Patients presenting with acute onset of focal neurological deficits must be evaluated for intracerebral hemorrhage (ICH). Digital subtraction angiography (DSA) is the most definitive method of identifying the aneurysmal source. While cerebral DSA offers advantages over CT angiography (CTA) and magnetic resonance angiography (MRA), it does so at the expense of greater risk. It carries a 1. 3-1. 8% risk of neurological complication and 0. 2-0. 3% risk of permanent deficit. Although DSA remains the most accurate technique for the diagnosis of cerebral vascular disorders, CT and MRI now play a significant part in the diagnosis and management of cerebral arteriovenous malformation (AVM). DSA is the gold standard in the detection and evaluation of intracranial vascular abnormalities when patients present with spontaneous ICH. Aneurysms and AVM are the typical causes of ICH uncovered by DSA. The procedure is invasive and carries a small but real amount of risk.

Computerized tomography scans are rapid, readily available, and relatively inexpensive. Volume of hemorrhage on computerized tomography (CT) is an important predictor of mortality and functional ability after intracerebral hemorrhage (ICH). Computerized tomography angiography (CTA) offers many clinical advantages over cerebral digital subtraction angiography (DSA) for the evaluation of intracranial vascular abnormalities in cases of ICH. CTA must be shown to have similar sensitivity and specificity as DSA in the detection of secondary causes of ICH. The use of non-contrast CT in the initial evaluation of patients presenting with suspected ICH is well established and universally accepted. Recently, advances in CTA have enabled this modality to gain wide acceptance in evaluating possible secondary causes of ICH, such as aneurysm or vascular malformation. As scanner technology and software rendering capabilities continue to improve, CTA appears poised to replace DSA and become the new gold standard for such evaluations.