MDCalc

Secondary Intracerebral Hemorrhage (sICH) Score

Quantifies likelihood of underlying vascular etiology in patients with ICH.

Probability of vascular cause on non-contrast computed tomography (NCCT)

See Evidence > Formula for definitions
Age
Sex
Absence of both hypertension AND impaired coagulation
Impaired coagulation: admission INR >3, aPTT >80 sec, platelet count <50,000, or daily antiplatelet therapy

Result:

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Advice
  • Bear in mind that the sICH Score is an adjunct to, and not a substitute for, clinical judgment.
  • In a patient with sICH Score <2 and CTA negative for vascular abnormality, catheter angiogram may present greater procedural risks than benefits from identifying an underlying vascular etiology.
  • In selected patients with sICH Score >2 and CTA negative for vascular abnormality, catheter angiogram may be considered after careful weighing of procedural risks and benefits. Note that CTA is not the gold standard but remains a highly sensitive and specific imaging technique for detecting vascular abnormalities.
Management
  • ICH is a neurological emergency. Immediate neurological and neurosurgical consultation should be obtained on patients with evidence of any ICH on imaging.
  • Hypertensive patients with acute ICH should undergo blood pressure reduction with intravenous agents. The target blood pressure should be discussed with the neurological or neurosurgical consultant.
  • The decision to administer reversal agents (e.g. desmopressin) blood products (e.g. prothrombin factor concentrate, fresh frozen plasma), or anti-epileptic medications should not be made without discussing with the neurological or neurosurgical consultant.
  • Platelet administration is NOT recommended in the setting of antiplatelet-related ICH.
Critical Actions

It is crucial to identify and reverse anticoagulant-associated ICH (using agents tailored to the underlying anticoagulant).

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