• Ha Son Nguyen, Ninh Doan, Michael Gelsomino, and Saman Shabani.
• Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. Electronic address: hsnguyen@mcw.edu.
• World Neurosurg. 2017 May 1; 101: 506-508.

BackgroundIn the setting of trauma, the cause of intracranial hemorrhage (ICH) is frequently attributed to the physical, traumatic event. Caution should still be directed toward nontraumatic (or spontaneous) causes responsible for the trauma, such as hypertension, cerebral amyloid angiopathy, aneurysms, vascular malformation, and hemorrhagic infarcts. The role for immediate computed tomography angiography remains controversial to evaluate for nontraumatic causes.MethodsA systematic review of the available literature in the Medline PubMed database.ResultsIn the available literature, only 12 patients with traumatic brain injury underwent computed tomography angiography of the head that either showed a vascular malformation and/or altered clinical management because of concerns of a vascular malformation. The ICH in 11 patients was attributed to rupture of a cerebral aneurysm; the other patient received a diagnostic angiogram that was negative.ConclusionsICH in patients with traumatic brain injury seems to be vastly associated with the traumatic event. Only rare cases have been attributed to aneurysmal rupture. None has been associated with arteriovenous malformation. Nevertheless, clinical vigilance remains reasonable, especially in younger patients and those with hemorrhage within the subarachnoid cisterns or sylvian fissure.Copyright © 2017 Elsevier Inc. All rights reserved.

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