PROSPECTIVE EVALUATION OF CEREBRAL-ANGIOGRAPHY AND COMPUTED-TOMOGRAPHY IN CEREBRAL HEMATOMA

One hundred and two consecutive patients with cerebral haematoma were prospectively allocated to one of two groups according to their CT on admission. Group 1 patients were thought to have a high probability of an underlying structural lesion and underwent cerebral angiography ac utely. If normal, this was repeated at three months. Group 2 patients were thought not to have such a lesion and underwent angiography at th ree months. Patients older than the mean age of the study population, and hypertensive patients were much less likely to harbour an aneurysm or arteriovenous malformation than younger or normotensive patients ( p < 0.01; sensitivity 87.9%, specificity 88.6%). An aneurysm or arteri ovenous malformation was the cause of haemorrhage in 12.8% of hyperten sive patients, in 30.9% of patients with haematoma involving the basal ganglia, and 18.2% of those with posterior fossa haemorrhage. Feature s of CT in isolation give a sensitivity of 77.2% and a specificity of 84.2%. Follow up angiography in group 1 showed an arteriovenous malfor mation in one of seven patients in whom the original study was normal. These results contrast sharply with data from previous retrospective studies. The decision to investigate a patient with cerebral haematoma should be primarily based on the patient's clinical condition, rather than on the site of haemorrhage.