CT angiography (CTA) and contrast-enhanced CT may identify patients at high risk of ICH expansion based on the presence of contrast within the hematoma, often termed a spot sign.50 54 A larger number of contrast spots suggests even higher risk of Early diagnosis of underlying vascular abnormalities can both influence clinical management and guide prognosis in ICH patients. Risk factors for underlying vascular abnormalities are Table 4. Integral Components of the History, Physical Examination, and Workup of the Patient With ICH in the Emergency Department Comments History Time of symptom onset (or time the patient was last normal) Initial symptoms and progression of symptoms Vascular risk factors History of stroke or ICH, hypertension, diabetes mellitus, and smoking Medications Anticoagulant drugs, antiplatelet agents, antihypertensive medications, stimulants (including diet pills), sympathomimetic drugs Recent trauma or surgery Carotid endarterectomy or carotid stenting, because ICH may be related to hyperperfusion after such procedures Dementia Associated with amyloid angiopathy Alcohol or illicit drug use Cocaine and other sympathomimetic drugs are associated with ICH, stimulants Seizures Liver disease May be associated with coagulopathy Cancer and hematologic disorders May be associated with coagulopathy Physical examination Vital signs A general physical examination focusing on the head, heart, lungs, abdomen, and extremities A focused neurological examination A structured examination such as the National Institutes of Health Stroke Scale can be completed in minutes and provides a quantification that allows easy communication of the severity of the event to other caregivers. GCS score is similarly well known and easily computed. 