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  • How useful are simple clinical features and non-invasive imaging at predicting an underlying structural cause of acute intracerebral haemorrhage?

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Editorial commentary
How useful are simple clinical features and non-invasive imaging at predicting an underlying structural cause of acute intracerebral haemorrhage?
  1. Craig S Anderson1,2
  1. 1 Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
  2. 2 The George Institute, Peking University Health Science Center, Beijing, People’s Republic of China
  1. Correspondence to Professor Craig S Anderson, The George Institute for Global Health, Sydney, NSW 2050, Australia; canderson{at}georgeinstitute.org.au

https://doi.org/10.1136/jnnp-2017-317564

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    Imaging approaches to the diagnosis of intracerebral haemorrhage

    The role of imaging in the detection of an underlying structural or macrovascular cause of acute intracerebral haemorrhage (ICH) is poorly defined, yet this issue has significant resource and investigative risk implications for patients and healthcare providers. In this issue, Hilkens et al 1 (see pp 674) introduce a simple individualised decision-making tool (age <50 vs ≥50–70 years, lobar/posterior fossa vs deep location, presence vs absence of small vessel disease (SVD) on CT, and with/without a positive (or uncertain) vs negative findings on CT angiography (CTA)) that shows high predictive ability for an underlying macrovascular cause of acute ICH.

    Conventionally, clinicians make decisions about whether, how and when to use vascular imaging—usually through sequential use of CTA, MRI alone and with angiography, and intra-arterial digital subtraction angiography …

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    Footnotes

    • Funding National Health and Medical Research Council.

    • Competing interests CSA holds a Senior Principal Research Fellowship at the National Health and Medical Research Council (NHMRC) of Australia. CSA reports receiving travel reimbursement and speaker fees from Takeda, and Advisory Board sitting fees from Amgen.

    • Provenance and peer review Commissioned; internally peer reviewed.

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      Nina A Hilkens Charlotte J J van Asch David J Werring Duncan Wilson Gabriël J E Rinkel Ale Algra Birgitta K Velthuis Gérard A P de Kort Theo D Witkamp Koen M van Nieuwenhuizen Frank-Erik de Leeuw Wouter J Schonewille Paul L M de Kort Diederik W J Dippel Theodora W M Raaymakers Jeannette Hofmeijer Marieke J H Wermer Henk Kerkhoff Korné Jellema Irene M Bronner Michel J M Remmers Henri Paul Bienfait Ron J G M Witjes H Rolf Jäger Jacoba P Greving Catharina J M Klijn the DIAGRAM study group F E De Leeuw H B Boogaarts E J van Dijk W J Schonewille W M J Pellikaan C Puppels-de Waard P L M de Kort J P Peluso J H van Tuijl J Hofmeijer F B M Joosten D W Dippel L Khajeh T W M Raaijmakers M J Wermer M A van Walderveen H Kerkhoff E Zock K Jellema G J Lycklama à Nijeholt I M Bronner M J M Remmers R J G M Witjes H P Bienfait K E Droogh-Greve R C J M Donders V I H Kwa T H Schreuder C L Franke J S Straver C Jansen S L M Bakker C C Pleiter M C Visser C J J van Asch B K Velthuis G J E Rinkel K M van Nieuwenhuizen C J M Klijn
      Journal of Neurology, Neurosurgery & Psychiatry 2018; 89 674-679 Published Online First: 18 Jan 2018. doi: 10.1136/jnnp-2017-317262