Many intracerebral hemorrhages (ICHs) are still expanding at the time of initial emergency department assessment, causing increased disability or death. Although it has been frustratingly difficult to achieve clinically meaningful reductions in hematoma expansion (HE),1 it nevertheless remains an important potential treatment target to improve ICH outcomes.
Ongoing contrast extravasation at the time of computed tomographic angiography can be visualized as the “spot sign.”2 These spots presumably reflect a fast rate of ongoing bleeding, as do larger spots compared with smaller spots.3 However, is rate of bleeding the only factor in HE, and is the spot sign the only neuroimaging prognosticator?
Smith EE. Risk for Intracerebral Hematoma Expansion—More Than Just the Spot Sign. JAMA Neurol. 2016;73(12):1401-1403. doi:10.1001/jamaneurol.2016.3048