Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
    • Education
  • Online Sections
    • Neurology Video Journal Club
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Genetics
    • Neuroimmunology & Neuroinflammation
    • Education
  • Online Sections
    • Neurology Video Journal Club
    • Inclusion, Diversity, Equity, Anti-racism, & Social Justice (IDEAS)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit a Manuscript
    • Author Center
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

User menu

  • Subscribe
  • My Alerts
  • Log in

Search

  • Advanced search
Neurology
Home
The most widely read and highly cited peer-reviewed neurology journal
  • Subscribe
  • My Alerts
  • Log in
Site Logo
  • Home
  • Latest Articles
  • Current Issue
  • Past Issues
  • Residents & Fellows

Share

May 17, 2022; 98 (20) Research Article

Simplified Edinburgh CT Criteria for Identification of Lobar Intracerebral Hemorrhage Associated With Cerebral Amyloid Angiopathy

Jochen A. Sembill, Michael Knott, Mingming Xu, Sebastian S. Roeder, Manuel Hagen, Maximilian I. Sprügel, Anne Mrochen, Matthias Borutta, View ORCID ProfilePhilip Hoelter, Tobias Engelhorn, Veit Rothhammer, Kosmas Macha, View ORCID ProfileJoji B. Kuramatsu
First published March 21, 2022, DOI: https://doi.org/10.1212/WNL.0000000000200261
Jochen A. Sembill
From the Departments of Neurology (J.A.S., S.S.R., M.H., M.I.S., A.M., M.B., V.R., K.M., J.B.K.) and Neuroradiology (M.K., P.H., T.E.), University of Erlangen-Nuremberg, Schwabachanlage, Erlangen, Germany; and Department of Neurology (M.X.), Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Michael Knott
From the Departments of Neurology (J.A.S., S.S.R., M.H., M.I.S., A.M., M.B., V.R., K.M., J.B.K.) and Neuroradiology (M.K., P.H., T.E.), University of Erlangen-Nuremberg, Schwabachanlage, Erlangen, Germany; and Department of Neurology (M.X.), Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Mingming Xu
From the Departments of Neurology (J.A.S., S.S.R., M.H., M.I.S., A.M., M.B., V.R., K.M., J.B.K.) and Neuroradiology (M.K., P.H., T.E.), University of Erlangen-Nuremberg, Schwabachanlage, Erlangen, Germany; and Department of Neurology (M.X.), Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sebastian S. Roeder
From the Departments of Neurology (J.A.S., S.S.R., M.H., M.I.S., A.M., M.B., V.R., K.M., J.B.K.) and Neuroradiology (M.K., P.H., T.E.), University of Erlangen-Nuremberg, Schwabachanlage, Erlangen, Germany; and Department of Neurology (M.X.), Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Manuel Hagen
From the Departments of Neurology (J.A.S., S.S.R., M.H., M.I.S., A.M., M.B., V.R., K.M., J.B.K.) and Neuroradiology (M.K., P.H., T.E.), University of Erlangen-Nuremberg, Schwabachanlage, Erlangen, Germany; and Department of Neurology (M.X.), Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Maximilian I. Sprügel
From the Departments of Neurology (J.A.S., S.S.R., M.H., M.I.S., A.M., M.B., V.R., K.M., J.B.K.) and Neuroradiology (M.K., P.H., T.E.), University of Erlangen-Nuremberg, Schwabachanlage, Erlangen, Germany; and Department of Neurology (M.X.), Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Anne Mrochen
From the Departments of Neurology (J.A.S., S.S.R., M.H., M.I.S., A.M., M.B., V.R., K.M., J.B.K.) and Neuroradiology (M.K., P.H., T.E.), University of Erlangen-Nuremberg, Schwabachanlage, Erlangen, Germany; and Department of Neurology (M.X.), Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Matthias Borutta
From the Departments of Neurology (J.A.S., S.S.R., M.H., M.I.S., A.M., M.B., V.R., K.M., J.B.K.) and Neuroradiology (M.K., P.H., T.E.), University of Erlangen-Nuremberg, Schwabachanlage, Erlangen, Germany; and Department of Neurology (M.X.), Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Philip Hoelter
From the Departments of Neurology (J.A.S., S.S.R., M.H., M.I.S., A.M., M.B., V.R., K.M., J.B.K.) and Neuroradiology (M.K., P.H., T.E.), University of Erlangen-Nuremberg, Schwabachanlage, Erlangen, Germany; and Department of Neurology (M.X.), Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Philip Hoelter
Tobias Engelhorn
From the Departments of Neurology (J.A.S., S.S.R., M.H., M.I.S., A.M., M.B., V.R., K.M., J.B.K.) and Neuroradiology (M.K., P.H., T.E.), University of Erlangen-Nuremberg, Schwabachanlage, Erlangen, Germany; and Department of Neurology (M.X.), Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Veit Rothhammer
From the Departments of Neurology (J.A.S., S.S.R., M.H., M.I.S., A.M., M.B., V.R., K.M., J.B.K.) and Neuroradiology (M.K., P.H., T.E.), University of Erlangen-Nuremberg, Schwabachanlage, Erlangen, Germany; and Department of Neurology (M.X.), Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Kosmas Macha
From the Departments of Neurology (J.A.S., S.S.R., M.H., M.I.S., A.M., M.B., V.R., K.M., J.B.K.) and Neuroradiology (M.K., P.H., T.E.), University of Erlangen-Nuremberg, Schwabachanlage, Erlangen, Germany; and Department of Neurology (M.X.), Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Joji B. Kuramatsu
From the Departments of Neurology (J.A.S., S.S.R., M.H., M.I.S., A.M., M.B., V.R., K.M., J.B.K.) and Neuroradiology (M.K., P.H., T.E.), University of Erlangen-Nuremberg, Schwabachanlage, Erlangen, Germany; and Department of Neurology (M.X.), Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, China.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • ORCID record for Joji B. Kuramatsu
Full PDF
Short Form
Citation
Simplified Edinburgh CT Criteria for Identification of Lobar Intracerebral Hemorrhage Associated With Cerebral Amyloid Angiopathy
Jochen A. Sembill, Michael Knott, Mingming Xu, Sebastian S. Roeder, Manuel Hagen, Maximilian I. Sprügel, Anne Mrochen, Matthias Borutta, Philip Hoelter, Tobias Engelhorn, Veit Rothhammer, Kosmas Macha, Joji B. Kuramatsu
Neurology May 2022, 98 (20) e1997-e2004; DOI: 10.1212/WNL.0000000000200261

