Computerized tomography angiography contrast extravasation (“spot sign”) in primary acute intracerebral hemorrhage

Abstract

Intracerebral hemorrhage (ICH) is a devastating condition associated with significant mortality due to ongoing hemorrhage and hematoma expansion. Hematoma expansion is highly predictive of neurological deterioration, poor functional outcome, and mortality. The identification and prevention of hematoma expansion are targets in ICH management as such. The CT angiography (CTA) “spot sign” has emerged in recent years as a potent predictor of hematoma expansion, and a potential tool in guiding therapies in both research and clinical care. This clinical case presentation demonstrates that we can with high accuracy visualize the contrast extravasation (so-called “spot sign”), ongoing hemorrhage and predict hematoma expansion in hyper-acute phase of intracerebral bleeding – even in 1 hour after the onset of the symptoms, using computerized angiographic tomography investigation.