Computed Tomography Angiography Spot Sign as a Predictor of Hematoma Expansion and Outcome in Spontaneous Intracerebral Hemorrhage

Ibrahim, Wael; Abdel Gawad, EL Hady Ahmed; ELmotayam, Amal Salah Eldin; Zidan, El Sayed H; Mahmoud, Wael Elsayed

doi:10.21608/zumj.2019.18839.1608

Computed Tomography Angiography Spot Sign as a Predictor of Hematoma Expansion and Outcome in Spontaneous Intracerebral Hemorrhage

Document Type : Original Article

Authors

¹ Neurology department faculty of medicine zagazig university

² Faculty of medicine, Zagazig University, Egypt.

³ neurology department, faculty of medicine, zagazig university

⁴ Radiology department, faculty of medicine, Zagazig university

⁵ Neurology department, faculty of Medicine Zagazig university

10.21608/zumj.2019.18839.1608

Abstract

Background: Spontaneous intracerebral hemorrhage (sICH) accounts for10–30 % of acute stroke cases. Hematoma expansion (HE) has been accounted for 30% of patients introducing inside six hours of onset.
Aim: To examine the clinical significance of the CT angiographic spot sign as an indicator for early HE and its relationship with outcome of patients with sICH.
Subject and methods: This study was done at Stroke Unit of Neurology Department, Zagazig University Hospitals and included 50 patients with sICH, 22 of them were males and 28 were females, their age ranged from 45-86 years. They were diagnosed clinically and by brain imaging within 6 hours following stroke onset. Follow-up CT scan was performed within 48 hours after the baseline CT scan to detect early HE. Cerebral CTA was done within 12-24 hours of onset of symptoms to detect spot sign. Spot sign was defined as the presence of active contrast extravasations into the hematoma at the time of CTA. The Intra-cerebral hemorrhage (ICH) scale and Barthel index (BI) were performed to assess patients' outcome.
Results: Spot sign was observed on CTA in 30 (60%) of 50 patients with ICH. Hematoma expansion occurred in 27 patients (25 of cases with positive spot sign on CTA, while only two cases had negative spot sign). There was highly statistically significant association between spot sign and hematoma expansion, and also with the outcome of the patients.
Conclusion: The Spot Sign is a promising sign for predicting hematoma expansion and outcome of patients with acute sICH.

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