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August 19, 2019

Is Hyperselection of Patients the Right Strategy?

Author Affiliations
  • 1Department of Neurology, University Lille, Inserm U1171, Degenerative & Vascular Cognitive Disorders, Centre Hospitalier Universitaire de Lille, Lille, France
JAMA Neurol. Published online August 19, 2019. doi:https://doi.org/10.1001/jamaneurol.2019.0213

In 2019, intracerebral hemorrhage (ICH) remains the most devastating type of stroke, with a 30-day mortality rate of 40% and 60% of survivors who are dependent 1 year after ICH.1 Intracerebral hemorrhage volume is one of the main determinants of poor outcome, and the associated estimated risk of death or dependency increases of 5% for each millimeter of growth in the short-term phase.2 Up to one-third of ICHs enlarge during the first 24 hours, and the predicted probability of growth increases nonlinearly according to the ICH volume at admission, antithrombotic use, and the time window from symptom onset to imaging.3 Because of its effect on poor prognosis, hematoma expansion represents an appealing therapeutic target. Patients at higher risk of ICH expansion may represent the perfect target for a trial evaluating hemostatic agents. While early multimodal imaging has transformed the management of ischemic stroke, multimodal imaging could contribute to identify patients at risk of hematoma expansion. The spot sign has been described as one of those interesting potential biomarkers.4