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

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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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Author notes

  1. Omar Hussein and Khalid Sawalha contributed equally as a first author.

Authors and Affiliations

  1. Cerebrovascular and Neurocritical Care Division, Department of Neurology, The Ohio State University Wexner Medical Center, 333 West 10 Avenue, Graves Hall, Columbus, OH, 43210, USA

    Omar Hussein, Khalid Sawalha, Mohammad Hamed, Ahmed Abd ElAzim, Michel T Torbey & Archana Hinduja

  2. Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, USA

    Lai Wei

Authors
  1. Omar Hussein
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  2. Khalid Sawalha
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  3. Mohammad Hamed
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  6. Michel T Torbey
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  7. Archana Hinduja
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Correspondence to Omar Hussein.

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On behalf of all the authors, the corresponding author states that there is no conflict of interest.

Ethical approval

The study has been approved by the International review board at our institution.

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Hussein, O., Sawalha, K., Hamed, M. et al. The intraventricular-spot sign: prevalence, significance, and relation to hematoma expansion and outcomes. J Neurol 265, 2201–2210 (2018). https://doi.org/10.1007/s00415-018-8975-8

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  • DOI: https://doi.org/10.1007/s00415-018-8975-8

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