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Permissions

Make Comment

See Comments

Downloads
285

Share

  • Article
  • Figures & Data
  • Info & Disclosures
Loading

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.

Abstract

Background and Objectives In patients with lobar intracerebral hemorrhage (ICH), etiologic characterization represents a tradeoff between feasibility, resource allocation, and diagnostic certainty. This study investigated the accuracy and clinical utility of the simplified Edinburgh CT criteria to identify underlying cerebral amyloid angiopathy (CAA).

Methods This external validation analyzed 210 consecutive patients with lobar ICH and available CT and MRI studies from a prospective single-center observational cohort study (2006–2015, Longitudinal Cohort Study on ICH Care [UKER-ICH,] NCT03183167). We investigated the interrater variability and diagnostic accuracy of the simplified Edinburgh CT-based criteria for identification of ICH associated with probable CAA according to MRI-based modified Boston criteria as a reference standard. We evaluated the utility of the simplified Edinburgh criteria by decision curve analysis, comparing the theoretical clinical net benefit (weighted benefit-harm at varying threshold probabilities) of the high-risk category (finger-like projections and subarachnoid hemorrhage) for ruling in and the low-risk category (neither finger-like projections nor subarachnoid hemorrhage) for ruling out with the assumptions of no or all patients having CAA (default strategies).

