Secondary Intracerebral Hemorrhage (sICH) Score
Quantifies likelihood of underlying vascular etiology in patients with ICH.
When to Use
Patients with ICH who have had non-contrast CT (NCCT).
- The Secondary ICH (sICH) Score predicts likelihood that a given ICH is secondary to an underlying vascular abnormality, based on clinical and radiographic characteristics.
- Should not be used for patients with any of the following:
- Subarachnoid hemorrhage in the basal cisterns.
- Clear-cut, pre-established acute ischemic infarct with secondary hemorrhage within the area of infarct.
- Known intracranial vascular abnormality or mass lesion.
- Known probable cerebral amyloid angiopathy per Boston criteria.
- Does not predict morbidity or mortality in ICH.
- Difference in discriminatory according to imaging interpretations by neurologists vs. radiologists has not been determined.
- Can help stratify which patients with ICH should undergo CT angiography (CTA) if CTA is not routinely performed for workup of ICH at specific institutions.
- In select cases, can help determine which patients with ICH should undergo catheter angiogram (the risks of which include, but are not limited to, renal injury, pseudoaneurysm, and arterial dissection) for definitive evaluation for an underlying vascular abnormality.
- May help with operative planning when emergent neurosurgery for ICH is indicated and either CTA or catheter angiogram cannot be done safely.
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- Bear in mind that the sICH Score is an adjunct to, and not a substitute for, clinical judgment.
- In a patient with sICH Score <2 and CTA negative for vascular abnormality, catheter angiogram may present greater procedural risks than benefits from identifying an underlying vascular etiology.
- In selected patients with sICH Score >2 and CTA negative for vascular abnormality, catheter angiogram may be considered after careful weighing of procedural risks and benefits. Note that CTA is not the gold standard but remains a highly sensitive and specific imaging technique for detecting vascular abnormalities.
- ICH is a neurological emergency. Immediate neurological and neurosurgical consultation should be obtained on patients with evidence of any ICH on imaging.
- Hypertensive patients with acute ICH should undergo blood pressure reduction with intravenous agents. The target blood pressure should be discussed with the neurological or neurosurgical consultant.
- The decision to administer reversal agents (e.g. desmopressin) blood products (e.g. prothrombin factor concentrate, fresh frozen plasma), or anti-epileptic medications should not be made without discussing with the neurological or neurosurgical consultant.
- Platelet administration is NOT recommended in the setting of antiplatelet-related ICH.
It is crucial to identify and reverse anticoagulant-associated ICH (using agents tailored to the underlying anticoagulant).
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