Early Inpatient Workup for Intracerebral Hemorrhage

Spontaneous non-traumatic intracerebral hemorrhage (ICH) is a leading cause of morbidity and mortality around the world. The initial evaluation is focused in the emergency department. A complete history is imperative in determining the need for further evaluation. Computed tomography (CT) is a sensitive and effective modality for identifying acute hemorrhage. Recent technological advancement in magnetic resonance imaging makes it a promising modality for detecting hyperacute ICH. It can also elude toward cerebral microbleeds (CMB), mass lesions, and cerebral venous sinus thrombosis. Vascular lesions responsible for ICH can be evaluated by computed tomography angiography (CTA), magnetic resonance angiography (MRA), and digital subtraction angiography (DSA). A select number of patients need to be evaluated with follow-up imaging. Laboratory tests focused on evaluating for coagulopathy and toxins is integral to initial evaluation. An etiological approach to diagnostic evaluation is helpful during the initial days of ICH. Proper diagnostic workup is essential to effective management and should be guided by demographics, history, clinical features, imaging, and laboratory findings.