Purpose Post-stroke cognitive impairment (PSCI) after spontaneous intracerebral hemorrhage (sICH) is highly prevalent and severely impacts patients’ long-term quality of life. However, accurate prediction tools that integrate acute-phase complications with sociodemographic characteristics are currently lacking. This study aimed to identify independent risk factors for PSCI in sICH patients and to construct a visual nomogram prediction model to guide clinical risk stratification prior to hospital discharge. Methods We retrospectively analyzed clinical data from 264 sICH patients admitted to the Affiliated Hospital of Xuzhou Medical University between July 2023 and July 2025. Patients were classified into cognitive impairment and cognitively normal groups based on the Montreal Cognitive Assessment (MoCA) score (<22). The dataset was randomly split into a training set ( n = 198, 75%) and a validation set ( n = 66, 25%). Univariate and multivariate logistic regression analyses were employed to screen for independent predictors, which were then used to construct the nomogram model. The model’s discriminative ability, calibration, and clinical utility were validated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA). Results The overall incidence of PSCI in this cohort was 44.3%. Multivariate logistic regression analysis identified pulmonary infection (OR 3.980, 95% CI 2.075–7.635, p = 0.002) and hematoma volume (OR 1.030, 95% CI 1.015–1.045, p < 0.001) as independent risk factors for PSCI, whereas years of education (OR 0.885, 95% CI 0.831–0.944, p < 0.001) served as an independent factor associated with reduced risk. The nomogram model demonstrated excellent discriminative ability with AUCs of 0.771 and 0.820 in the training and validation sets, respectively. Calibration curves indicated high consistency between predicted probabilities and observed outcomes. DCA confirmed clinical net benefit across a wide range of threshold probabilities. Conclusion This study successfully developed a nomogram prediction model incorporating pulmonary infection, hematoma volume, and years of education. The model suggests that cognitive decline after sICH is associated with a combination of systemic inflammation (brain–body axis interaction), primary structural injury, and insufficient cognitive reserve. This user-friendly and accurate scoring tool can assist clinicians in identification of high-risk subgroups for PSCI upon completion of inpatient care, thereby informing intensified clinical monitoring and rehabilitation planning.

Outcomes of a blood pressure control protocol for intracerebral hemorrhage in the emergency department.

Impact of prehospital comprehensive stroke center vs. primary stroke center triage protocol on outcome of patients with spontaneous intracerebral hemorrhage.

Factors associated with in-hospital case fatality following spontaneous intracerebral hemorrhage among young ghanaians: findings from a hospital-based stroke registry.

ICH-FOS for evaluating surgical outcomes in supratentorial spontaneous ICH: Toward precision neurosurgical care.

To summarize the clinical experience in emergency surgical treatment of antithrombotic drug-related intracerebral hemorrhage (ATR-ICH) and explore the surgical strategies and key points of perioperative management. A retrospective analysis was conducted on the clinical data of 26 patients with ATR-ICH who underwent emergency surgery in the Department of Neurosurgery of our hospital from January 2023 to December 2024. Targeted coagulation function reversal measures were implemented in all patients preoperatively and intraoperatively. All patients were taking antithrombotic drugs [5 on warfarin, 2 on direct oral anticoagulants (DOACs), 2 on heparin] or antiplatelet drugs (9 on aspirin, 5 on clopidogrel, 3 on aspirin+clopidogrel) when acute intracerebral hemorrhage occurred (including spontaneous intracerebral hemorrhage and posttraumatic intracerebral hemorrhage). Preoperative GCS scores were 6 to 8 in 16 cases and 9 to 12 in 10 cases. The average hematoma volume was 75.6mL. All patients underwent craniotomy for hematoma evacuation, among which 12 cases received decompressive craniectomy. Early postoperative rebleeding (within 72h) occurred in 1 case, and 1 case died. At discharge, GOS scores were as follows: 6 cases of good recovery, 12 cases of moderate disability, 5 cases of severe disability, 2 cases of vegetative state, and 1 case of death. The core of emergency surgery for ATR-ICH lies in rapid and effective reversal of coagulation function, strict grasp of surgical timing, refined surgical operation, and multidisciplinary collaboration during the perioperative period. Data from this group of cases show that standardized comprehensive treatment can significantly reduce the rebleeding rate and improve patient prognosis.

