The accuracy of non-contrast brain CT scan in predicting the presence of a vascular etiology in patients with primary intracranial hemorrhage.

Spontaneous intraparenchymal cerebral hemorrhages (SIPH) account for 10-15% of acute strokes. Sorting these patients according to the risk of harboring an underlying vascular etiology may help selecting the patients who would mostly benefit from Multidetector CT Angiography (MDCTA). The aim of this study was to evaluate the accuracy of Non-Contrast brain CT (NCCT) in predicting possible vascular etiologies in patients with SIPH. In this retrospective study, we evaluated the NCCT of 334 patients who presented with SIPH from March 2017 to March 2021 and we looked for vascular etiologies in the CTA which was performed for these patients. We used NCCT criteria to predict the presence of any vascular etiologies in SIPH patients and proposed a scoring system based on these criteria which might predict the risk of vascular ICH (VICH score). Out of 334 evaluated patients, 9.3% had an underlying vascular etiology. Independent predictors of the vascular etiology included: age < 46 years, no history of hypertension and coagulation disorders, lobar hemorrhages, and presence of significant perilesional edema. We used these criteria and NCCT classification to create a practical scoring system to predict the risk of vascular ICH (VICH). In our study, VICH score ≥ 4 had 51.6% sensitivity and 96.4% specificity for predicting a positive MDCTA as the maximum optimal cut-off point. The VICH score seemed to be successful in predicting vascular etiologies in this retrospective cohort of 334 patients. This scoring system can be used to select patients if there are limited resources to perform CT angiography.

A Giant Sacrococcygeal Chordoma: A Case Report.

Sacrococcygeal chordoma is a rare malignant bone tumor. Although there are tough membranes such as the periosteum and presacral fascia (which resist transgression by the tumors), chordoma usually invades the rectal wall. The serious problem with these tumors is the late diagnosis and its high likelihood to become enlarged. The main treatment options for this tumor is surgical resection, radiotherapy, and chemotherapy. Due to the tumor vicinity to important organs such as bladder and its neurovascular structures, it makes surgical excision extremely challenging. The aim of this study is to describe a 50-year-old man with a giant sacrococcygeal mass. The novelty of this case report is the huge and unique size of the tumor which has not reported previously as well the special surgical approaches performed to remove the tumor.