Role of angiography in primary capsulo-ganglionic haemorrhage: A review

Spontaneous intracerebral haemorrhage (SICH) is the second most common cause of stroke, accounts in contrast to ischaemic stroke and carries a high risk of morbidity and mortality. SICH refers to brain haemorrhage in the absence of trauma and is often associated with hypertension. It is a conventional belief that hypertension is the aetiology in most of the haemorrhage in the basal ganglia region, and angiography is rarely performed in such patients. This protocol carries a risk of missing potentially curable underlying vascular conditions such as arteriovenous malformations and aneurysms, especially in younger patients without a history of hypertension. Performing an angiogram for all patients however is an overkill and unnecessary waste of resources. The role of cerebral angiography to distinguish a primary SICH from secondary SICH in all patients with SICH is thus controversial. Hence, it is the choice of the type of angiogram between digital subtraction angiogram Digital Subtraction Angiography (DSA) and computerised tomography angiogram Computerised Tomography Angiography (CTA). This article attempts to review the current diagnostic angioimaging guidelines for intracerebral haemorrhage with an aim to evolve a management protocol.