In Japan, which has become a super-aging society, the incidence of spontaneous intracerebral hemorrhage among older adults is increasing. Managing these patients is often complicated by frailty and systemic comorbidities. Although these issues pose unique challenges, there is limited research on spontaneous intracerebral hemorrhage in this population, leaving their clinical characteristics and prognoses unclear. This retrospective study reviewed spontaneous intracerebral hemorrhage patients aged ≥75 years who were admitted to our institution from April 2004 to March 2024. Demographics, clinical presentation, imaging findings, and in-hospital outcomes were analyzed to identify risk factors for both 30-day and complication-related mortality. A total of 501 patients were included in the study, with 213 (42.5%) categorized as the oldest-old (age ≥85 years). Over the 2-decade study period, the proportion of oldest-old spontaneous intracerebral hemorrhage patients increased, and this age group exhibited a high risk of complication-related mortality (16.9%). Multivariate analysis identified age ≥85 years (odds ratio: 4.25, 95% confidence interval: 2.12-8.51, p < 0.001), Glasgow Coma Scale score ≤8 at admission (odds ratio: 2.27, 95% confidence interval: 1.19-4.34, p = 0.013), and serum albumin ≤3.5 g/dL at admission (odds ratio: 2.12, 95% confidence interval: 1.07-4.19, p = 0.031) as independent risk factors for complication-related mortality. The prognosis of spontaneous intracerebral hemorrhage in older adults is significantly worse in individuals aged ≥85 years. Older patients with spontaneous intracerebral hemorrhage are at a heightened risk of complication-related mortality, which is primarily associated with advanced age, neurological severity, and hypoalbuminemia.

This study aimed to retrospectively analyze consultations requested from the emergency departments (EDs) to the neurosurgery (NS) department of a tertiary care hospital, and to comprehensively evaluate the clinical characteristics, referral reasons, and diagnostic and therapeutic processes of these patients. In addition, the study aims to provide concrete recommendations for strategic objectives such as optimizing hospital workflow, enhancing interphysician coordination, and standardizing consultation processes. This single-center, retrospective study evaluated patients who presented to the ED of a tertiary care hospital and for whom a neurosurgical consultation was requested between January 1, 2024 and December 31, 2024. Demographic data, consultation request notes prepared by emergency physicians, consultation responses provided by NS specialists, and radiological imaging findings of the patients were reviewed in detail. Of the patients, 69% were consulted for traumatic and 31% for non-traumatic reasons. Among traumatic cases, falls were identified as the most common cause, whereas headache and altered mental status were the leading reasons in non-traumatic cases. Of the 386 patients, did not require neurosurgical intervention and were safely directed to clinical follow-up, representing the majority of NS consultations (44.8%). Surgical intervention was performed in 40 of 386 patients (10.3%). The frequency of consultations was notably higher during the summer months. The increase in admissions during the summer months demonstrates the necessity of planning adapted to seasonal workload. In pediatric head trauma, the application of the Pediatric Emergency Care Applied Research Network rules, and in suspected cauda equina syndrome, performing joint history-taking and physical examination, may enhance diagnostic accuracy and reduce unnecessary imaging. In cases of spontaneous subarachnoid hemorrhage and spontaneous intracerebral hemorrhage, rapid access can be strengthened through telemedicine, artificial intelligence-assisted analysis, and joint educational meetings.

