Serum and urine tests Complete blood count, electrolytes, blood urea nitrogen and creatinine, and glucose Higher serum glucose is associated with worse outcome16,17 Prothrombin time (with INR) and an activated partial thromboplastin time Warfarin-related hemorrhages are associated with an increased hematoma volume, greater risk of expansion, and increased morbidity and mortality18,19 Cardiac-specific troponin Elevated troponin levels are associated with worse outcome20,21 Toxicology screen to detect cocaine and other sympathomimetic drugs of abuse Cocaine and other sympathomimetic drugs are associated with ICH Urinalysis and urine culture, as well as a pregnancy test in a woman of childbearing age Other routine tests Neuroimaging CT or MRI; consider contrast-enhanced or vascular imaging ECG To assess for active coronary ischemia or prior cardiac injury; ECG abnormalities can mark concomitant myocardial injury22,23 CT indicates computed tomography; GCS, Glasgow Coma Scale; ICH, intracerebral hemorrhage; INR, international normalized ratio; and MRI, magnetic resonance imaging. Hemphill et al Management of Spontaneous ICH 2037 age <65 years, female sex, nonsmoker, lobar ICH, intraven- tricular extension, and absence of a history of hypertension MRI, magnetic resonance angiography, magnetic resonance venography, and CTA or CT venography can identify specific causes of hemorrhage, including arterio- venous malformations, tumors, moyamoya, and cerebral vein CTA has been more widely studied and is highly sensitive and specific for detecting vascular abnormali- A catheter angiogram may be considered if clinical suspicion is high or noninvasive studies are suggestive of an Radiological evidence suggestive of vascu- lar abnormalities as causative for ICH can include the presence of subarachnoid hemorrhage, enlarged vessels or calcifications along the margins of the ICH, hyperattenuation within a dural venous sinus or cortical vein along the presumed venous drain- unusual hematoma shape, presence of edema out of proportion to the time of presumed ICH, an unusual hemor- rhage location, and the presence of other abnormal structures in the brain (like a mass). 