ANGIOGRAPHY IN NONTRAUMATIC BRAIN HEMATOMA - AN ANALYSIS OF 100 CASES

Purpose: The primary purpose of this project was to study the anatomic al characteristics of intracerebral haematoma (ICH) in order to determ ine features that may negate the need for angiography in some patients . Material and Methods: The study was prospective and designed to inve stigate the underlying cause of non-traumatic ICH in 100 cases assesse d by conventional angiography. Patients were excluded if there was a h istory of trauma or known pre-existing brain abnormality. All patients were examined with CT and angiography within 4 days of the ictus. Res ults: Ruptured aneurysms or arteriovenous malformations (AVMs) were di agnosed on the initial angiogram in 49% of cases: 27 AVMs and 22 aneur ysms. One case of superior sagittal sinus thrombosis was also detected . Vascular abnormalities were found most frequently in the under-40 ag e group and in cases in which subarachnoid haemorrhage, intraventricul ar haemorrhage or extracerebral haematoma accompanied the ICH. The tem poral lobe was the most frequent anatomical location (37%). When a tem poral lobe haematoma extended into the Sylvian fissure from the inferi or pole of the temporal lobe or when it was associated with subarachno id haemorrhage, structural abnormalities were found in over 90% of cas es Conclusions: There are groups of patients with ICH in whom the CT f eatures are highly suggestive of AVM or aneurysm rupture. If the initi al angiography is negative in these cases, careful follow up by repeat angiography and/or MR imaging is essential. However, potentially trea table abnormalities cannot be excluded with certainty by the distribut ion of the haematoma on CT alone, even if there is a history of pre-ex isting hypertension.