Delgado Almandoz reported a secondary intracerebral hemorrhage (SICH) score to identify a patient with intracerebral hemorrhage who may have an underlying vascular etiology. This can help guide vascular imaging studies. The authors are from Massachusetts General Hospital and Washington University in St. Louis.
Vascular lesions may include: arteriovenous malformations, aneurysm, dural venous sinus thrombosis
Patient selection: intracerebral hemorrhage and age >= 18 years
Parameters:
(1) category of non-contrast CT (NCCT)
(2) age in years
(3) sex
(4) hypertension or impaired coagulation (coagulopathy)
High probability of underlying vascular abnormality - one or both of the following:
(1) enlarged vessels or calcifications along the margin of the intracerebral hemorrhage
(2) hyperattenuation within a dural venous sinus or cortical vein along the presumed venous drainage path of the intracerebral hemorrhage
Low probability of underlying vascular abnormality:
(1) site of hemorrhage in basal ganglia, thalamus or brain stem
Intermediate probability of underlying vascular abnormality:
(1) site of hemorrhage other than sites mentioned for low probability
|
Parameter
|
Finding
|
Points
|
|
category of non-contrast CT
|
high probability
|
2
|
|
|
intermediate probability
|
1
|
|
|
low probability
|
0
|
|
age
|
18 to 45 years
|
2
|
|
|
46 to 70 years
|
1
|
|
|
>= 71 years
|
0
|
|
sex
|
female
|
1
|
|
|
male
|
0
|
|
hypertension or coagulopathy
|
either or both
|
0
|
|
|
neither
|
1
|
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 6
• A score >= 3 is considered high.
Conventional catheter angiography is performed if
(1) the initial CT angiogram is positive or equivocal.
(2) the initial CT angiogram is negative AND the SICH score is >= 3.
