scholarly journals From Spot Sign to Bleeding on the Spot: Classic and Original Signs of Expanding Primary Spontaneous Intracerebral Hematoma

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Ali Kanj ◽  
Abir Ayoub ◽  
Malak Aljoubaie ◽  
Ahmad Kanj ◽  
Assaad Mohanna ◽  
...  
Keyword(s):  
Intracranial Hemorrhage ◽  
Medical Center ◽  
Hematoma Expansion ◽  
Intracerebral Hematoma ◽  
Magnetic Resonance Study ◽  
Spot Sign ◽  
Early Predictors ◽  
Drastic Increase ◽  
Spontaneous Intracranial Hemorrhage ◽  
Mri Study

Expansion of a primary spontaneous intracranial hemorrhage (PSICH) has become lately of increasing interest, especially after the emergence of its early predictors. However, these signs lacked sensitivity and specificity. The flood phenomenon, defined as a drastic increase in the size of a PSICH during the same magnetic resonance study, was first described in this paper based on the data of a university medical center in Lebanon. Moreover, further review of this data resulted in 205 studies with presumed diagnosis of primary spontaneous intracranial hemorrhage within the last 10 years, of which 29 exams showed typical predictors of hematoma expansion on computed tomography. The intended benefit of this observation is to draw the radiologists’ attention towards minimal variations in the volume of the hematoma between the two extreme sequences of the same MRI study, in order to detect inconspicuous flood phenomena—a direct sign of hematoma expansion.

Prevalence and diagnostic performance of computed tomography angiography spot sign for intracerebral hematoma expansion depend on scan timing

2014 ◽  
Vol 56 (12) ◽  
pp. 1039-1045 ◽  
Author(s):  
Akio Tsukabe ◽  
Yoshiyuki Watanabe ◽  
Hisashi Tanaka ◽  
Yuki Kunitomi ◽  
Mitsuo Nishizawa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Diagnostic Performance ◽  
Hematoma Expansion ◽  
Intracerebral Hematoma ◽  
Spot Sign

Spot sign and live-imaged dramatic intracerebral hematoma expansion

Neurology ◽  
2011 ◽  
Vol 76 (14) ◽  
pp. 1275-1276
Author(s):  
M. A. Almekhlafi ◽  
J. C. Kosior ◽  
D. Dowlatshahi ◽  
A. M. Demchuk ◽  
P. G. Bermejo ◽  
...  
Keyword(s):  
Hematoma Expansion ◽  
Intracerebral Hematoma ◽  
Spot Sign

scholarly journals Early Spot Sign is Associated with Functional Outcomes in Primary Intracerebral Hemorrhage Survivors

2020 ◽  
Author(s):  
Ming Yen Hsiao ◽  
Wen-Che Tseng ◽  
Yu-Fen Wang ◽  
Tyng-Guey Wang
Keyword(s):  
Linear Regression ◽  
Intracerebral Hemorrhage ◽  
Hospital Stay ◽  
Multiple Linear Regression ◽  
Functional Outcomes ◽  
Medical Center ◽  
Motion Artifacts ◽  
Common Finding ◽  
Hematoma Expansion ◽  
Spot Sign

Abstract Background The computed tomography angiography (CTA) spot sign is a validated predictor of hematoma expansion and 30-day mortality in intracerebral hemorrhage (ICH). However, whether the spot sign predicts worse functional outcomes among ICH survivors remains unclear. This study investigated the frequency of the spot sign and its association with functional outcomes and length of hospital stay among ICH survivors.Methods This was a retrospective analysis of consecutive patients with primary ICH who received CTA within 24 h from presentation to admission to the emergency department of a single medical center between January 2007 and December 2017. Patients who died before discharge and those referred from other hospitals were excluded. CTAs with motion artifacts were excluded from the analysis. The presence of a spot sign was examined by an experienced neuroradiologist. Functional outcomes were determined based on the modified Rankin Scale (mRS) score and Barthel Index (BI). Severe dependency in activities of daily living (ADL) was defined as BI of ≤60 and severe disability as an mRS score of ≥4. Odds ratio (OR) and multiple linear regression were used as measures of association.Results In total, 66 patients met the inclusion criteria, of whom 9 (13.64%) were positive for a spot sign. No significant differences were observed in baseline characteristics between patients with and without a spot sign. Patients with a spot sign tended to be severely dependent in ADL at discharge (66.67% vs 41.07%; OR = 2.87; p = 0.15) and were more likely to require ICH-related surgery (66.67% vs 24.56%; OR = 6.14; p = 0.01). In multiple linear regression, patients with a higher spot sign score had a significantly longer hospital stay (coefficient = 9.57; 95% CI = 2.11–17.03; p = 0.013).Conclusions The presence of a spot sign is a common finding and is associated with longer hospital stay and possibly worse functional outcomes in ICH survivors.

