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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 14  |  Issue : 3  |  Page : 179-182

Computed tomographic evaluation of intracerebral hemorrhage


1 Department of RadioDiagnosis, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
2 Department of Medicine, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India

Date of Submission18-Apr-2019
Date of Decision30-May-2019
Date of Acceptance20-Jul-2019
Date of Web Publication2-May-2020

Correspondence Address:
Dr. Monika Pote
Department of Radio Diagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_75_19

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  Abstract 


Context: Computed tomography (CT) has been the standard imaging modality for the initial evaluation of patients presenting with acute stroke symptoms. The primary diagnostic advantage of CT in the hyperacute phase is its ability to rule out the presence of hemorrhage. The accurate early detection of blood is crucial since a history of intracerebral hemorrhage is a contraindication to the use of thrombolytic agents. Aims: The aim of this study is to study the role of CT in the evaluation of intracerebral hemorrhage. Settings and Design: Prospesctive cross sectional observational study. Subjects and Methods: This was a prospective study of 110 patients irrespective of age group with a clinical suspicion of intracerebral hemorrhage done in the Department of Radiodiagnosis, AVBRH, DMIMS (DU), Sawangi (Meghe), Wardha, Maharashtra, India. Results: Out of 110 patients diagnosed with intracerebral hemorrhage, 67 (61%) patients were male and 43 (39%) were female. The main clinical presentation was abrupt onset severe headache, vomiting, difficulty in speech, seizures, weakness in limbs, altered mental sensorium, and sudden loss of consciousness. Among risk factors, the most common was hypertension present in 70 (63.6%) patients followed by diabetes in 62 (56.3%) patients. The putamen is the most common site of intracerebral hemorrhage involved in 47 (42.7%) patients followed by the thalamus in 24 (21.8%) patients. Conclusions: In the present day, CT is the initial modality of choice and is found to be very helpful in diagnosing intracerebral hemorrhage; it plays a crucial role in patient care by determining which course of treatment is called for.

Keywords: Computed tomography scan, intracerebral hemorrhage, subarachnoid hemorrhage


How to cite this article:
Pote M, Phatak S, Thakare P. Computed tomographic evaluation of intracerebral hemorrhage. J Datta Meghe Inst Med Sci Univ 2019;14:179-82

How to cite this URL:
Pote M, Phatak S, Thakare P. Computed tomographic evaluation of intracerebral hemorrhage. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 Sep 25];14:179-82. Available from: http://www.journaldmims.com/text.asp?2019/14/3/179/283598




  Introduction Top


Cerebrovascular accident (CVA) is defined by the abrupt onset of a neurological deficit that is attributable to a focal vascular cause.[1] Intracerebral hemorrhage accounts for 10%–20% of CVA worldwide.[2]

Most cases (77%–88%) of spontaneous (nontraumatic) intracerebral hemorrhage are termed primary intracerebral hemorrhage, with a presumption that they are caused by small vessel diseases of the brain, mainly hypertensive arteriopathy and cerebral amyloid angiopathy. The causes of secondary intracerebral hemorrhage include intracranial vascular malformations such as arteriovenous malformations, dural arteriovenous fistulae, saccular aneurysms, cavernomas, tumor-related bleeding, and hemorrhagic venous sinus thrombosis.[3]

The main clinical presentation was abrupt onset severe headache, vomiting, difficulty in speech, seizures, weakness in limbs, altered mental sensorium, and sudden loss of consciousness.

The incident rate and death rate from intracerebral hemorrhage increase with age. About 16%–80% of patients die with each episode of intracerebral hemorrhage. Those who survive are usually left with permanent disability. Thus, it becomes a great medical and social problem. The accurate and early diagnosis may improve morbidity and mortality rates.[4],[5]

Computed tomography (CT) is the only imaging test performed in the setting of acute stroke at other institutions. The reasons for this appear to be the speed; the high sensitivity of CT for detecting and differentiating hemorrhagic and ischemic stroke and its greater availability at many institutions.[6] CT helps to compare the patterns of abnormalities which are diagnosed by clinical profiles and pathologic findings.[7] CT scanning is pivotal in determining which course of treatment is called for.


