Abstract
We thank Drs. Lattanzi and Silvestrini for their interest in our article.1 Increased blood pressure variability may lead to poor outcome after acute intracerebral hemorrhage (ICH) but a post hoc analysis of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2 (INTERACT2) showed that this association was not mediated by an increased risk of ICH growth.2 Hematoma expansion is a very early event in the natural history of ICH and, therefore, we agree that time is a key factor. Ischemic stroke treatment in mobile stroke units reduces the time from symptom onset to treatment.3 Early identification and treatment of patients with ICH at high risk of hematoma growth may become feasible in the prehospital setting using mobile stroke units equipped with noncontrast CT (NCCT). In a previous analysis, we showed that intrahematoma hypodensities, timing of baseline NCCT, and presence of the CT angiography spot sign predicted ICH expansion independently from each other.4 Further studies are needed to investigate whether the integration of different imaging markers provides additional value in the identification of ICH patients at high risk of hemorrhage growth.
Published Version
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