An above image panel shows an intracerebral hemorrhage (blue arrows) in the right frontal lobe on an unenhanced image; a spot sign (yellow arrow) on a CTA source image; puddling of contrast extravasation (red arrowheads and yellow arrow) on an enhanced image. Unenhanced follow-up CT 6 hours later shows hematoma expansion (blue arrows). The patient underwent hematoma evacuation. Also noted on these images is subdural and subarachnoid hemorrhage.
- 10% - 30% of all stroke
- Outcome worse than ischemic stroke, up to 50% mortality at 30 days
- Causes: hypertension, amyloid angiopathy and anticoagulation
- Pathomechanism - believed to be due to parenchymal microaneurysm with rupture
- Hematoma size
- Hematoma expansion (definition: increase of 33-50% or absolute change in volume between 12.5 to 20 mL of hematoma). Known risks of expansion include antecedent warfarin use and ultra-early presentation
- Definition: one or more 1- to 2-mm foci of enhancement within the hematoma on CT angiography source images
- On a routine enhanced CT scan, if there is an enlargement of contrast density - this is called "contrast extravasation"
- The sign has been described in primary intracerebral hemorrhage; but it could be seen - and termed "spot sign mimics" in cases of secondary intracerebral hemorrhage (i.e. aneurysm, calcification, etc.)
- Independent predictor of hematoma expansion
2. Wada R, Aviv RI, Fox AJ, et al. CT angiography "spot sign" predicts hematoma expansion in acute intracerebral hemorrhage. Stroke 2007;38:1257-1262.