Transcranial Sonography to Differentiate Primary Intracerebral Hemorrhage from Cerebral Infarction with Hemorrhagic Transformation

Background and purpose: The differentiation of primary intracerebral hemorrhage (ICH) from parenchymal hemorrhagic transformation within an ischemic infarction (PHI) is crucial in order to adapt therapeutic measures. We hypothesized that a distinction of ICH and PHI can be made at bedside via transcranial gray-scale and perfusion sonography.

Methods: We prospectively included 14 patients with intracranial hemorrhage on admission imaging in this pilot study. Differentiation between ICH and PHI was made either by cerebral magnetic resonance imaging or follow-up computed tomography scan. All patients were examined via gray-scale and perfusion sonography.

Results: Eight patients were diagnosed with ICH, and 6 patients with PHI. Volumes of ICH did not differ between the two groups. However, PHI patients showed a significantly larger perfusion deficit compared to ICH patients (P < .01). At a cutoff value of 1.41 of the mismatch index of perfusion deficit and hyperechogenic lesion, the PHI diagnosis can be made with a 100%-sensitivity and 100%-specificity.

Conclusion: Differentiation of ICH and PHI via multimodal transcranial sonography with mismatch imaging is possible. Since sonographic imaging as a bedside-method is cost- as well as time-efficient, it may be a helpful tool for differentiation between these two entities particularly in critically ill patients with unclear ICH.