Spontaneous intracerebral hemorrhage (ICH) is a devastating condition, with high mortality and morbidity. For decades, neurosurgical treatment has been studied as a potential treatment, yet consensus on its role is still lacking. In a recent Cochrane review, we showed that surgical evacuation may have benefit in terms of functional recovery and survival, but the certainty of the evidence was low. Craniotomy probably reduces mortality but has uncertain effects on functional outcome, while minimally invasive approaches appear more promising. Decompressive craniectomy has only been investigated in a single small trial. Key uncertainties remain regarding overall effectiveness, optimal surgical technique, timing of intervention, and patient selection. Until ongoing trials provide more robust evidence, clinical practice requires careful patient selection, multidisciplinary decision-making, and participation in ongoing trials.

Objective: To identify neurological recovery trajectories in patients with spontaneous intracerebral hemorrhage (ICH) using a latent class mixed model (LCMM), to examine the related clinical and meteorological factors, and to develop a predictive model for adverse neurological outcomes. Methods: A total of 1 067 patients with spontaneous ICH admitted to the First Affiliated Hospital of Harbin Medical University in 2023 were retrospectively enrolled. Demographic, clinical, imaging, and meteorological data on the day of onset were collected. All patients were followed up from the time of admission at a unified time point, and modified Rankin Scale (mRS) scores were recorded at discharge and at 3, 6, and 12 months after discharge. Based on the mRS scores, LCMM was applied to identify neurological recovery trajectories. Univariate and multivariate multinomial logistic regression analyses were performed to determine influencing factors. On the basis of the LCMM-derived categories, certain subgroups were strategically merged to construct a binary predictive model for risk of poor neurological outcomes in patients. Model performance and interpretability were evaluated through ROC curve, calibration curves, and SHAP (Shapley Additive Explanations) analysis. Results: A total of 1 067 ICH patients [690 males (64.7%) and 377 females (35.3%)], aged[M(Q1, Q3)] 61 (53, 69)years, were included. Four neurological function recovery trajectories were identified in the study: partial improvement group(611 cases, 57.3%), gradual improvement group(203 cases, 19.0%), rapid improvement group(182 cases, 17.1%), and persistent disability group(71 cases, 6.7%). Different trajectory types were associated with GCS scores, hematoma location, hematoma volume, and meteorological variables. The patients in the gradual improvement group were associated with higher maximum temperature (OR=1.10, 95%CI: 1.06-1.15), lower minimum temperature (OR=0.91, 95%CI: 0.88-0.95), smaller diurnal temperature variation (OR=0.83, 95%CI: 0.78-0.88), onset in autumn (OR=4.06, 95%CI: 1.87-8.85), onset in winter (OR=4.18, 95%CI: 1.74-10.03), no history of cardio-cerebrovascular disease (OR=1.64, 95%CI: 1.08-2.50), higher GCS scores (OR=1.29, 95%CI: 1.18-1.40), and lobar hemorrhage (OR=2.66, 95%CI: 1.37-5.14). The patients in the rapid improvement group were associated with no history of cardio-cerebrovascular disease (OR=2.35, 95%CI: 1.45-3.84), shorter hospital stays (OR=0.93, 95%CI: 0.88-0.98), higher GCS scores (OR=2.29, 95%CI: 1.87-2.80), no midline shift (OR=2.10, 95%CI: 1.09-4.06), right-sided hemorrhage (OR=1.64, 95%CI: 1.10-2.46), as well as lobar hemorrhage (OR=3.58, 95%CI: 1.70-7.51) and infratentorial hemorrhage (OR=3.02, 95%CI: 1.61-5.66). The patients in the persistent disability group were associated with smaller diurnal temperature variation (OR=0.89, 95%CI: 0.81-0.97), shorter hospital stays (OR=0.95, 95%CI: 0.91-1.00), lower GCS scores (OR=0.82, 95%CI: 0.74-0.90), larger hematoma volumes (OR=1.02, 95%CI: 1.00-1.03), and infratentorial hemorrhage (OR=4.71, 95%CI: 1.67-13.30). The constructed binary predictive model for neurological functional outcomes demonstrated good performance(AUC=0.812, 95%CI: 0.786-0.838) and satisfactory calibration curve fit(Brier score=0.168). SHAP analysis identified GCS score and meteorological variables(maximum temperature, minimum temperature, and diurnal temperature range)(mean absolute Shapley values of 1.07, 0.50, 0.45, 0.32)as the most influential predictors in the model. Conclusions: LCMM can effectively identify dynamic neurological recovery trajectories in ICH patients. GCS score and meteorological factors are key predictors, and the constructed model exhibited good predictive performance and interpretability.