  Subjects and Methods Top


A prospective, cross-sectional, observational study of 110 patients irrespective of age group was conducted in the Department of Radiodiagnosis, AVBRH, DMIMS (DU) Sawangi (Meghe), Wardha. All the patients with a clinical suspicion of intracerebral hemorrhage referred to our department were included in the study. The exclusion criteria were uncooperative patients in whom CT cannot be performed. Consent was taken from the patients before the procedure.

Equipment

CT Philips Brilliance 16 slice. The patient was placed on gantry table in the supine position; scans were taken parallel to the floor of the anterior fossa, the lowest section through the external auditory meatus continuing to the top of the head (orbito meatal line to high parietal region), with caudal angulation of gantry. Slice thickness of 5 mm is used for scanning with the further reconstruction of 3 mm.

Ethical approval

Ethical approval was obtained from the Ethical Committee, DMIMS before commencing the study.


  Results Top


Most of the patients were in the age group of 60–79 years, accounting for 40 (36.3%), followed by 80–99 years of age 33 (30%) patients. Least patients were in the age group of 20–39 years, accounting for 6 (5.4%) patients [Table 1].
Table 1: Age-wise distribution of patients in intracerebral hemorrhage

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In our study, there was male preponderance. Of 110 patients, 67 (61%) were male and 43 (39%) were female, with a male-to-female ratio is 67:43, i.e., 1.5:1 [Figure 1].
Figure 1: Gender-wise distribution of patients in intracerebral hemorrhage

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In our study, out of 110 patients, maximum patients had a history of hypertension, accounting for 70 (63.6%), followed by a history of diabetes in 62 (56.3%) patients [Table 2].
Table 2: Risk factors in intracerebral hemorrhage

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In our study, intracerebral hemorrhage was observed in 110 patients with the involvement of different areas of the brain. The putamen was the most commonly affected area in 47 (42.7%) patients. The thalamus was involved in 24 (21.8%) patients. The cerebellum was involved in 13 (11.8%), the pons was involved in 6 (5.4%), and 20 (18.1%) patients had miscellaneous involvement.


  Discussion Top


Our study was directed to evaluate the role of CT scan in patients presenting with intracerebral hemorrhage and differentiating between hemorrhage, infarct, and other causes of CVAs and to determine the location and reasonably assessing the territory of blood vessels involved and to correlate the various risk factors. CT scan is the gold standard for detecting acute intracerebral hemorrhage with high sensitivity.[8]

Our study comprised patients belonging to the age groups of between 20 and 99 years. Maximum patients (n = 40; 36.3%) belonged to the age group of between 60 and 79 years, followed by 80–99 years (n = 33; 30%), which is similar to a study done by Lokesh Kumar et al. In their study, maximum patients were in the age group of 60–69 years followed by 70–79 years.[6] Another study done by Suman et al. also showed that the most frequently affected age group was 60–69 (30%) years.[7]

In our study, there is a male preponderance over female in the incidence of intracerebral hemorrhage, with a male: female ratio of 1.5:1.0, which is in accordance with the study done by Ike. In their study, patients with stroke reported a male gender preponderance.[9] Another study done by Suman et al.[7] and Sinha and Karim[10] also show male preponderance over female in the incidence of hemorrhage.

Among the risk factors, hypertension and diabetes are closely associated with intracerebral hemorrhage. In our study, 70 (63.6%) patients had a history of hypertension followed by diabetes 62 (56.3%) patients. Fifty-three (48.1%) patients had a history of dyslipidemia. Smoking and alcohol consumption was present in 30 (27.2%) and 43 (39%) patients, respectively, which is in accordance with the study done by Razzaq et al.[11] In Razzaq et al.'s study, 50% of patients had a history of hypertension and 45% patients had a history of diabetes. Desalu et al.[12] concluded in their study that hypertension, diabetes mellitus, and tobacco were the most common identifiable risk factors for intracerebral hemorrhage.

