Secondary Intracerebral Hemorrhage (sICH) Score

Estimates the likelihood that an intracerebral hemorrhage has an underlying vascular cause.

Age

Sex

Neither known hypertension nor impaired coagulation at presentation

Non-contrast CT appearance

Result0 points

Estimated probability of an underlying vascular etiology (e.g. AVM, aneurysm, dural fistula) is about 0 %.

Probability of vascular etiology: 0 %

When to use

Adults presenting with spontaneous intracerebral hemorrhage, to help decide who warrants vascular imaging (CTA/MRA/DSA) to look for a secondary cause.

Formula

Sum of points for Age (18-45y=2, 46-70y=1, >=71y=0), female sex (1), no known hypertension/coagulopathy (1), and non-contrast CT category (0-2). Range 0-6.

Pearls and pitfalls

A score >2 had high sensitivity (~86%) and specificity (~72%) for identifying a vascular etiology in the derivation cohort.
Not intended for patients with a clearly identifiable secondary cause already evident on presentation (e.g. known trauma, anticoagulant overdose).

References

Delgado Almandoz JE, et al. Practical scoring system for the identification of patients with intracerebral hemorrhage at highest risk of harboring an underlying vascular etiology: the Secondary Intracerebral Hemorrhage Score. AJNR Am J Neuroradiol. 2010;31(9):1653-60.