Table 2.
Red flags for secondary ICH.
| Possible Causes of Secondary ICH | Red Flags | Suggested Investigations |
|---|---|---|
| Arteriovenous malformation | young age; Lobar ICH; |
MRI; CTA/MRA/DSA |
| Coagulopathy | History of anticoagulant use; Large and irregularly shaped hematoma |
NCCT/CTA |
| Cavernous angioma | Recurrent ICH in the same location; Lobar or brainstem ICH |
Hemorrhage surrounded by hypointense halo or rim on T2-weighted imaging; Punctuate hypointense foci on T2*GRE/SWI |
| Moyamoya disease | Onset of ICH at young age; Ischemic symptoms; Migraine-like headache; |
MRI showing “ivy sign”-linear high signals; DSA showing typical “puff-of-smoke” appearance |
| Intracranial aneurysm | Associated Subarachnoid hemorrhage | CTA/MRA/DSA showing intracranial aneurysm |
| Venous sinus thrombosis | Young and middle-aged patients; Moderate to severe headache; Lobar ICH |
MRI showing infarcts not restricted to typical arterial territories; CTV/DSA |
| Tumor | Lobar ICH; disproportionate edema; Mass effect |
MRI showing mass lesion |
| Posterior reversible encephalopathy syndrome | Headache; Encephalopathy; Seizures; Visual disturbance; Lobar ICH |
MRI abnormalities in posterior or watershed region |
| Infective endocarditis | Fever; Valvular regurgitation |
MRI showing associated infarcts; Echocardiogram showing valvular vegetation |
Abbreviation: MRI = magnetic resonance imaging, CTA = computed tomographic angiography, MRA = magnetic resonance angiography, DSA = digital subtraction angiography, GRE = gradient echo, SWI = susceptibility-weighted imaging, CTV = computed tomographic venography, EEG = electroencephalogram.