Farid Radmanesh1, Guido J Falcone1, Christopher D Anderson1, Thomas W K Battey1, Alison M Ayres1, Anastasia Vashkevich1, Kristen A McNamara1, Kristin Schwab1, Javier M Romero1, Anand Viswanathan1, Steven M Greenberg1, Joshua N Goldstein1, Jonathan Rosand1, H Bart Brouwers2. 1. From 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.). 2. From 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.). brouwers@chgr.mgh.harvard.edu.
Abstract
BACKGROUND AND PURPOSE: Patients with intracerebral hemorrhage (ICH) who present with a spot sign on computed tomography angiography are at increased risk of hematoma expansion and poor outcome. Because primary ICH is the acute manifestation of chronic cerebral small vessel disease, we investigated whether different clinical or imaging characteristics predict spot sign presence, using ICH location as a surrogate for arteriolosclerosis- and cerebral amyloid angiopathy-related ICH. METHODS: Patients with primary ICH and available computed tomography angiography at presentation were included. Predictors of spot sign were assessed using uni- and multivariable regression, stratified by ICH location. RESULTS: Seven hundred forty-one patients were eligible, 335 (45%) deep and 406 (55%) lobar ICH. At least one spot sign was present in 76 (23%) deep and 102 (25%) lobar ICH patients. In multivariable regression, warfarin (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.01-5.71; P=0.04), baseline ICH volume (OR, 1.20; 95% CI, 1.09-1.33, per 10 mL increase; P<0.001), and time from symptom onset to computed tomography angiography (OR, 0.89; 95% CI, 0.80-0.96, per hour; P=0.009) were associated with the spot sign in deep ICH. Predictors of spot sign in lobar ICH were warfarin (OR, 3.95; 95% CI, 1.87-8.51; P<0.001) and baseline ICH volume (OR, 1.20; 95% CI, 1.10-1.31, per 10 mL increase; P<0.001). CONCLUSIONS: The most potent associations with spot sign are shared between deep and lobar ICH, suggesting that the acute bleeding process that arises in the setting of different chronic small vessel diseases shares commonalities.
BACKGROUND AND PURPOSE:Patients with intracerebral hemorrhage (ICH) who present with a spot sign on computed tomography angiography are at increased risk of hematoma expansion and poor outcome. Because primary ICH is the acute manifestation of chronic cerebral small vessel disease, we investigated whether different clinical or imaging characteristics predict spot sign presence, using ICH location as a surrogate for arteriolosclerosis- and cerebral amyloid angiopathy-related ICH. METHODS:Patients with primary ICH and available computed tomography angiography at presentation were included. Predictors of spot sign were assessed using uni- and multivariable regression, stratified by ICH location. RESULTS: Seven hundred forty-one patients were eligible, 335 (45%) deep and 406 (55%) lobar ICH. At least one spot sign was present in 76 (23%) deep and 102 (25%) lobar ICHpatients. In multivariable regression, warfarin (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.01-5.71; P=0.04), baseline ICH volume (OR, 1.20; 95% CI, 1.09-1.33, per 10 mL increase; P<0.001), and time from symptom onset to computed tomography angiography (OR, 0.89; 95% CI, 0.80-0.96, per hour; P=0.009) were associated with the spot sign in deep ICH. Predictors of spot sign in lobar ICH were warfarin (OR, 3.95; 95% CI, 1.87-8.51; P<0.001) and baseline ICH volume (OR, 1.20; 95% CI, 1.10-1.31, per 10 mL increase; P<0.001). CONCLUSIONS: The most potent associations with spot sign are shared between deep and lobar ICH, suggesting that the acute bleeding process that arises in the setting of different chronic small vessel diseases shares commonalities.
