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Current theory in imaging of intracranial vascular disease

Department of Neuroradiology, Newcastle General Hospital, Westgate Road, Newcastle-upon-Tyne NE4 6BE, UK

• CT remains the investigation of choice for suspected acute intracranial haemorrhage.
  
• Non-invasive angiographic techniques such as MR angiography (MRA) and CT angiography (CTA) are improving rapidly and are likely to replace conventional angiography for the diagnosis of vascular intracranial lesions.
  
• Normal CT does not exclude subarachnoid haemorrhage and, in appropriate clinical circumstances, lumbar puncture is necessary for exclusion of diagnosis.
  
• In ruptured aneurysms, endovascular treatment has significantly reduced morbidity and mortality compared with surgery at 1 year.
  
• Colour duplex ultrasound is usually the first line investigation for diagnosis of extracranial atherosclerotic disease, and concordance with MRA and/or CTA obviates the need for conventional angiography.
  
• Although MRI is excellent for demonstration of venous sinus thrombosis, caution is need when interpreting the MR venogram.
  

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