Dar Dowlatshahi1, Vignan Yogendrakumar2, Richard I Aviv3, David Rodriguez-Luna4, Carlos A Molina4, Yolanda Silva5, Imanuel Dzialowski6, Anna Czlonkowska7, Jean-Martin Boulanger8, Cheemun Lum9, Gord Gubitz10, Vasantha Padma11, Jayanta Roy12, Carlos S Kase13, Rohit Bhatia11, Michael D Hill14, Andrew M Demchuk14. 1. Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada ddowlat@toh.on.ca. 2. Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada. 3. Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. 4. Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain. 5. Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona (IDIBGi) Foundation, Girona, Spain. 6. Department of Neurology, Elblandklinikum Meissen Academic Teaching Hospital of the Technische University, Dresden, Germany. 7. 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland. 8. Department of Medicine, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, Canada. 9. Department of Diagnostic Imaging, Neuroradiology Section, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada. 10. Department of Neurology, Dalhousie University, Halifax, Canada. 11. Department of Neurology, All India Institute of Medical Sciences, New Delhi, India. 12. AMRI Neurosciences Center, Mukundapurz, Kolkata, India. 13. Department of Neurology, Boston Medical Center, Boston, USA. 14. Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada Calgary Stroke Program, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
Abstract
BACKGROUND: Hematoma expansion is a major predictor of morbidity and mortality after intracerebral hemorrhage (ICH). Both baseline hematoma volume and the CT-angiogram (CTA) spot sign predict hematoma expansion. Because the CTA spot sign may represent foci of active hemorrhage, we hypothesized that patients with smaller baseline hematoma volumes are less likely to be spot sign positive, and therefore less likely to expand. AIM: We sought to validate our prior finding that small hematomas are unlikely to expand, and to determine the relationship between baseline hematoma volume, spot sign status, and risk of hematoma expansion. METHODS: Data were from the prospective PREDICT ICH study. Patients presenting within 6 h of symptom onset with completed baseline CT, CTA, and follow-up CT were included. Baseline hematoma volume was categorized a priori (<3 mL, 3-10 mL, 10-20 mL, >20 mL). The primary outcome was significant hematoma expansion (≥6 mL, ≥12.5 mL or ≥33%) and secondary outcomes were early neurological worsening, good clinical outcome (modified Rankin Scale 0-3), and mortality at 90 days. RESULTS: Among 315 patients meeting the inclusion criteria, baseline hematoma volume category predicted absolute hematoma expansion (p < 0.001), spot sign prevalence (p < 0.001), early neurologic worsening (p = 0.002), clinical outcome (p < 0.001), and mortality (p < 0.001). Very small hematomas (<3 mL) were unlikely to be spot positive (7.7%), unlikely to expand (2.6%), and were associated with a 73% chance of good clinical outcome. Spot sign appeared to be most predictive of expansion in the 3-10 mL baseline hematoma volume category. CONCLUSION: Very small hematomas are unlikely to expand and have a low spot sign prevalence. Hemostatic therapy trials may be best targeted at hemorrhages >3 mL in volume.
BACKGROUND:Hematoma expansion is a major predictor of morbidity and mortality after intracerebral hemorrhage (ICH). Both baseline hematoma volume and the CT-angiogram (CTA) spot sign predict hematoma expansion. Because the CTA spot sign may represent foci of active hemorrhage, we hypothesized that patients with smaller baseline hematoma volumes are less likely to be spot sign positive, and therefore less likely to expand. AIM: We sought to validate our prior finding that small hematomas are unlikely to expand, and to determine the relationship between baseline hematoma volume, spot sign status, and risk of hematoma expansion. METHODS: Data were from the prospective PREDICT ICH study. Patients presenting within 6 h of symptom onset with completed baseline CT, CTA, and follow-up CT were included. Baseline hematoma volume was categorized a priori (<3 mL, 3-10 mL, 10-20 mL, >20 mL). The primary outcome was significant hematoma expansion (≥6 mL, ≥12.5 mL or ≥33%) and secondary outcomes were early neurological worsening, good clinical outcome (modified Rankin Scale 0-3), and mortality at 90 days. RESULTS: Among 315 patients meeting the inclusion criteria, baseline hematoma volume category predicted absolute hematoma expansion (p < 0.001), spot sign prevalence (p < 0.001), early neurologic worsening (p = 0.002), clinical outcome (p < 0.001), and mortality (p < 0.001). Very small hematomas (<3 mL) were unlikely to be spot positive (7.7%), unlikely to expand (2.6%), and were associated with a 73% chance of good clinical outcome. Spot sign appeared to be most predictive of expansion in the 3-10 mL baseline hematoma volume category. CONCLUSION: Very small hematomas are unlikely to expand and have a low spot sign prevalence. Hemostatic therapy trials may be best targeted at hemorrhages >3 mL in volume.
Authors: Gregoire Boulouis; Andrea Morotti; Andreas Charidimou; Dar Dowlatshahi; Joshua N Goldstein Journal: Stroke Date: 2017-03-13 Impact factor: 7.914
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: Vignan Yogendrakumar; Tim Ramsay; Dean A Fergusson; Andrew M Demchuk; Richard I Aviv; David Rodriguez-Luna; Carlos A Molina; Yolanda Silva Blas; Imanuel Dzialowski; Adam Kobayashi; Jean-Martin Boulanger; Cheemun Lum; Gord Gubitz; Padma Srivastava; Jayanta Roy; Carlos S Kase; Rohit Bhatia; Michael D Hill; Magdy Selim; Dar Dowlatshahi Journal: Neurocrit Care Date: 2019-08 Impact factor: 3.210
Authors: Jochen A Sembill; Joji B Kuramatsu; Stefan T Gerner; Maximilian I Sprügel; Sebastian S Roeder; Dominik Madžar; Manuel Hagen; Philip Hoelter; Hannes Lücking; Arnd Dörfler; Stefan Schwab; Hagen B Huttner Journal: Ann Clin Transl Neurol Date: 2020-03-04 Impact factor: 4.511