Early hematoma expansion in primary intracerebral hemorrhage: incidence and predictors

Hany Hamed Abd Elhady Helal,Mohammed Osman Rabie,Azza Abbas Ghali,Wafik Said Bahnasy

doi:10.1186/s41983-019-0108-5

Hany Hamed Abd Elhady Helal, Mohammed Osman Rabie + Show 2 more

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https://doi.org/10.1186/s41983-019-0108-5

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Abstract

BackgroundHematoma expansion (HE) is the leading cause of early neurological deterioration, poor functional outcome, and increased mortality in patients with spontaneous intracerebral hemorrhage (S-ICH). The study aimed to estimate the risks and predictors of early HE in patients with S-ICH and the effect of this HE on patient’s survival and functional outcome.MethodsThis study was carried out on 72 patients with S-ICH submitted to baseline non-contrast brain CT (NCCT) and CT angiography for determination of hematoma site, size, border irregularity, blend sign, and spot sign score (SSS). Rescan was done 48 h after stroke onset or on clinical deterioration to resize the HV and diagnose HE. Modified Rankin Scale (MRS) was done 3 months after stroke onset to assess the effect of HE on patients’ physical dependence.ResultsHE occurred in 28/72 (38.9%) of included patients. Risks of HE included old age, smoking, elevated baseline mean arterial blood pressure, and high admission modified National Institute of Health stroke scale. NCCT predictors of HE included large volume, irregular border, and presence of blend sign. The presence of spot sign in early CTA is more accurate than NCCT predictors with 54%, 91%, 79%, and 75% for sensitivity, specificity, positive predictive value, and negative predictive value, respectively.ConclusionsHE is a major cause of early clinical deterioration, increased mortality, and poor functional outcome. Early CTA for detection of spot sign is indicated in patients with large volume, irregular border, and/or blend sign in NCCT.

Highlights

Spontaneous intracerebral hemorrhage (S-Intracerebral hemorrhage (ICH)) is defined as rapidly developing neurological signs attributable to a focal collection of blood within the brain parenchyma and/or the ventricular system that is not caused by trauma [1]
Contrast leakage during CT angiography (CTA) inside the hematoma resulted in spot sign that had been extensively researched and seems to be a promising early predictor of Hematoma expansion (HE) which could be relied on updating ICH early intervention before irreversible cerebral damage takes place [6]
The results of the present study revealed that HE occurred in approximately 40% of spontaneous intracerebral hemorrhage (S-ICH) patients who were subjected to higher mortality, increased degree of disabilities, and lower functional independence than those who did not develop HE

Summary

Introduction

Spontaneous intracerebral hemorrhage (S-ICH) is defined as rapidly developing neurological signs attributable to a focal collection of blood within the brain parenchyma and/or the ventricular system that is not caused by trauma [1]. It is the second most common type of stroke accounting for 10–15% of cases and usually carries high risks of severe functional disability and mortality [2]. Hematoma expansion (HE) is the leading cause of early neurological deterioration, poor functional outcome, and increased mortality in patients with spontaneous intracerebral hemorrhage (S-ICH). The study aimed to estimate the risks and predictors of early HE in patients with S-ICH and the effect of this HE on patient’s survival and functional outcome

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