Practical Scoring System for the Identification of Patients with Intracerebral Hemorrhage at Highest Risk of Harboring an Underlying Vascular Etiology: The Secondary Intracerebral Hemorrhage Score

A 50-year-old woman with a history of hypertension and intact coagulation presented with acute onset of left-sided weakness. A, Indeterminate NCCT scan demonstrates an acute right temporal ICH without associated IVH or SAH (SICH score, 3). B, CTA source image demonstrates an 11-mm outpouching arising from the right MCA bifurcation (arrowhead), consistent with an aneurysm. C, CTA MIP image in the axial plane redemonstrates the right MCA bifurcation aneurysm (arrowhead).

A 60-year-old woman without a history of hypertension and with intact coagulation presented with increasing headache during the past several days. A and B, High-probability NCCT scan demonstrates an acute right mesiotemporal ICH with subtle associated hyperattenuation within the distal right vein of Labbe (arrow, B) and right transverse sinus (arrowhead, B; SICH score,5). C, Coronal NCCT scan reformation improves depiction of the hyperattenuation within the distal right vein of Labbe (arrow) and right transverse sinus (arrowhead). D, CT venogram source image obtained immediately after the CTA demonstrates nonopacification of the right transverse and sigmoid sinuses (arrowheads), consistent with DVST. E, CT venogram MIP image after calvarial segmentation redemonstrates the right transverse and sigmoid sinus thrombosis (arrowheads).

A 44-year-old woman without history of hypertension and with intact coagulation presented with headache. A, Indeterminate NCCT scan demonstrates a left parietal ICH (SICH score, 5). There was associated subdural hemorrhage overlying the left frontal lobe but no associated IVH or SAH. B, CTA source image demonstrates an abnormal vessel along the inferior aspect of the ICH in the left parietal lobe, consistent with an AVF (arrowhead). C, Frontal left internal carotid artery catheter angiogram confirms the presence of a left parietal AVF with deep venous drainage into the left internal cerebral vein.

A 50-year-old woman without a history of hypertension and with intact coagulation presented with acute onset of unresponsiveness. A, Low-probability NCCT scan demonstrates an acute right basal ganglia ICH with associated IVH (SICH score, 3). B, CTA source image demonstrates a 3-mm outpouching arising from a lenticulostriate branch of the right middle cerebral artery (arrowhead), consistent with an aneurysm. C, CTA MIP image in the sagittal plane redemonstrates the right lenticulostriate aneurysm (arrowheads) as well as a diffuse luminal irregularity in the visualized anterior cerebral artery branches (arrows). D, CTA MIP image in the axial plane demonstrates diffuse luminal irregularity in the right middle cerebral artery branches (arrowheads). These findings are consistent with vasculitis with secondary pseudoaneurysm formation and rupture. The patient was ultimately found to have Lyme disease affecting the central nervous system.