Expanding diagnostic workup for hypertensive intracerebral hemorrhage: a retrospective LATAM cerebrovascular registry comparison

Amado Jiménez-Ruiz, Stroke and Cerebrovascular Diseases Clinic, and Neurology Department, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, Jal., Mexico
Naomi N. Becerra-Aguiar, Faculty of Medicine, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jal., Mexico
Victor Aguilar-Fuentes, Faculty of Medicine, Benemérita Universidad Autónoma de Puebla, Pue., Mexico
Juan C. Ayala-Alvarez, Neurology Department, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, Jal., Mexico
Enrique Gómez-Figueroa, Neurology Department, Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, Jal., Mexico
Carlos Cantú, Neurology and Psychiatry Department, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”, Mexico City, Mexico
Antonio Arauz, Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía “Manuel Valasco Suárez”, Mexico City, Mexico
Fabiola Serrano-Arias, Stroke Clinic, Instituto Nacional de Neurología y Neurocirugía “Manuel Valasco Suárez”, Mexico City, Mexico
José L. Ruiz-Sandoval, Stroke and Cerebrovascular Diseases Clinic Hospital Civil de Guadalajara “Fray Antonio Alcalde”, Guadalajara, Jal.,; Faculty of Medicine, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jal.; Department of Neurosciences, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Jal.. Mexico

Background: The leading cause of spontaneous intracerebral hemorrhage (ICH) is hypertensive arteriolopathy. In addition to age and hypertension history, patients usually present other comorbidities that potentially increase morbimortality. Ancillary studies other than non-contrast computerized tomography (NCCT) may help clarify the diagnosis and increase the detection of potentially modifiable vascular risk factors. Unfortunately, their use is not routinely performed. Objective: The study aimed to determine the frequency of ancillary studies performed in patients with hypertensive ICH. Methods: We performed a retrospective analysis of three Latin American cerebrovascular registries from academic medical centers, analyzing the results with descriptive statistics focusing on diagnosis and short-term outcomes. Results: We analyzed a total of 1,324 patients (mean age 64 years). Hypertension and obesity were the most prevalent risk factors. Only 14% underwent MRI, 10.3% extracranial ultrasonography, and 6.7% echocardiography. Among the three registries, the Latin America Stroke Registry performed more ancillary studies. Most of the patients presented a poor clinical outcome and in-hospital death. Conclusions: The use of ancillary studies in the diagnostic workup of ICH was poor in the three registries, and mortality was high. The lack of ancillary studies performed may negatively impact outcomes.

Keywords: Intracerebral hemorrhage. Hypertension. Neuroimaging.