Abstract WMP83: Prediction of Intracerebral Hematoma Expansion: Multicenter External Validation of the CTA Spot Sign Score

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Thien J Huynh ◽  
Andrew Demchuk ◽  
Dar Dowlatshahi ◽  
Ölem Krischek ◽  
Alex Kiss ◽  
...  
Keyword(s):  
External Validation ◽  
Area Under The Curve ◽  
Hematoma Expansion ◽  
Intracerebral Hematoma ◽  
Spot Sign ◽  
Perfect Agreement ◽  
Sagittal Sinus ◽  
Spot Number ◽  
Hematoma Growth ◽  
Contrast Ct

Background and Purpose: The spot sign score (SSS) stratifies hematoma expansion risk in patients with acute intracerebral hemorrhage (ICH) but is not externally validated. We sought to validate the SSS and assess prognostic spot characteristics associated with hematoma expansion in a prospective multicenter study. Methods: We studied 228 ICH patients presenting < 6 hours post-onset enrolled in the PREDICT (PREdicting hematoma growth anD outcome in ICH using contrast bolus CT) study, a multicentre prospective observational cohort study of ICH patients evaluated with baseline non-contrast CT, CT angiography (CTA), and 24-hour follow-up CT. Primary outcome was significant hematoma expansion (>6ml or >33%). Secondary outcomes were absolute and relative expansion. Blinded CTA spot sign characterization (spot number, maximum axial size and attenuation, and relative attenuation compared to the ipsilateral internal carotid artery and superior sagittal sinus) and SSS calculation was performed independently by two neuroradiologists and a radiology resident. Multivariable regression for prediction of hematoma expansion was performed and diagnostic performance of the SSS and spot characteristics was examined with ROC analysis and tests for trend. Results: SSS independently predicted significant, absolute, and relative hematoma expansion (p-values of 0.001, <0.001, and 0.009, respectively), adjusting for initial hematoma volume, INR, mean arterial pressure, and time from onset-to-baseline CT, and demonstrated near perfect interobserver agreement (κ = 0.82). Spot number and SSS demonstrated similar area under the curve (AUC 0.69 vs. 0.68, p=0.149) for hematoma expansion. Incremental risk of hematoma expansion was demonstrated with increasing SSS however a significant trend was not identified (p trend=0.720). Of all spot characteristics, only spot number was independently associated with expansion (p<0.001) providing incremental risk stratification (p trend=0.050) and near perfect agreement (κ=0.85). Median absolute hematoma growth for 0, 1, 2 to 3, ≥4 spots was 0.4, 4, 12, 82 ml respectively. Conclusion: Spot number is the single best predictor of significant ICH expansion and appears to be as good as the total SSS in predicting expansion.

scholarly journals Spot sign and live-imaged dramatic intracerebral hematoma expansion

Neurology ◽  
2010 ◽  
Vol 75 (9) ◽  
pp. 834-834 ◽  
Author(s):  
P. G. Bermejo ◽  
J. A. Garcia ◽  
S. Perez-Fernandez ◽  
J. F. Arenillas
Keyword(s):  
Hematoma Expansion ◽  
Intracerebral Hematoma ◽  
Spot Sign

Perihematomal Edema Is Greater in the Presence of a Spot Sign but Does Not Predict Intracerebral Hematoma Expansion

Stroke ◽  
2016 ◽  
Vol 47 (2) ◽  
pp. 350-355 ◽  
Author(s):  
David Rodriguez-Luna ◽  
Teri Stewart ◽  
Dar Dowlatshahi ◽  
Jayme C. Kosior ◽  
Richard I. Aviv ◽  
...  
Keyword(s):  
Hematoma Expansion ◽  
Intracerebral Hematoma ◽  
Spot Sign ◽  
Perihematomal Edema

Abstract WP361: Sex Differences in Intracerebral Hemorrhage Severity and Mortality

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sandro Marini ◽  
Andrea Morotti ◽  
Alison M Ayres ◽  
Katherine Crawford ◽  
Nicolette H Friedman ◽  
...  
Keyword(s):  
Sex Differences ◽  
Intracerebral Hemorrhage ◽  
Medical Center ◽  
Academic Medical Center ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Case Fatality ◽  
Hematoma Expansion ◽  
Spot Sign ◽  
One Year

