Abstract TP39: Delayed CT "Swirl Sign" Predicts Outcome in Intracerebral Hemorrhage.

Abstract

BACKGROUND: “Swirl sign” on an initial CT scan indicates ongoing hemorrhage in a hematoma and has been associated with increased mortality. OBJECTIVE: To assess CT swirl sign(CTSS) for predicting outcome in acute primary intracerebral hemorrhage. METHODS: Acute ICH patients within 24 hours of symptom onset were recruited. Baseline Non contrast and contrast enhanced CT scan and CT angiography of the brain was done. Follow up CT(FU CT) scan was done 24 hours from baseline.Hematoma volume(HV), CT spot and swirl sign were assessed. All patients were managed as per standard guidelines. Outcome assessment with modified rankin scale(mRS) was carried out at 1 month and 3 months RESULTS: 25 patients were recruited.Mean age was 52.44+11.35years,72% males, time from symptom onset ranged from 180-990 mins (mean-499 mins), GCS range 7-15 ,NIHSS range 6-33 (Mean 19.76), Mean systolic, diastolic and mean arterial pressures at baseline were 186.40 ,108.72 and 134.32 mm Hg. 10 (40%) had hematoma expansion (HE; > 33% increase in hematoma volume on FU CT). Mortality was 36% (9). Prevalence of CT spot sign was 4% . CTSS at baseline and follow-up was 24% (6)and 32%(8) respectively. 87.5% with delayed CTSS had a poor outcome (mRS>2). Delayed CTSS was associated with increased early mortality (1 month) (p = 0.005) and poor outcome at 3 months (p=0.03). CONCLUSION: Delayed CT Swirl sign (>24 hours) is a predictor of mortality and outcomes in acute primary supratentorial intracerebral hemorrhage. It may serve as a marker for aggressive BP lowering even in patients presenting after 6-8 hours