Microglia-mediated neuroinflammation is closely associated with the pathogenesis of secondary brain injury following spontaneous intracerebral hemorrhage (ICH). However, the relationship between immune response regulation and metabolic patterns in microglia remains unclear. Histone Deacetylases 1 and 2, a class of lysine deacetylases, regulates gene transcription by modulating histone acetylation modifications and is widely involved in various cellular activities of microglia. In this study, we observed that knockout of HDAC1/2 in microglia alleviated neurological deficits caused by ICH, preserved white matter integrity, and accelerated hematoma clearance post-ICH. Mechanistically, we found that after ICH, microglia exhibited increased expression of hexokinase 2 (HK2) and enhanced glycolysis. HDAC1/2 knockout/pharmacological inhibition affected the acetylation level of HK2, inhibited its glycolytic activity, and promoted a metabolic shift in activated microglia from glycolysis to fatty acid oxidation. This shift was associated with reduced pro-inflammatory responses and enhanced phagocytic activity in microglia. Enhanced fatty acid oxidation may have a detrimental effect on mitochondrial function, and HDAC1/2 inhibition simultaneously promoted mitophagy in microglia. Additionally, HDAC1/2 inhibition triggered microglial apoptosis and suppressed proliferation, ultimately leading to a reduction in microglial cell numbers. Overall, this study reveals the potential mechanisms by which targeting HDAC1/2, through acetylation modifications and transcriptional regulation, modulates microglial function and metabolism after ICH, thereby exerting protective effects.

Spontaneous intracerebral hemorrhage (ICH) is characterized by acute onset and high rates of disability and mortality. Although surgical intervention is theoretically capable of decreasing intracranial pressure efficiently and mitigating secondary brain injury, its clinical benefit has long lacked high-level evidence. This article systematically reviews the evolution of ICH surgical treatment-from empirical attempts in the 17th century, through the establishment of early evidence-based guidelines in the CT era of the 20th century, to the conceptual innovation driven by minimally invasive technology in the 21st century. Currently, critical unresolved issues include optimal timing of surgery, selection of surgical approach, intelligent surgical technologies, selection for deep hemorrhage patients, and the surgery in brainstem hemorrhage. Future progress requires multicenter, high-quality clinical research to advance standardized, visualized, precise, intelligent, and homogeneous surgical interventions, thereby providing high-quality evidence from Chinese populations for the diagnosis and treatment of spontaneous ICH worldwide.

