Computerized Tomography and Magnetic Resonance Imaging

Distinguishing between ICH and ischemic stroke becomes a daunting task if only clinical criteria are used, though the presence of headache, nausea, and vomiting significantly elevated blood pressure, and an early reduction in the patient's level of consciousness favor the diagnosis of ICH. Brain computerized tomography (CT) is essential for making the diagnosis of ICH and for guiding patient-risk allocation and management based on the location of the bleed. An ICH > 30 cc is usually an indicator of poor prognosis, with mortality rates increasing significantly if ICH volume is more than 60 cc; in particular, if the initial Glasgow Coma Scale (GCS) is <8 (4). Calculation of hematoma volume is based on the "ABC" method, in which A is the length of the clot, B is the diameter perpendicular to A (width), and C is its thickness (based on the number of slices on CT multiplied by the thickness of each slice) (5). Hematoma location is also critical from a treatment perspective. For example, patients with a cerebellar hemorrhage > 3 cm in diameter have better outcomes with early surgical evacuation (2).

Although magnetic resonance imaging (MRI) sequences continue to be studied as a radiologic tool to diagnose ICH, the most clinically relevant role of MRI remains enabling estimation of the age of the hemorrhage and assessment of possible etiologies (aneurysm, arterio-venous malformation (AVM), and tumor). Brain CT remains the initial diagnostic study of choice in patients with suspected ICH (6 ).

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