Cerebral Hemorrhage: Diagnostic Tests

Only imaging can distinguish between intracerebral hemorrhage (hemorrhagic apoplexy) and ischemic apoplexy (stroke due to vascular occlusion)! As soon as the patient arrives at the hospital, the medical device diagnostic examination must be performed in order to treat the patient adequately.

Obligatory medical device diagnostics.

  • Computed tomography of the skull (cranial CT, cranial CT or cCT) – to differentiate between intracerebral hemorrhage and ischemic apoplexy; furthermore, to detect:
    • Type, size, localization of cerebral hemorrhage.
    • Acute hemorrhage?
    • Subacute bleeding (after one week)?
    • Chronic bleeding (after six weeks)?
  • Magnetic resonance imaging of the skull (cranial MRI, cranial MRI or cMRI) – more effective than cCT for microbleeds (< 10 mm) and chronic bleeding.

Optional medical device diagnostics – depending on the results of the history, physical examination and obligatory laboratory parameters – for differential diagnostic clarification.

  • Angiography (imaging of blood vessels by contrast medium in an X-ray examination) – for atypically localized bleeding and to detect vascular anomalies such as angiomas (blood sponges), arteriovenous malformation (AVM/congenital malformation of blood vessels), Durafistula (pathological/diseased short circuit connection between arteries and veins at the level of the meninges), cerebral aneurysm, cerebral cavernous malformation (anlage disorder of the vascular system).
  • Encephalogram (EEG; recording of the electrical activity of the brain) – after a cerebral hemorrhage, the risk of epileptic seizures (fighting seizures) is increased

Note

  • After the initial imaging diagnosis (performed at baseline), a CT should be performed again if the patient’s level of consciousness worsens or if the neurological deficits progress (progress) or at the latest after 6 hours. This is the only way to respond appropriately to an increase in blood volume or postoperative hemorrhage.
  • In the case of bleeding with penetration into the ventricular system (cavity system in the brain) (intraventricular hemorrhage (IVB)) and in the case of a possible obstruction of the outflow of cerebrospinal fluid (cerebrospinal fluid (CSF), colloquially “nerve water“), a further control by CT is recommended after one to three days.