Background: Patients with spontaneous intracerebral hemorrhage (SICH) who present with severe hypertension (SHTN; systolic blood pressure [SBP] &gt;220 mmHg) have been underrepresented in major SICH trials. Consequently, current management strategies for SHTN are extrapolated from studies of patients with mild to moderate hypertension (mmHTN; SBP 140–220 mmHg). Whether these two groups differ in clinical characteristics and outcomes remains uncertain. Methods: We prospectively enrolled consecutive patients with SICH between October 2024 and June 2025 at a large academic center in the southeastern United States. Eligible patients were adults (≥18 years) with confirmed SICH and an initial SBP ≥140 mmHg. Baseline demographics, clinical characteristics, and in-hospital outcomes were abstracted from the electronic medical record. The primary outcome was in-hospital mortality, and the primary exposure was SBP at presentation, categorized as SHTN (SBP &gt;220 mmHg) or mmHTN (SBP 140–220 mmHg). Binomial logistic regression was used to identify predictors of in-hospital mortality. Results: Fifty six were enrolled (6 with SHTN, 50 with mmHTN). Compared with mmHTN patients, those with SHTN were younger (mean age 58 [SD 7.8] vs. 64 [11.8]), more often male (66.7% vs. 54.0%), and more likely to have a history of hypertension (100% vs. 88%). The initial Glasgow Coma Scale score was lower in the SHTN group (9 [5] vs. 11 [5]), and mean presenting SBP was higher (234 [17.4] vs. 165 [27] mmHg). SHTN patients more frequently had intraventricular hemorrhage (67% vs. 52%), higher baseline ICH scores (2.5 vs. 1.6), and higher rates of intubation (33% vs. 16%). However, baseline ICH volumes were similar (11.6 vs. 12.4 mL). Positive urine drug screens for cocaine (17% vs. 6%) and amphetamines (17% vs. 4%) were more common in the SHTN group. In-hospital mortality was 17% in SHTN and 28% in mmHTN. ICH volume was the only predictor of in-hospital mortality (odds ratio [OR] 1.1; p=0.02), while SHTN was not (OR 0.48; p=0.59). Conclusions: Patients with SICH and SHTN may differ in their presenting characteristics compared with those with mmHTN. However, ICH volume and not SHTN, was the only predictor of in-hospital mortality. Larger studies are warranted to better clarify the impact of SHTN on outcomes (death and disability) to guide blood pressure management in this high-risk population.

Introduction: Intracerebral hemorrhage (ICH) is a severe stroke subtype associated with high mortality and disability. Hematoma expansion (HE) is a major determinant of poor outcomes in ICH, yet effective treatments to limit HE remain elusive. Tranexamic acid, an antifibrinolytic agent, has been proposed to reduce ongoing bleeding in ICH, based on its success in trauma and surgical settings. The STOP-MSU trial tested whether tranexamic acid within 2 hours of symptom onset could reduce HE in spontaneous ICH. However, no effect was found. We hypothesized that fibrinolysis would explain the results. Methods: We conducted a prospective, multicenter observational study across six medical centers in the United States. Eligible patients were adults aged 21 or older who presented with a radiologically confirmed spontaneous ICH within 12 hours of symptom onset. Whole blood samples were collected within 12 hours of ICH symptom onset and analyzed with thromboelastography (TEG). TEG is a non-invasive, point-of-care assay that assesses coagulation factors, fibrinogen, platelets, and fibrinolysis in a single waveform. Fibrinolysis is measured as the percentage of accelerated fibrinolysis within 30 minutes (LY30), with hyperfibrinolysis defined as &gt;8%. Results: A total of 110 patients with spontaneous ICH had readable TEG results. The median time from symptom onset to first blood draw was 6.3 hours [IQR 4.6–9.4 hours], and from hospital admission to first blood draw was 2.6 hours [1.6–4.3 hours]. The TEG results showed inactive fibrinolysis with a median LY30 value of 0.1% [IQR 0.0%–0.6%] at first blood draw for this cohort. Only one patient exhibited hyperfibrinolysis with a LY30 of 16%. Most patients (n = 87, 79.1%) had LY30 values less than 1%. Using a more liberal threshold of &gt;3% for hyperfibrinolysis, only 3 patients (2.7%) in our cohort would have met the requirements for tranexamic acid treatment. Conclusion: There is little fibrinolysis to correct in patients with acute spontaneous ICH. Thus, tranexamic acid seems unlikely to have a biologically plausible mechanism to reduce hematoma expansion and improve patient outcomes. These results suggest that alternative therapeutic mechanisms, such as agents promoting coagulation cascade activation, may be more effective in preventing hematoma expansion in ICH patients.