Results Of 210 patients, 70 (33.3%) had high risk, 67 (31.9%) had medium risk, and 73 (34.8%) had low risk for CAA-associated ICH according to simplified Edinburgh CT criteria, showing moderate interrater variability. Discrimination was good (area under the receiver operating characteristics curve 0.74, 95% CI 0.67–0.81) without evidence of poor calibration (Hosmer-Lemeshow, p = 0.54) for validation of MRI-based diagnosis of probable CAA (n = 94 of 210, 44.8%). The rule-in criteria (high risk), had 87.1% (79.3%–92.3%) specificity, and the rule-out criteria (low risk), had 80.9% (71.1%–88.0%) sensitivity. Decision curve analysis suggested a theoretical clinical net benefit for ruling in but not for ruling out probable CAA compared to default strategies.

Discussion Applying the simplified Edinburgh CT criteria during diagnostic workup seems clinically useful and may accurately identify CAA in patients with lobar ICH.

Trial Registration Information ClinicalTrials.gov Identifier: NCT03183167.

Classification of Evidence This study provides Class II evidence that in patients with lobar hemorrhages, the simplified Edinburgh criteria accurately identify those at high risk of CAA.

Glossary

CAA=
cerebral amyloid angiopathy;
ICH=
intracerebral hemorrhage;
SAH=
subarachnoid hemorrhage;
UKER-ICH=
Longitudinal Cohort Study on ICH Care

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • ↵* These authors contributed equally to this work.

  • Class of Evidence: NPub.org/coe

  • Editorial, page 823

  • Received August 17, 2021.
  • Accepted in final form February 4, 2022.
  • © 2022 American Academy of Neurology
View Full Text

AAN Members

We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.

Google Safari Microsoft Edge Firefox

Click here to login

AAN Non-Member Subscribers

Click here to login

Purchase access

For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)

Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here 

Purchase
Individual access to articles is available through the Add to Cart option on the article page.  Access for 1 day (from the computer you are currently using) is US$ 39.00.  Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means.  The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use.  Distributing copies (electronic or otherwise) of the article is not allowed.

Disputes & Debates: Rapid online correspondence

No comments have been published for this article.
Comment

REQUIREMENTS

If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org

Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.

If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.

Submission specifications:

  • Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
  • Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
  • Submit only on articles published within 6 months of issue date.
  • Do not be redundant. Read any comments already posted on the article prior to submission.
  • Submitted comments are subject to editing and editor review prior to posting.

More guidelines and information on Disputes & Debates

Compose Comment

More information about text formats

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Author Information
NOTE: The first author must also be the corresponding author of the comment.
First or given name, e.g. 'Peter'.
Your last, or family, name, e.g. 'MacMoody'.
Your email address, e.g. higgs-boson@gmail.com
Your role and/or occupation, e.g. 'Orthopedic Surgeon'.
Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.
Publishing Agreement
NOTE: All authors, besides the first/corresponding author, must complete a separate Publishing Agreement Form and provide via email to the editorial office before comments can be posted.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

You May Also be Interested in

Back to top
  • Article
    • Abstract
    • Glossary
    • Methods
    • Results
    • Discussion
    • Study Funding
    • Disclosure
    • Acknowledgment
    • Appendix Authors
    • Footnotes
    • References
  • Figures & Data
  • Info & Disclosures
Advertisement

Related Articles

  • CT Diagnosis of Cerebral Amyloid AngiopathyBlood Will Out

Topics Discussed

  • All Cerebrovascular disease/Stroke
  • CT
  • MRI
  • Prognosis
  • Intracerebral hemorrhage

Alert Me

  • Alert me when eletters are published
Neurology: 99 (6)

Articles

  • Ahead of Print
  • Current Issue
  • Past Issues
  • Popular Articles
  • Translations

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Activate a Subscription
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • Neurology: Education
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

© 2022 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise