Utility of routine follow-up imaging in patients with small paraflacine and/ or paratentorial hemorrhages

Objective: Imaging follow-up for acute intracranial hemorrhage has followed the same protocols despite differences in clinical progression and outcome associated with bleed in different compartments. We evaluated isolated, small parafalcine and paratentorial subdural hemorrhages to determine the necessity of routine imaging follow up. Methods: We conducted a retrospective review of all patients presenting to the Emergency Department who were found to have an isolated parafalcine and/or paratentorial subdural hemorrhage, and obtained follow up imaging over the course of 3 years. Subsequent imaging was reviewed to assess for changes in hemorrhage size and the average number of studies performed; clinical data was reviewed for changes in patient status and any intervention if performed. Results: 95 patients were identified with isolated parafalcine and/or paratentorial hemorrhage that were evaluated with multiple follow-up imaging studies. The average initial subdural hemorrhage thickness was 3.5 mm, with all smaller than 1 cm. The average number of subsequent imaging studies performed was 2.7. All patients received follow up imaging despite remaining neurologically stable. 96 % of the patients had stable to decreased size off hemorrhage on follow up exams. The remaining 4% had a slight increase on the second imaging study but, stabilized without any intervention. Anticoagulation use had no correlation with increase on subsequent imaging. Conclusion: Small isolated parafalcine and/or paratentorial hemorrhage in a neurologically stable patient and absence of anticoagulation does not require scheduled routine follow-up imaging.