Introduction: Prior studies evaluating the relationship between antiplatelet therapy (APT) and outcomes after spontaneous intracerebral hemorrhage (ICH) have grouped all antiplatelet agents together, and it is therefore unclear if specific antiplatelet agents or particular combinations of antiplatelet medications have differential effects on ICH outcomes. Methods: We performed a retrospective cohort study of patients with ICH from 2011-2021 in the Get With The Guidelines-Stroke registry. The exposure was the type of APT defined as either monothrerapy (aspirin, clopidogrel, prasugrel, ticagrelor used alone), dual APT combinations involving these 4 medications, or no APT. The outcomes were in-hospital mortality, and unfavorable discharge disposition defined as a composite of in-hospital mortality or hospice discharge. We used multiple logistic regression to study the relationship between incremental APT combinations and outcomes, after adjustment for demographics, vascular comorbidities, ICH severity (NIHSS Stroke Scale, external ventricular drain use), hospital characteristics (teaching status, urban location, annual case volume), and withdrawal of care. Results: Among 426,481 patients with ICH, 109,512 were on APT monotherapy, 17,009 were on dual APT, while 300,558 did not receive any APT prior to the ICH. In the multivariate logistic regression analyses, aspirin monotherapy was not associated with higher mortality compared with no APT, but clopidogrel, prasugrel, and ticagrelor monotherapies, and all dual APT combinations, were associated with higher odds of in-hospital mortality (Figure 1). Aspirin monotherapy was associated with lower odds of unfavorable discharge disposition compared with no APT, but there was a trend suggesting higher odds of unfavorable discharge disposition with other APT monotherapies and dual APT combinations (Figure 2). Conclusions: In a large, diverse US cohort of ICH patients, increasing potency of antiplatelet therapy at the time of ICH was associated with higher mortality and a trend toward poor discharge disposition. Better knowledge of these relationships will be crucial in the management of antiplatelet associated ICH.

Background: The ICH Score is the standard early prognostic tool in spontaneous intracerebral hemorrhage (ICH) but does not incorporate MRI markers of small vessel disease or secondary ischemic injury. Cerebral microbleeds (CMBs), visible on GRE/SWI MRI and reflecting chronic vascular injury, and acute diffusion-weighted imaging (DWI) lesions may improve prediction of long-term outcomes after ICH. Whether inclusion of these imaging biomarkers can improve functional outcome prediction beyond the ICH Score in acute ICH has not been fully defined. Objective: To determine whether CMB burden and DWI lesion presence improve 90-day functional outcome prediction beyond the ICH Score. Methods: We retrospectively identified adults with spontaneous ICH who underwent MRI including DWI and GRE/SWI sequences, performed either after minimally invasive surgery (MIS) in surgically evacuated patients or post-onsent in nonsurgical patients. DWI lesion presence was recorded. Cerebral microbleeds were visually counted for total burden by two blinded raters. The primary outcome was 90-day modified Rankin Scale (mRS). Logistic regression compared the ICH Score, MRI biomarkers, and combined models, with discrimination assessed by AUC. Results: A total of 102 patients (mean age 59.7 ± 12.9 years, mean admission GCS 10.1 ± 3.9, 59% male) with spontaneous ICH were included. The ICH Score alone predicted poor 90-day functional outcome (mRS &gt; 2) with an AUC of 0.76. A combined model incorporating the ICH Score and MRI biomarkers achieved an AUC of 0.83, representing a statistically significant improvement in discrimination compared with the ICH Score alone (ΔAUC = 0.07, p = 0.049, DeLong test). These findings indicate that MRI biomarkers provide added prognostic value beyond the standard clinical score. Conclusions: CMB burden and DWI lesion presence add significant prognostic value beyond the ICH Score in acute ICH. Incorporating these MRI markers may improve individualized risk stratification and outcome prediction.

