Neurosurgery Blog: Role of Magnetic Resonance Imaging In Non-Lobar Hypertensive Intracerebral Hemorrhage (P5.136)

Thursday, April 17, 2014

Role of Magnetic Resonance Imaging In Non-Lobar Hypertensive Intracerebral Hemorrhage (P5.136)

Neurology recent issues

OBJECTIVE:To determine the diagnostic yield of brain MRI in patients with "typical" non-lobar hypertensive ICH.To determine the impact of the MRI findings on management.Hypothesis: The diagnostic yield of brain MRI in patients with typical non-lobar hypertensive ICH is low, and does not result in significant changes in management.BACKGROUND:Despite the increased use and availability of MRI, its role in intracerebral hemorrhage remains largely uncertain, resulting in significant variation in clinical practice amongst neurologistsDESIGN/METHODS:Retrospective chart review (October '11 - March '13 admitted to OSUMC), ICD9 codes for ICH used to identify subjects.Inclusion criteria:Hematoma in a location typical for hypertensive ICH identified via initial head CT.History of HTN, OR patient presenting with sBP in excess of 180 mmHgExclusion criteria: lobar ICH, known underlying vascular or structural abnormality, hemorrhage secondary to trauma or herniation, concomitant anti-coagulation, History of underlying coagulopathy, Hemorrhagic conversion of ischemic stroke, Associated non-parenchymal hemorrhage (i.e. SAH, SDH, IVH), no baseline head CT availableRESULTS:222 patients identified using ICD9 codes, 48 patients met inclusion criteria. 24 of 48 had brain MRI done as part of initial work-up. Brain MRI obtained in 3 out of 24 patients (12.5%) with non-lobar hypertensive ICH revealed abnormality not appreciated on initial head CT. Brain MRI obtained in 1 out of 24 patients (4%) with non-lobar hypertensive ICH resulted in an evidenced-based change of management (ASA d/c'ed in patient identified to have cerebral amyloid angiopathy)Based on one-sample z test statistical analysis, the yield of MRI leading to a change in management was not statistically significant.CONCLUSIONS:The diagnostic yield of brain MRI in patients with typical non-lobar hypertensive ICH location is low, and does not appear to result in significant changes in management.MRI may be appropriate when there is high suspicion for amyloid angiopathy and the patient is on anti-platelet or anti-coagulant therapy.

Disclosure: Dr. Adeli has nothing to disclose. Dr. Behrouz has nothing to disclose.

Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/P5.136?rss=1