London, United Kingdom 2013 E-Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 595 26 Intracerebral/subarachnoid haemorrhage and venous diseases A pragmatic diagnostic algorithm to detect acutely treatment-relevant underlying pathologies (ATRUP) in patients with spontaneous intracerebral hemorrhage (ICH). A prospective cohort study. H.M. Schneble1, P. Reiner2, J.P. Guichard3, D. Bresson4, H. Chabriat5, C Stapf6 Dept. of Neurology, APHP - Hôpital Lariboisière, Paris, FRANCE1, Dept. of Neurology, APHP - Hôpital Lariboisière, Paris, FRANCE2, Dept. of Neuroradiolgy, APHP - Hôpital Lariboisière, Paris, FRANCE3, Dept. of Neurosurgery, APHP - Hôpital Lariboisière, Paris, FRANCE4, Dept. of Neu-rology, APHP - Hôpital Lariboisière, Paris, FRANCE5, Dept. of Neurology, APHP - Hôpital Lari-boisière, Paris, FRANCE6 Background: Acute ICH is the deadliest form of stroke, but the diagnostic work-up has only been in-sufficiently defined. We tested a pragmatic step-wise diagnostic algorithm including CT/CTA, MRI/ MRA, and digital subtraction angiography (DSA) for the detection of acutely treatment-relevant un-derlying pathologies (ATRUP). Patients and Methods: We analyzed 152 prospective, consecutive patients (43% women, mean age 61.1 years +/-14) hospitalized for acute ICH. All patients had initial CT/CTA. Those without evident underlying cause and no contraindication underwent MRI/MRA. Finally, diagnostic DSA was per-formed in cases without evident ICH etiology on prior imaging. Results: Of the 152 patients, 4 (3%) showed deep ICH with CT evidence of severe small vessel dis-ease. In 3 (2%), CTA revealed sinus venous thrombosis. The remaining 141 patients without con-traindication (2 had a pacemaker, 2 showed rapid clinical worsening) underwent subsequent MRI/ MRA allowing detection of an underlying pathology in 96 (63%), including 19 (13%) ATRUP: 9 had secondary hemorrhagic infarcts, 4 showed cavernous malformations, 3 had acute CVT, and 3 had reversible acute cerebral vasoconstriction syndrome (RCVS), and 2 had an underlying glioblas-toma. Forty-five patients (30%) remained without diagnosis of an underlying pathology and un-derwent DSA revealing another 9 (6%) ATRUP: 2 with an underlying dural arteriovenous fistula, 2 AVMs, 2 with Moya-Moya disease, 2 ruptured aneurysm, and 1 acute RCVS. Conclusion: The diagnostic accuracy of brain CT alone is insufficient for the diagnostic work-up in ICH patients. A pragmatic, stepwise imaging algorithm based on additional CTA, MRI/MRA and DSA lead to the detection of ATRUP in 20% (n=31) and the diagnosis of an underlying vascular pathology in 74% (n=112). The results may help to develop more unified recommendations for sys-tematic diagnostic work-up in patients with acute ICH.
Karger_ESC London_2013
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