Diagnosis and Acute Management of Intracerebral Haemorrhage

Abstract

Intracerebral haemorrhage is a form of haemorrhagic stroke that is associated with significant morbidity and mortality. Its clinical course can be fulminant, meaning that the early diagnosis and management of this condition is particularly time critical. Early diagnosis through computed tomography (CT) imaging and implementation of interventions such as blood pressure control and reversal of coagulopathy can improve outcomes in this patient cohort. Prolonged time to hospital presentation or imaging diagnosis can delay delivery of appropriate care. Factors associated with delays to care are not currently well defined, and identification of a modifiable factor could enhance management of patients with this condition. An increase in the volume of haematoma following initial diagnosis can be associated with precipitous neurological decline, and occurs in a significant subset of patients. The presence of a spot sign on CT angiography imaging represents a site of active contrast extravasation and is associated with an increased risk of haematoma expansion. More recently, the presence of spot signs on delayed contrast imaging sequences such as post contrast CT and CT perfusion have emerged as alternate predictors of haematoma expansion, as have certain non contrast CT imaging signs. It is currently not clear which is the imaging sign with the greatest level of diagnostic accuracy in predicting haematoma expansion in patients with intracerebral haemorrhage. Aims of this thesis: To characterise through a systematic review the diagnostic accuracy of various types of delayed CT spot signs in predicting rates of haematoma expansion in patients with intracerebral haemorrhage. To characterise in patients with intracerebral haemorrhage the average time taken from ictus to hospital presentation and diagnosis, along with factors associated with delayed presentation. To directly compare the diagnostic accuracy of non contrast, first pass angiography and perfusion CT signs in predicting haematoma expansion.