In our study, the putamen is the most commonly affected area in almost 47 (42.7%) patients followed by the thalamus [Figure 3] (24; 21.8%) patients. Cerebellum and pons affected in 13 (11.8%) and 6 (5.4%) patients, respectively [Figure 4]. These findings of the study were almost similar to the studies reported by Thacker et al.[13] In their study, they reported the involvement of putamen in 48% patients, thalamus in 16% patients, and cerebellum in 12% patients [Figure 2]. In few cases, subarachnoid hemorrhage was also noted [Figure 5].
Figure 3: Axial noncontrast computed tomography scan showing intracerebral hemorrhage: Ill-defined hyperdense collection with perilesional edema in the left gangliocapsular region causing effacement of adjacent sulcogyral spaces and ipsilateral lateral ventricle

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Figure 4: Axial noncontrast computed tomography scan showing pontine hemorrhage: Hyperdense collection in the pons with perilesional edema and effacing the left pontine cistern

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Figure 2: Distribution of intracerebral hemorrhage

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Figure 5: (a and b) Axial noncontrast computed tomography scan showing SAH: Hyperdensity in the bilateral Sylvain fissures (a) and supra and infratentorial cisternal (b) and sulcul spaces

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  Conclusion Top


CT is the initial modality of choice; it is found to be very helpful in diagnosing intracerebral hemorrhage; and it plays a crucial role in the patient care due to its widespread availability, rapid image acquisition, no contraindication to pacemaker and ferromagnetic devices, increased imaging resolution, and fewer equivocal imaging findings. No flow-related artifacts have been reported with the use of a contrast material bolus and acquisition in the venous phase and are cost-effective. It should be done in all cases of intracerebral hemorrhage.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gaskill-Shipley MF. Routine CT evaluation of acute stroke. Neuroimaging Clin N Am 1999;9:411-22.  Back to cited text no. 1
    
2.
Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: A systematic review. Lancet Neurol 2009;8:355-69.  Back to cited text no. 2
    
3.
Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. N Engl J Med 2001;344:1450-60.  Back to cited text no. 3
    
4.
Sajjadi M, Karami M, Amirfattahi R, Bateni V, Ahamadzadeh MR, Ebrahimi B. A promising method of enhancement for early detection of ischemic stroke. J Res Med Sci 2012;17:843-9.  Back to cited text no. 4
    
5.
Hatano S. Experience from a multicentre register. Bull World Health Organ 1976;54:541-53.  Back to cited text no. 5
    
6.
Lokesh Kumar T, Gore VN, Patil GC. The role of computed tomography in the evaluation of cerebrovascular accidents. Int J Res Med Sci 2016;4:4305-9.  Back to cited text no. 6
    
7.
Suman S, Kumari B, Singh GN. Study on role of CT in cerebrovascular accidents in a tertiary care hospital. IJCMR 2015;4:2454-7379.  Back to cited text no. 7
    
8.
Morgenstern LB, Hemphill JC 3rd, Anderson C, Becker K, Broderick JP, Connolly ES Jr., et al. Guidelines for the management of spontaneous intracerebral hemorrhage: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2010;41:2108-29.  Back to cited text no. 8
    
9.
Ike SO. The pattern of admissions into the medical wards of the University of Nigeria Teaching Hospital, Enugu (2). Niger J Clin Pract 2008;11:185-92.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Sinha R, Karim AR. Role of computed tomography in evaluation of cerebrovascular accidents. Ann Int Med Dent Res. DOI: 10.21276/aimdr.2017,3.2.RD10  Back to cited text no. 10
    
11.
Razzaq AA, Khan BA, Baig SM. Ischemic stroke in young adults of South Asia. J Pak Med Assoc 2002;52:417-22.  Back to cited text no. 11
    
12.
Desalu OO, Wahab KW, Fawale B, Olarenwaju TO, Busari OA, Adekoya AO, et al. A review of stroke admissions at a tertiary hospital in rural Southwestern Nigeria. Ann Afr Med 2011;10:80-5.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Thacker AK, Radhakrishnan K, Maloo JC, el-Magbri AA, Mousa ME. Clinical and computed tomography analysis of intracerebral haemorrhage. J Assoc Physicians India 1991;39:317-9.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2]



 

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Abstract
Introduction
Subjects and Methods
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