Assessing the use of contrast CT in intracerebral hemorrhage

Intracerebral hemorrhage (ICH) is the deadliest stroke sub-type and currently has no disease-specific treatment. As bleeding continues early in the course of ICH, early hemostatic therapy may be an effective treatment option. However, reliable predictors for ICH expansion are crucial for guiding intervention. One potential predictor is the "spot sign" test, which is identified through computed tomography angiography (CTA) as small, enhancing foci of bleeding. This test has shown promise in predicting hematoma expansion. However, recent clinical trials have failed to confirm its predictive value. It is essential to evaluate the spot sign's utility in clinical practice and assess the safety of CTA imaging in ICH patients. This may help create accurate models for determining the effectiveness of ultra-early hemostatic interventions and ensure diagnostic safety. In this article, we review the literature on hemostatic and thrombotic processes following the infusion of iodinated contrast media during CTA testing. Understanding these processes may help evaluate utility of contrast CT in diagnosis of intracerebral hemorrhage.