Original ArticleDiagnostic Accuracy of a Simple Clinical Score to Screen for Vascular Abnormalities in Patients with Intracerebral Hemorrhage
Section snippets
Derivation Cohort
We retrospectively obtained data from an imaging database of patients with nontraumatic ICH examined at the Instituto de Neurocirugía Asenjo, a tertiary care public hospital in Santiago, Chile, who underwent diagnostic cerebral angiography between August 2003 and December 2005. The initial database included a total of 1840 patients. We included only those patients with an acute ICH (less than 72 hours), diagnosed by CT scan, older than 15 years, and who had no contraindication for DSA. Patients
Derivation Cohort
The sample consisted of 160 cases of spontaneous ICH, mean age 41.4 (standard deviation 14.8), 85 women (53.1%). Eighty-two patients (51.3%) had positive angiographic findings. Demographic and clinical characteristics of patients with or without angiographic findings in the derivation cohort are shown in Table 1. Most cases of positive angiograms were AVMs as shown in Table 2.
Logistic regression analysis showed that younger age (≤50 years) and no history of hypertension were independent factors
Discussion
Our results demonstrate that this simple scoring scale can be used at the bedside of patients with ICH diagnosed using NCCT to decide if they should undergo further vascular imaging. The probability of an underlying vascular malformation is very high if the score is over 8. Increasing scores over 5 will have increasing LRs of changing the pretest probabilities to detect a vascular malformation as the underlying cause if CTA, MRA, or DSA is performed. These LRs range from small to high shifts in
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Hypertension is a Leading Cause of Nontraumatic Intracerebral Hemorrhage in Young Adults
2020, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :Considering the high incidence of vascular malformations as a cause of nontraumatic ICH and possibilities of poor outcomes in event of failure to diagnose these vascular malformations, vessel imaging should be part of all nontraumatic ICH in young adults. Diagnostic yield of vessel imaging is higher among patients younger than 50 years with lobar hemorrhage, and without history of hypertension or coagulopathy.17,18 Comprehensive workup is essential to prevent future risk of recurrent ICH.
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