.001

Renan Domingues, MD ^a,^b, Costanza Rossi, MD, PhD ^a, Charlotte Cordonnier, MD, PhD ^a,^⁎
^a Department of Neurology, University of Lille, UDSL, CHU Lille, Inserm U 1171, Lille 59000, France
^b CAPES Foundation, Ministry of Education, Quadra 2, Bloco L, Lote 06, Edifício Capes - CEP: 70.040-020 - Brasilia-DF, Brazil

^∗Corresponding author. Department of Neurology, University of Lille, UDSL, CHU Lille, Inserm U 1171, Lille Cedex 59037, France.

Résumé

Intracerebral hemorrhage (ICH) is a devastating condition with multiple possible underlying causes. Early diagnosis of ICH associated with a precise diagnostic work-up is mandatory. Clinical signs may give clues to diagnosis but are not reliable enough and imaging remains the cornerstone of management. Noncontrast computed tomography and magnetic resonance imaging (MRI) are highly sensitive for ICH identification. Additionally, MRI may disclose brain parenchymal biomarkers that can contribute to the etiologic diagnosis. Vessel examination should be carried out whenever there is a clinical suspicion of underlying structural lesions, such as vascular malformations or tumors. To date, conventional angiography remains the gold standard to detect intracranial vascular malformations in patients with ICH.

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Keywords : Intracerebral hemorrhage, Deep perforating vasculopathy, Cerebral amyloid angiopathy, Diagnostic evaluation, MRI, Digital subtraction angiography

Plan

Key points

Introduction

What are the causes to search for in patients with intracerebral hemorrhage?

Importance of Intracerebral Hemorrhage Location to Tailor Diagnostic Work-Up

Causes of Intracerebral Hemorrhage

Diagnostic work-up

Clinical Presentation

Main Clinical Symptoms

Neuroimaging Findings

Summary

Disclosures: R. Domingues has no disclosures. C. Rossi was investigator in Brainsgate (Impact-24), Astra-Zeneca (SOCRATES), Pfizer (A9951024). No personal funding, all honoraria were paid to Adrinoid or Lille University Hospital. C. Cordonnier was investigator in Photothera (NEST3), Brainsgate (Impact-24), Astra-Zeneca (SOCRATES). She is principal investigator in France for Pfizer (A9951024). She received speaker fees from Bayer, BMS. No personal funding, all honoraria were paid to Adrinoid or Lille University Hospital.