Jennifer E Soun1, Daniel Montes2, Fang Yu3, Andrea Morotti4, Adnan I Qureshi5,6, Isabelle Barnaure7, Jonathan Rosand8,9, Joshua N Goldstein10, Javier M Romero2. 1. Department of Radiological Sciences, University of California, Irvine, Orange, CA, USA. jesoun@uci.edu. 2. Department of Neuroradiology, Massachusetts General Hospital, Boston, MA, USA. 3. Department of Neuroradiology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 4. Stroke Unit, IRCCS Mondino Foundation, Pavia, Italy. 5. Department of Neurology, Zeenat Qureshi Stroke Institute, St Cloud, MN, USA. 6. Department of Neurology, University of Missouri, Columbia, MO, USA. 7. Division of Neuroradiology, Hôpitaux Universaires de Genève, Geneva, Switzerland. 8. Henry and Allison McCamce Center for Brain Health (JR), Massachusetts General Hospital, Boston, MA, USA. 9. Division of Neurocritical Care and Emergency Neurology (JR), Massachusetts General Hospital, Boston, MA, USA. 10. Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Abstract
PURPOSE: The spot sign is associated with intracerebral hemorrhage (ICH) expansion and neurological decline. However, the relationship of the spot sign to secondary intraventricular hemorrhage (IVH) has not been well established. The presence of the spot sign in secondary IVH may provide information regarding neurologic outcome in a population with known poor prognosis. METHODS: A subset analysis was performed of patients with IVH from the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-II) study, a randomized clinical trial examining the effect of intensive blood pressure reduction on hematoma expansion. The presence of the spot sign was determined on CTA and IVH expansion was measured in the first 24 hours. The primary outcome measure was early neurological decline (END), defined as ≥ 2-point decrease in Glasgow Coma Scale (GCS) score or ≥ 4-point increase in NIH Stroke Scale (NIHSS). Secondary outcomes including various radiological and clinical factors were also measured. RESULTS: Of 57 patients included in this analysis, the spot sign was present in 17 (29.8%). The spot sign was a predictor of END in univariate (P < 0.005 for GCS and P = 0.04 for NIHSS) and multivariate analyses using GCS scores (OR=7.2, CI 1.6 - 32.5, P = 0.01). Median 90 day modified Rankin Scale (mRS) scores were significantly different between spot sign-positive and spot sign-negative groups (P = 0.02). CONCLUSIONS: The presence of the spot sign is associated with END in patients with secondary IVH. Identifying this radiologic feature could have important implications for triaging these patients to the appropriate level of care.
RCT Entities:
PURPOSE: The spot sign is associated with intracerebral hemorrhage (ICH) expansion and neurological decline. However, the relationship of the spot sign to secondary intraventricular hemorrhage (IVH) has not been well established. The presence of the spot sign in secondary IVH may provide information regarding neurologic outcome in a population with known poor prognosis. METHODS: A subset analysis was performed of patients with IVH from the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-II) study, a randomized clinical trial examining the effect of intensive blood pressure reduction on hematoma expansion. The presence of the spot sign was determined on CTA and IVH expansion was measured in the first 24 hours. The primary outcome measure was early neurological decline (END), defined as ≥ 2-point decrease in Glasgow Coma Scale (GCS) score or ≥ 4-point increase in NIH Stroke Scale (NIHSS). Secondary outcomes including various radiological and clinical factors were also measured. RESULTS: Of 57 patients included in this analysis, the spot sign was present in 17 (29.8%). The spot sign was a predictor of END in univariate (P < 0.005 for GCS and P = 0.04 for NIHSS) and multivariate analyses using GCS scores (OR=7.2, CI 1.6 - 32.5, P = 0.01). Median 90 day modified Rankin Scale (mRS) scores were significantly different between spot sign-positive and spot sign-negative groups (P = 0.02). CONCLUSIONS: The presence of the spot sign is associated with END in patients with secondary IVH. Identifying this radiologic feature could have important implications for triaging these patients to the appropriate level of care.
Authors: Jens Witsch; Guido J Falcone; Audrey C Leasure; Charles Matouk; Matthias Endres; Lauren Sansing; Daniel Woo; Kevin N Sheth Journal: Neurocrit Care Date: 2021-01-21 Impact factor: 3.210