Clinical Scorecard: Assessment of Intracranial Hemorrhage Size and Location in Acute Stroke Cases: Its Relationship with Initial NIHSS Scores and Implications for Direct-to-Angiography Protocols

At a Glance

Key Highlights

• Intraparenchymal hemorrhage comprised 89% of cases.
• Median hemorrhage volume was 18 mL, with significant correlation to NIHSS scores.
• Lobar hemorrhages had the greatest volumes, while infratentorial hemorrhages caused severe deficits despite smaller volumes.
• Only 2.8% of patients with NIHSS ≥7 had isolated infratentorial hemorrhage.
• FDCT image quality in the posterior fossa is problematic due to beam-hardening artifacts.

Guideline-Based Recommendations

Diagnosis

• Use flat-panel detector CT (FDCT) to rule out hemorrhage before thrombectomy in suspected large vessel occlusion.

Management

• Consider direct-to-angiography (DTA) protocols to reduce treatment delays in acute stroke cases.

Monitoring & Follow-up

• Monitor NIHSS scores to assess stroke severity and potential hemorrhage impact.

Risks

• Approximately 20% of patients with NIHSS ≥7 may have hemorrhagic stroke, necessitating careful imaging assessment.

Patient & Prescribing Data

Adults with confirmed spontaneous intracranial hemorrhage.

DTA workflows may improve treatment times but require reliable hemorrhage exclusion.

Clinical Best Practices

• Ensure high-quality imaging of the posterior fossa during DTA workflows.
• Utilize semi-automated segmentation for accurate hemorrhage volume assessment.

Related Resources & Content

• Swiss Stroke Registry