| Resumen: |
BACKGROUND AND PURPOSE: There are no generally accepted criteria for the etiologic classification of intracerebral hemorrhage (ICH). For this reason, we have developed a set of etiologic criteria and have applied them to a large number of patients to determine their utility. METHODS: The H-ATOMIC classification includes 7 etiologic categories: Hypertension, cerebral Amyloid angiopathy, Tumour, Oral anticoagulants, vascular Malformation, Infrequent causes and Cryptogenic. For each category, the etiology is scored with three degrees of certainty: Possible(3), Probable(2) and Definite(1). Our aim was to perform a basic study consisting of neuroimaging, blood tests, and CT-angio when a numerical score (SICH) suggested an underlying structural abnormality. Combinations of >1 etiologic category for an individual patient were acceptable. The criteria were evaluated in a multicenter and prospective study of consecutive patients with spontaneous ICH. RESULTS: Our study included 439 patients (age 70. 8 ± 14. 5 years; 61. 3% were men). A definite etiology was achieved in 176 (40. 1% of the patients: Hypertension 28. 2%, cerebral Amyloid angiopathy 0. 2%, Tumour 0. 2%, Oral anticoagulants 2. 2%, vascular Malformation 4. 5%, Infrequent causes 4. 5%). A total of 7 patients (1. 6%) were cryptogenic. In the remaining 58. 3% of the patients, ICH was attributable to a single (n = 56, 12. 7%) or the combination of ≥2 (n = 200, 45. 5%) possible/probable etiologies. The most frequent combinations of etiologies involved possible hypertension with possible CAA (H3A3, n = 38) or with probable CAA (H3A2, n = 29), and probable hypertension with probable OA (H2O2, n = 27). The most frequent category with any degree of certainty was hypertension (H1+2+3 = 80. 6%) followed by cerebral amyloid angiopathy (A1+2+3 = 30. 9%). CONCLUSIONS: According to our etiologic criteria, only about 40% patients received a definite diagnosis, while in the remaining patients ICH was attributable to a single possible/probable etiology or to more than one possible/probable etiology. The use of these criteria would likely help in the management of patients with ICH. |
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identificación
(Institut d'Investigació Biomèdica Sant Pau)
