Active extravasation of contrast within the hemorrhage (spot sign): a multidetector computed tomography finding that predicts growth and a worse prognosis in non-traumatic intracerebral hemorrhage

Extravasamento ativo de contraste no interior da hemorragia (spot sign): um achado de TCMD que prediz crescimento e pior prognóstico nas hemorragias intraparenquimatosas cerebrais não traumáticas

Intracerebral hemorrhage (ICH) causes high rates of disability and neurological sequelae

Objective

To evaluate spot signs as predictors of expansion and worse prognosis in non-traumatic ICH in a Brazilian cohort.

Method

We used multidetector computed tomography angiography to study 65 consecutive patients (40 men, 61.5%), with ages varying from 33 to 89 years (median age 55 years). Clinical and imaging findings were correlated with the findings based on the initial imaging.

Results

Of the individuals who presented a spot sign, 73.7% died (in-hospital mortality), whereas in the absence of a spot sign the mortality rate was 43.0%. Although expansion of ICH was detected in 75% of the patients with a spot sign, expansion was observed in only 9.0% of the patients who did not present a spot sign.

Conclusions

The spot sign strongly predicted expansion in non-traumatic ICH and an increased risk of in-hospital mortality.

spot sign; multidetector computed tomography angiography; hemorrhagic stroke; brain hemorrhage