Background and objective: Due to conflicting results in multiple studies, uncertainty remains regarding sex differences in incidence, pathophysiology, and outcome after intracerebral hemorrhage (ICH). We investigated the differential impact of sex on ICH severity and mortality. Methods: We analyzed prospectively collected ICH patients ascertained between 1994 and 2015 at a single tertiary care academic medical center. Clinical variables including past medical history, medications, hemorrhage characteristics, and case-fatality rate at 90 days and one year were assessed. Categorical and continuous characteristics were compared between sexes using chi-square test and t-test, respectively. Multivariable logistic regression was used to examine associations between sex and ICH severity as well as outcome. Results: A total of 2403 patients were investigated: 1292 (53.8 %) male and 1111 female (46.2%). Men with ICH were younger (72 vs. 77 years), had greater smoking and alcohol use, and were more likely to have hypertension, diabetes, hypercholesterolemia and coronary artery disease (all p< 0.05), consistent with previous studies. Lobar hemorrhages frequency was higher in women compared to men (46.5% lobar hemorrhages in women vs 37.1% lobar hemorrhages in men, p<0.001). Hematoma expansion was more frequent in men (19% vs. 12.5%, p=0.001) in univariate analysis, and after controlling for admission INR, time from onset to CT, baseline hematoma volume, spot sign and blood pressure values, men continued to demonstrate a higher risk of hematoma expansion (Odds Ratio [OR] 1.98, 95% confidence interval [CI] 1.11 - 3.52, p=0.020). The overall case fatality at 90 days was 37.4%. Controlling for univariate differences and known predictors of mortality, male sex was independently associated with both 90-day (OR 1.53, CI 1.05 - 2.23, p=0.025) and one year mortality (OR 1.80, CI 1.20 - 2.69, p=0.005). Conclusions: Sex independently affects early ICH expansion and outcome after ICH, with men experiencing a higher risk of both expansion as well as early and late mortality. Further research is needed to explore the biological mechanisms mediating these observed differences.

Meningioma with Intracerebral Hematoma

Neurosurgery ◽  
1984 ◽  
Vol 15 (2) ◽  
pp. 237-240 ◽  
Author(s):  
Chander M. Kohli ◽  
Rebecca L. Crouch
Keyword(s):  
Intracranial Hemorrhage ◽  
Surgical Intervention ◽  
Intracerebral Hematoma ◽  
Comprehensive Review ◽  
Spontaneous Intracranial Hemorrhage ◽  
The Subject

Abstract A case of spontaneous intracranial hemorrhage associated with a meningioma is presented. Intracranial hemorrhage has been reported to be associated with meningioma in 45 cases. A comprehensive review of the subject is presented. The importance of the diagnosis of associated hemorrhage and subsequent surgical intervention is emphasized.

scholarly journals Early spot sign is associated with functional outcomes in primary intracerebral hemorrhage survivors

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wen-Che Tseng ◽  
Yu-Fen Wang ◽  
Tyng-Guey Wang ◽  
Ming-Yen Hsiao
Keyword(s):  
Linear Regression ◽  
Intracerebral Hemorrhage ◽  
Hospital Stay ◽  
Multiple Linear Regression ◽  
Functional Outcomes ◽  
Medical Center ◽  
Motion Artifacts ◽  
Common Finding ◽  
Hematoma Expansion ◽  
Spot Sign

Abstract Background The computed tomography angiography (CTA) spot sign is a validated predictor of hematoma expansion and 30-day mortality in intracerebral hemorrhage (ICH). However, whether the spot sign predicts worse functional outcomes among ICH survivors remains unclear. This study investigated the frequency of the spot sign and its association with functional outcomes and length of hospital stay among ICH survivors. Methods This was a retrospective analysis of consecutive patients with primary ICH who received CTA within 24 h from presentation to admission to the emergency department of a single medical center between January 2007 and December 2017. Patients who died before discharge and those referred from other hospitals were excluded. CTAs with motion artifacts were excluded from the analysis. The presence of a spot sign was examined by an experienced neuroradiologist. Functional outcomes were determined based on the modified Rankin Scale (mRS) score and Barthel Index (BI). Severe dependency in activities of daily living (ADL) was defined as BI of ≤60 and severe disability as an mRS score of ≥4. Odds ratio (OR) and multiple linear regression were used as measures of association. Results In total, 66 patients met the inclusion criteria, of whom 9 (13.64%) were positive for a spot sign. No significant differences were observed in baseline characteristics between patients with and without a spot sign. Patients with a spot sign tended to be severely dependent in ADL at discharge (66.67% vs 41.07%; OR = 2.87; p = 0.15) and were more likely to require ICH-related surgery (66.67% vs 24.56%; OR = 6.14; p = 0.01). In multiple linear regression, patients with a higher spot sign score had a significantly longer hospital stay (coefficient = 9.57; 95% CI = 2.11–17.03; p = 0.013). Conclusions The presence of a spot sign is a common finding and is associated with longer hospital stay and possibly worse functional outcomes in ICH survivors.

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