Extra Investigation Might Be Necessary in High-Risk CT-Negative Cerebrovascular Cases

Cerebrovascular accidents occur in elderly patients in whom neurodegenerative changes increase the risk of vascular permeation and concomitant intracranial bleeding. In rare cases, intracerebral massive hemorrhage happens in hospitalized patients with apparently stable clinical picture. We report two cases illustrating this phenomenon, discuss the possible pathomechanism involved in those tragic incidents and suggest possible prevention measures for these patients. A negative CT image in a patient with neurological symptoms, especially who are on warfarin with or without considerably elongated coagulation time, may be subject to a sudden intracranial hemorrhage. Microvascular abnormalities might be detected on perfusion CT imaging and should therefore be performed in all CT negative patients with close observation for 24 hours before contemplating discharge.