Abstract WP437: The CT Angiography Spot Sign, Hematoma Expansion and Functional Outcome in Spontaneous Cerebellar ICH

Abstract

Background: The CT angiography (CTA) spot sign is associated with hematoma expansion, mortality and poor functional outcome in supratentorial and pontine spontaneous intracerebral hemorrhage (ICH). However, no studies are available on the spot sign in patients with spontaneous cerebellar ICH. We therefore aim to assess its association with hematoma expansion and outcome in cerebellar ICH. Methods: We investigated consecutive patients with spontaneous cerebellar ICH treated non-surgically at three academic hospitals between 2002 and 2017. We determined patient characteristics, presence of the CTA spot sign, baseline hematoma volumes, hematoma expansion (>33% or >6ml), speed of expansion (baseline hematoma volume/time onset-CT scan) and in-hospital and 90-day mortality and functional outcome. Associations were tested using uni- and multivariable logistic regression. Results: We included 358 patients with cerebellar ICH of which 181 (51%) underwent a CTA. Of these 181 patients, 60 (33%) were treated surgically and therefore excluded from this study. This resulted in 121 patients of which 15 (12%) had a CTA spot sign. In univariable analyses, patients with a CTA spot sign presented with larger hematoma volumes [median (IQR): 22 (7-41) vs. 6 (3-14), p=0.005], higher rates of hematoma expansion [50% vs. 24%, p=0.167] and higher speed of expansion [median (IQR): 9 (21-2) vs. 2 (5-0), p=0.015]. Patients also had higher mortality at discharge [80% vs. 18%, p=<.001] and 90-days [80% vs. 26%, p=<0.001] and higher rates of poor functional outcome (mRS 4-6) at discharge [93% vs. 63%, p=0.020] and 90-days [93% vs. 53%, p=0.006]. In multivariable analyses correcting for age, sex and speed of expansion, the presence of the CTA spot sign is independently associated with 90-days mortality [OR 3.9, 95%CI 1.5-12.9] and 90-days poor functional outcome [OR 4.1, 95%CI 1.2-21.0]. Conclusions: In patients with spontaneous cerebellar ICH, the CTA spot sign is associated with hematoma expansion, speed of hematoma expansion, mortality, and poor functional outcome. This may assist physicians in the risk stratification of patients with spontaneous cerebellar ICH.