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Risk factors for computed tomography angiography spot sign in deep and lobar intracerebral hemorrhage are shared

Farid Radmanesh1, Guido J Falcone1, Christopher D Anderson1

  • 1From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.).

Stroke
|May 31, 2014
PubMed

Insights

The spot sign in intracerebral hemorrhage (ICH) is associated with warfarin use and larger initial hematoma volume, regardless of ICH location. This suggests commonalities in bleeding processes across different small vessel diseases.

Area of Science:

  • Neurology
  • Radiology
  • Vascular Medicine

Background:

  • Intracerebral hemorrhage (ICH) patients with a spot sign on computed tomography angiography face higher risks of hematoma expansion and poor outcomes.
  • Primary ICH is linked to chronic cerebral small vessel disease, influencing bleeding characteristics.

Purpose of the Study:

  • To identify clinical and imaging predictors of the spot sign in intracerebral hemorrhage.
  • To investigate if ICH location (deep vs. lobar) influences these predictors, serving as a surrogate for arteriolosclerosis and cerebral amyloid angiopathy.

Main Methods:

  • Analysis of 741 patients with primary ICH and available computed tomography angiography.
  • Uni- and multivariable regression analyses were performed, stratified by ICH location (deep vs. lobar).

Main Results:

  • The spot sign was present in 23% of deep ICH and 25% of lobar ICH cases.
  • In deep ICH, warfarin use, larger baseline ICH volume, and shorter time to computed tomography angiography predicted the spot sign.
  • In lobar ICH, warfarin use and larger baseline ICH volume were significant predictors.

Conclusions:

  • Warfarin use and baseline ICH volume are potent predictors of the spot sign, common to both deep and lobar ICH.
  • These shared predictors suggest that the acute bleeding in ICH, despite varying underlying small vessel diseases, involves common pathological processes.
Abstract

Keywords:
cerebral amyloid angiopathycerebral small vessel diseasecomputed tomography angiographyhypertensionintracerebral hemorrhagespot sign

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