Which patients presenting with spontaneous ICH should be considered for a diagnostic cerebral angiogram/DSA?

Given the ease of obtaining CT angiograms, the majority of patients both with and without a history of hypertension are routinely getting CTA's. This has truly led to a minimization of the need for diagnostic cerebral angiograms. While the diagnostic performance of noninvasive neuroimaging is not clearly established, CTA's appear to have a good sensitivity and specificity after ICH for the detection of intracranial vascular malformations and often suffice as a first line in evaluation.

Cerebral angiography should be considered in patients of a younger age group (<50 years of age) who present with a deep, lobar, or posterior fossa ICH and do not have a previous history of hypertension, or do not have evidence of small vessel disease on imagin...