ESOC 2018: Intracerebral Haemorrhage (II) Joint ESO – SSA Session
Rustam Al-Shahi Salman, professor of neurology at the University of Edinburgh gave a talk on the uses of brain CT in identifying underlying causes of intracerebral haemorrhage. He recommended the CT-based DIAGRAM prediction score (http://jnnp.bmj.com/content/early/2018/01/17/jnnp-2017-317262) for rational use of further imaging, and proposed the CT/APOE-based Edinburgh CAA criteria (https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(18)30006-1/fulltext) as an example of how underlying cerebral small vessel diseases can be identified with simple tests. He encouraged researchers to investigate these criteria for their association with outcome in cohort studies and modification of treatment effect in randomised controlled trials.
Carlos Molina, neurologist at the University Hospital of Vall d´Hebron, Barcelona gave a talk on the spot sign of contrast extravasation in CT angiography. CTA spot sign is a strong and validated predictor of early ICH growth However, sensitivity to predict ICH growth is low, CTA is not widely available 24/7 and it may potentially delay decision making. Multiphase CTA may improve sensitivity and discriminates between arterial from venous spot signs. Other non-contrast CT markers are potentially useful, but still require further validation and standardization
Jonathan Rosand, Professor of Neurology at Harvard Medical School and Massachusetts General Hospital, discussed current and future opportunities for the application of genetic testing to improve the care of patients with intracerebral hemorrhage. He noted that while physicians traditionally consider genetic testing in young patients, or those with a strong family history, there are likely to be many opportunities where genetic testing will inform management decisions for ICH survivors in the future, such as selection of long-term blood pressure targets.
Nicolas Raposo, MD from the department of Neurology at Toulouse hospital, France gave a talk on amyloid PET in diagnosing cerebral amyloid Angiopathy (CAA), as the underlying cause of intracerebral hemorrhage (ICH). He summarized the studies investigating amyloid PET tracers in CAA patients. He discussed the diagnostic accuracy, the advantages and limitations of PET amyloid imaging in CAA patients. His take home message is that amyloid PET is a promising imaging that may help in diagnosing CAA in patients with ICH, but larger studies with standardized criteria for PET positivity and pathologically proven CAA cases are needed to assess its diagnostic value.
Candice Delcourt, Neurologist and senior research fellow at the George Institute in Sydney spoke on long-term outcome after intracerebral haemorrhage. She summarised the meta-analyses and cohort studies looking at outcome data on death, disability and quality of life. Her take-home messages were that: death rate after ICH remains high at up to 50%, recurrence of ICH and ischaemic stroke is at least 2% per year. Patients are at risk of late seizures, depression and dementia. The main predictors of bad outcome are age, ICH volume and clinical severity. Treatment of blood pressure is beneficial.
