Abstract
Intracerebral hemorrhage (ICH) accounts for 10% to 20% of all strokes worldwide and is associated with high morbidity and mortality. Neuroimaging is clinically important for the rapid diagnosis of ICH and underlying etiologies, but also for identification of ICH expansion, often as-sociated with an increased risk for poor outcome. In this context, rapid assessment of early hema-toma expansion risk is both an opportunity for therapeutic intervention and a potential hazard for hematoma evacuation surgery. In this review, we provide an overview of the current literature surrounding the use of multimodal neuroimaging of ICH for etiological diagnosis, prediction of early hematoma expansion, and prognostication of neurological outcome. Specifically, we discuss standard imaging using computed tomography, the value of different vascular imaging modalities to identify underlying causes and present recent advances in magnetic resonance imaging and computed tomography perfusion.
Highlights
Intracerebral hemorrhage (ICH) is one of the most devastating forms of stroke: oneyear mortality approaches 50% and five-year survival is less than 30% [1]
We provide an overview of the current literature surrounding the use of multimodal neuroimaging of ICH for etiological diagnosis, prediction of early hematoma expansion, and prognostication of neurological outcome
We provide an overview of the current literature surrounding the use of multimodal neuroimaging of ICH for etiological diagnosis, prediction of early hematoma expansion, and prognostication of outcome
Summary
Intracerebral hemorrhage (ICH) is one of the most devastating forms of stroke: oneyear mortality approaches 50% and five-year survival is less than 30% [1]. While incidence has decreased over the past three decades, ICH was responsible for 2.8 million deaths and 64.5 million disability-adjusted life years between 1990 and 2016 [2] This significant global burden highlights an urgent need to develop novel strategies to treat and prevent ICH. Secondary prevention approaches range from hypertension control in small vessel vasculopathies to endovascular embolization of arteriovenous malformations; these are based on etiological diagnoses made with multimodal imaging. We provide an overview of the current literature surrounding the use of multimodal neuroimaging of ICH for etiological diagnosis, prediction of early hematoma expansion, and prognostication of outcome. 2. Imaging to Identify ICH Etiology The term primary ICH traditionally refers to ICH arising from chronic, progressive cerebral small vessel disease, most commonly hypertensive arteriopathy (sporadic nonamyloid microangiopathies) and cerebral amyloid angiopathy (CAA) [3,4]. In particular the strictly lobar distribution of multiple cerebral microbleeds and/or the presence of cortical superficial siderosis are strong validated markers of CAA included in the Boston Criteria. [10,11,12] Other CAA markers such as enlarged perivascular spaces and white matter hyperintensities extent have been described and may improve the diagnosis of CAA in clinical research settings and in clinical practice [13]
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