Authors: Andrew M Demchuk; Dar Dowlatshahi; David Rodriguez-Luna; Carlos A Molina; Yolanda Silva Blas; Imanuel Dzialowski; Adam Kobayashi; Jean-Martin Boulanger; Cheemun Lum; Gord Gubitz; Vasantha Padma; Jayanta Roy; Carlos S Kase; Jayme Kosior; Rohit Bhatia; Sarah Tymchuk; Suresh Subramaniam; David J Gladstone; Michael D Hill; Richard I Aviv Journal: Lancet Neurol Date: 2012-03-08 Impact factor: 44.182
Authors: Dar Dowlatshahi; Jason K Wasserman; Franco Momoli; William Petrcich; Grant Stotts; Matthew Hogan; Mukul Sharma; Richard I Aviv; Andrew M Demchuk; Santanu Chakraborty Journal: Stroke Date: 2013-10-31 Impact factor: 7.914
Authors: H Bart Brouwers; Alessandro Biffi; Kristen A McNamara; Alison M Ayres; Valerie Valant; Kristin Schwab; Javier M Romero; Anand Viswanathan; Steven M Greenberg; Jonathan Rosand; Joshua N Goldstein Journal: Stroke Date: 2012-05-23 Impact factor: 7.914
Authors: J N Goldstein; L E Fazen; R Snider; K Schwab; S M Greenberg; E E Smith; M H Lev; J Rosand Journal: Neurology Date: 2007-03-20 Impact factor: 9.910
Authors: Josser E Delgado Almandoz; Albert J Yoo; Michael J Stone; Pamela W Schaefer; Joshua N Goldstein; Jonathan Rosand; Alexandra Oleinik; Michael H Lev; R Gilberto Gonzalez; Javier M Romero Journal: Stroke Date: 2009-07-02 Impact factor: 7.914
Authors: Sharyl R Martini; Matthew L Flaherty; W Mark Brown; Mary Haverbusch; Mary E Comeau; Laura R Sauerbeck; Brett M Kissela; Ranjan Deka; Dawn O Kleindorfer; Charles J Moomaw; Joseph P Broderick; Carl D Langefeld; Daniel Woo Journal: Neurology Date: 2012-11-21 Impact factor: 9.910
Authors: Andrea Morotti; H Bart Brouwers; Javier M Romero; Michael J Jessel; Anastasia Vashkevich; Kristin Schwab; Mohammad Rauf Afzal; Christy Cassarly; Steven M Greenberg; Renee Hebert Martin; Adnan I Qureshi; Jonathan Rosand; Joshua N Goldstein Journal: JAMA Neurol Date: 2017-08-01 Impact factor: 18.302
Authors: Sandro Marini; William J Devan; Farid Radmanesh; Laura Miyares; Timothy Poterba; Björn M Hansen; Bo Norrving; Jordi Jimenez-Conde; Eva Giralt-Steinhauer; Roberto Elosua; Elisa Cuadrado-Godia; Carolina Soriano; Jaume Roquer; Christina E Kourkoulis; Alison M Ayres; Kristin Schwab; David L Tirschwell; Magdy Selim; Devin L Brown; Scott L Silliman; Bradford B Worrall; James F Meschia; Chelsea S Kidwell; Joan Montaner; Israel Fernandez-Cadenas; Pilar Delgado; Steven M Greenberg; Arne Lindgren; Charles Matouk; Kevin N Sheth; Daniel Woo; Christopher D Anderson; Jonathan Rosand; Guido J Falcone Journal: Stroke Date: 2018-06-18 Impact factor: 7.914
Authors: Andrea Morotti; Gregoire Boulouis; Andreas Charidimou; Kristin Schwab; Christina Kourkoulis; Christopher D Anderson; M Edip Gurol; Anand Viswanathan; Javier M Romero; Steven M Greenberg; Jonathan Rosand; Joshua N Goldstein Journal: Stroke Date: 2018-09 Impact factor: 7.914
Authors: A Morotti; J M Romero; M J Jessel; H B Brouwers; R Gupta; K Schwab; A Vashkevich; A Ayres; C D Anderson; M E Gurol; A Viswanathan; S M Greenberg; J Rosand; J N Goldstein Journal: AJNR Am J Neuroradiol Date: 2016-05-19 Impact factor: 3.825
Authors: Vignan Yogendrakumar; Andrew M Demchuk; Richard I Aviv; David Rodriguez-Luna; Carlos A Molina; Yolanda S Blas; Imanuel Dzialowski; Adam Kobayashi; Jean-Martin Boulanger; Cheemun Lum; Gord Gubitz; Vasantha Padma; Jayanta Roy; Carlos S Kase; Rohit Bhatia; Michael D Hill; Dar Dowlatshahi Journal: Eur Stroke J Date: 2017-06-15
Authors: Andrea Morotti; Andreas Charidimou; Chia-Ling Phuah; Michael J Jessel; Kristin Schwab; Alison M Ayres; Javier M Romero; Anand Viswanathan; M Edip Gurol; Steven M Greenberg; Christopher D Anderson; Jonathan Rosand; Joshua N Goldstein Journal: JAMA Neurol Date: 2016-11-01 Impact factor: 18.302