Fast Five Quiz: Test Your Knowledge on Key Aspects of Hemorrhagic Stroke

Amy Kao, MD

Disclosures

May 10, 2018

CT angiography and contrast-enhanced CT scanning may be considered to help identify patients at risk for hematoma expansion. Extravasation of contrast within the hematoma indicates high risk.

Brain imaging is a crucial step in the evaluation of suspected hemorrhagic stroke and must be obtained on an emergent basis. Brain imaging aids diagnosing hemorrhage, and it may identify complications such as intraventricular hemorrhage, brain edema, or hydrocephalus. Either noncontrast CT scanning or MRI is the modality of choice.

Conventional angiography is the criterion standard in evaluating for cerebrovascular disease and for providing less-invasive endovascular interventions. This modality can be performed to clarify equivocal findings or to confirm and treat disease seen on MRA, CT angiography, transcranial Doppler ultrasonography, or neck ultrasonography.

Although the traditional approach to excluding underlying vascular abnormalities in patients with spontaneous intracerebral hemorrhage is to use digital subtraction angiography in the acute and subacute phases, Wong and colleagues found that MRA was able to detect most structural vascular abnormalities in the subacute phase in most patients. Consequently, they recommend MRA as the screening test.

For more on the workup of hemorrhagic stroke, read here.

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