Introduction: Spontaneous intracerebral hemorrhage (sICH) is a neurological condition associated with poor functional outcomes and high mortality. The role of surgical intervention is an area of ongoing research, with several trials showing mixed results. We conducted a meta-analysis to investigate the effectiveness of surgery compared to best medical management (BMM) in patients with sICH. Methods: We analyzed randomized controlled trials found through PubMed, Embase, and Cochrane databases. Studies that were not randomized control trials or included the pediatric population were excluded. Studies that investigated other causes of ICH such as vascular malformations or sinus thrombosis were also excluded. We used modified Rankin Scale (mRS) score of 0-3 at 180 days as the efficacy outcome. Mortality at 90 days was evaluated as the safety outcome. We assessed heterogeneity using a restricted maximum-likelihood estimator, along with the Q-test and I 2 statistic. Results: Four clinical trials, namely STICH-I, STICH-II, MISTIE, III and ENRICH, were included. STICH-II only enrolled patients with lobar sICH, while the other studies included lobar, basal ganglia, and thalamic hemorrhages. STICH-I and STICH-II trials randomized patients to BMM or invasive surgery (e.g., craniotomy, stereotactic and burr hole surgery). MISTIE-III and ENRICH trials randomized patients between BMM and minimally invasive surgery (MIS). When analyzed separately, invasive surgical intervention (OR 1.20, 95% CI [0.97, 1.48]) and MIS (OR 1.32, 95%CI [0.98, 1.76]) did not show any benefit over BMM. However, there was a higher likelihood of a favorable outcome (OR 1.24, 95% CI [1.05, 1.47]) and improved mortality (OR 0.79, 95% CI [0.63, 0.99]) with any surgical intervention (invasive or MIS) when compared to BMM. Conclusion: Our results showed better functional outcomes and improved mortality with surgical intervention in patients with sICH. Further research is warranted to elucidate these findings.

Recombinant factor VIIa versus placebo for spontaneous intracerebral haemorrhage within 2 h of symptom onset (FASTEST): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial.

Background&amp;Purpose: Macrovascular lesions represent a small but clinically significant cause of spontaneous ICH, disproportionately affecting younger individuals. Accurate etiological work up is critical in guiding appropriate secondary prevention. ASL, a non-contrast MRI perfusion technique, has demonstrated strong diagnostic performance in pediatric ICH but has not been widely validated in the adult population. We evaluate the impact of ASL implementation on the detection of culprit arteriovenous shunts (arteriovenous malformation and dural arteriovenous fistulas) and subsequent DSA practices at a single comprehensive stroke center. Methods: Patients with spontaneous intraparenchymal and/or intraventricular hemorrhage enrolled in a prospective registry were retrospectively included if both CT angiography (CTA) and MRI were obtained during the initial diagnostic work up. Patients were divided into the pre-ASL group if admitted prior to the implementation of ASL (2006-2012), or the post-ASL group if admitted after the implementation of ASL (2022-2023). Detection of shunting lesions was compared between CTA and MRI, as well as DSA, if performed. Results: The pre-ASL group (n=110) and the post-ASL group (n=82) demonstrated similar baseline characteristics. In the pre- and post-ASL groups, culprit arteriovenous shunts were diagnosed at similar rates of 8.1% and 11% ( p = 0.509 ), respectively; CTA yielded similar detection rates of 6.4% vs 8.5% ( p = 0.567 ); MRI detection rate increased from 5.5% vs 11% ( p = 0.159 ), though did not reach statical significance; DSAs were recommended less often, in 42% vs 23% of cases ( p = 0.007) and were associated with a higher rate of positivity in the post-ASL group, 47.4%, compared to 17.4% in the pre-ASL group ( p = 0.012 ) . Conclusions: These findings suggest that ASL imaging can be used as an effective adjunct to standard imaging techniques in the etiological work up for spontaneous ICH for the detection of arteriovenous shunting lesions. Future directions include comparing detection rates of arteriovenous shunting lesions and DSA practices in patients who underwent either CTA or MRI alone.

Application of “three-in-one” technique in spontaneous supratentorial intracerebral hemorrhage with cerebral herniation