"Computed tomography-negative" intracerebral hemorrhage: case report and implications for management.

BACKGROUND Noncontrast computed tomographic (CT) scanning of the brain is the main imaging modality recommended for the initial emergency evaluation of acute stroke. The main role of CT in this setting is to rule out intracerebral hemorrhage, especially in subjects who are potential candidates for thrombolytic therapy. OBJECTIVES AND RESULTS We studied a patient who had symptoms suggestive of a transient ischemic attack. Although serial CT scans showed no evidence of hemorrhage, a subacute intracerebral hemorrhage was demonstrated by magnetic resonance imaging. CONCLUSIONS This case suggests that an alternative to CT scanning should be considered in patients with acute stroke to lower the risk of an undetected intracerebral hemorrhage, especially in patients being considered for thrombolytic or anticoagulant therapy. There is evidence in the literature of other "CT-negative" cases of intracerebral hemorrhage, as well as the availability of alternative imaging techniques such as gradient echo ("susceptibility-weighted") magnetic resonance imaging sequences, which can enhance the ability of magnetic resonance imaging to detect an acute intracerebral hemorrhage.

[1]  H. Adams.  Emergent Use of Anticoagulation for Treatment of Patients With Ischemic Stroke , 2002, Stroke.

[2]  Fernando Vinuela,et al.  Magnetic Resonance Imaging Detection of Microbleeds Before Thrombolysis: An Emerging Application , 2002, Stroke.

[3]  Á. Chamorro.  Immediate anticoagulation in acute focal brain ischemia revisited: gathering the evidence. , 2001, Stroke.

[4]  H P Hartung,et al.  Frequency and Location of Microbleeds in Patients With Primary Intracerebral Hemorrhage , 2000, Stroke.

[5]  S. Greenberg,et al.  Warfarin-associated hemorrhage and cerebral amyloid angiopathy , 2000, Neurology.

[6]  J. Hatazawa,et al.  Assessment of lacunar hemorrhage associated with hypertensive stroke by echo-planar gradient-echo T2*-weighted MRI. , 2000, Stroke.

[7]  F. Fazekas,et al.  Magnetic resonance imaging of cerebral microbleeds. , 2000, Current opinion in neurology.

[8]  S. Warach,et al.  MRI features of intracerebral hemorrhage within 2 hours from symptom onset. , 1999, Stroke.

[9]  S M Davis,et al.  Identification of major ischemic change. Diffusion-weighted imaging versus computed tomography. , 1999, Stroke.

[10]  Á. Chamorro,et al.  Heparin in acute stroke with atrial fibrillation: clinical relevance of very early treatment. , 1999, Archives of neurology.

[11]  D. Tanné,et al.  Initial clinical experience with IV tissue plasminogen activator for acute ischemic stroke: A multicenter survey , 1999, Neurology.

[12]  J M Zabramski,et al.  Guidelines for the management of spontaneous intracerebral hemorrhage: A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. , 1999, Stroke.

[13]  W Hacke,et al.  A standardized MRI stroke protocol: comparison with CT in hyperacute intracerebral hemorrhage. , 1999, Stroke.

[14]  P Kapeller,et al.  Histopathologic analysis of foci of signal loss on gradient-echo T2*-weighted MR images in patients with spontaneous intracerebral hemorrhage: evidence of microangiopathy-related microbleeds. , 1999, AJNR. American journal of neuroradiology.

[15]  P Kapeller,et al.  MRI evidence of past cerebral microbleeds in a healthy elderly population , 1999, Neurology.

[16]  C. Benesch,et al.  Small chronic hemorrhages and ischemic lesions in association with spontaneous intracerebral hematomas. , 1999, Stroke.

[17]  P. Sandercock,et al.  Is there still a role for intravenous heparin in acute stroke? No. , 1999, Archives of neurology.

[18]  G. Albers,et al.  A standardized MRI stroke protocol: comparison with CT in hyperacute intracerebral hemorrhage. , 1999, Stroke.

[19]  S W Atlas,et al.  MR detection of hyperacute parenchymal hemorrhage of the brain. , 1998, AJNR. American journal of neuroradiology.

[20]  X. Bosch,et al.  Imaging the brain. , 1998, The New England journal of medicine.

[21]  Zheng-Ming Chen,et al.  CAST: randomised placebo-controlled trial of early aspirin use in 20 000 patients with acute ischaemic stroke , 1997, The Lancet.

[22]  Peter Sandercock,et al.  The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19 435 patients with acute ischaemic stroke , 1997, The Lancet.

[23]  R. Edelman,et al.  Detection of hyperacute primary intraparenchymal hemorrhage by magnetic resonance imaging. , 1996, Stroke.

[24]  T. Nakada,et al.  Computed TomographyNegative Acute Thalamic Hematoma , 1996, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[25]  Koroshetz Wj,et al.  Tissue plasminogen activator for acute ischemic stroke. , 1996, The New England journal of medicine.

[26]  Joseph P. Broderick,et al.  Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. , 1995 .

[27]  R. Hart,et al.  Oral anticoagulants and intracranial hemorrhage. Facts and hypotheses. , 1995, Stroke.

[28]  E. Wijdicks,et al.  Intracerebral Hemorrhage After Fibrinolytic Therapy for Acute Myocardial Infarction , 1993, Stroke.

[29]  J. Bogousslavsky,et al.  Fatal hemorrhage during anticoagulation of cardioembolic infarction: role of cerebral amyloid angiopathy. , 1993, European neurology.

[30]  H. Adams,et al.  Use of antithrombotic drugs in the treatment of acute ischemic stroke , 1989, Neurology.

[31]  P. Sandercock,et al.  NEGATIVE COMPUTERISED TOMOGRAPHIC SCAN IN PATIENT WITH INTRACEREBRAL HAEMATOMA , 1986, The Lancet.

[32]  D. Kuhl,et al.  Computed tomography of intracerebral hematomas. I. Transmission CT observations on hematoma resolution. , 1977, AJR. American journal of roentgenology.

[33]  M. Bergström,et al.  Variation with Time of the Attenuation Values of Intracranial Hematomas , 1977, Journal of computer assisted tomography.

[34]  M. Fine,et al.  Evaluation of intracerebral hematoma by computed tomography. , 1977, Computerized tomography.

[35]  Council , 1954, The Aeronautical Journal (1968).