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Journal of Neurology

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01-10-2018 | Original Communication

The intraventricular-spot sign: prevalence, significance, and relation to hematoma expansion and outcomes

Authors: Omar Hussein, Khalid Sawalha, Mohammad Hamed, Ahmed Abd ElAzim, Lai Wei, Michel T Torbey, Archana Hinduja

Published in: Journal of Neurology | Issue 10/2018

Abstract

Background

The presence of the spot sign on computed tomography angiogram (CTA) is considered a sign of active bleeding, and studies have shown it can predict hematoma expansion in intraparenchymal hemorrhage (IPH). The spot sign in intraventricular hemorrhage (IVH) has not been explored yet. The purpose of this study is to estimate the prevalence of the intraventricular-spot sign, and its prediction of hematoma expansion and clinical outcomes.

Methods

We retrieved data of hemorrhagic stroke patients seen at our medical center from January 2013 to January 2018. A total of 321 subjects were filtered for the prevalence analysis (PA). We further excluded 114 subjects without a follow-up CT-head for the hematoma expansion analysis (HEA). Patients were grouped based on the location of hemorrhage into three groups: isolated IPH with the spot sign always in IPH (i-IPH), isolated IVH with the spot sign always in IVH (i-IVH), and combined IPH and IVH which would be further sub-grouped according to the location of the spot sign: in IPH only (IPH+/IVH) and in IVH only (IPH/IVH+). The prevalence, demographics, and incidence of hematoma expansion were compared between the groups using Pearson’s chi-square test and Student’s t test.

Results

The prevalence of the spot sign was 8, 20, 17, 5% in (i-IPH), (i-IVH), (IPH+/IVH), and (IPH/IVH+) groups, respectively. The rate of hematoma expansion were (42 vs. 13%), (33 vs. 31%), (80 vs. 22%), and (25 vs. 22%) in spot sign positive vs. negative subjects in each group, respectively (p values = 0.023, = 1, <0.001, and = 1).

Conclusion

We studied the prediction of spot sign on hematoma expansion and clinical outcomes in the different subtypes of ICH. Our study showed that spot sign is a good predictor in IPH but not IVH. Despite the rarity of IVH; the prevalence of spot sign was higher in IVH than IPH. This might be due to anatomical and physiological variations.

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Title: The intraventricular-spot sign: prevalence, significance, and relation to hematoma expansion and outcomes
Authors: Omar Hussein
Khalid Sawalha
Mohammad Hamed
Ahmed Abd ElAzim
Lai Wei
Michel T Torbey
Archana Hinduja
Publication date: 01-10-2018
Publisher: Springer Berlin Heidelberg
Published in: Journal of Neurology / Issue 10/2018
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-018-8975-8

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Springer Medicine

The intraventricular-spot sign: prevalence, significance, and relation to hematoma expansion and outcomes

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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