title: Computed tomography angiography spot sign does not predict case fatality in aneurysmal subarachnoid hemorrhage with intraparenchymal extension.
abstract: OBJECTIVE
  Many patients with aneurysmal subarachnoid hemorrhage (SAH) with intraparenchymal extension develop early hematoma expansion, which is not explained by aneurysmal rerupture in half of cases. In patients with primary intracerebral hemorrhage, the computed tomography angiography (CTA) spot sign predicts hematoma expansion and poor outcome. We conducted a 2-center prospective cohort study to evaluate whether CTA spot sign predicts case fatality in aneurysmal subarachnoid hemorrhage with intraparenchymal extension.
  
  
  METHODS
  We studied consecutive patients with aneurysmal subarachnoid hemorrhage with intraparenchymal extension. Two experienced readers, blinded to clinical data, analyzed CTAs for spot sign presence. We assessed the proportion of patients with the CTA spot sign and tested its association with in-hospital and 90-day case fatality, using univariable and multivariable logistic regression.
  
  
  RESULTS
  In 32 of 236 patients (14%), we found at least 1 spot sign. Acute surgical hematoma evacuation with aneurysm occlusion occurred in 120 patients (51%). The overall in-hospital case fatality rate was 37%. The CTA spot sign was not associated with in-hospital (multivariable odds ratio, 0.51 [95% confidence interval, 0.06-3.26]) or 90-day (multivariable odds ratio, 0.59 [0.21-1.65]) case fatality.
  
  
  CONCLUSIONS
  The found frequency of CTA spot signs is lower after aneurysmal than primary intracerebral hemorrhage and is not associated with in-hospital or 90-day case fatality in patients with aneurysmal subarachnoid hemorrhage with intraparenchymal extension.
authors.affiliation: Center for Human Genetic Research-Rosand Lab, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge St, CPZN-6818, Boston, MA 02114, USA. brouwers@chgr.mgh.harvard.edu
authors.forename: H Bart
authors.initials: HB
authors.lastname: Brouwers
authors.forename: Daan
authors.initials: D
authors.lastname: Backes
authors.forename: W Taylor
authors.initials: WT
authors.lastname: Kimberly
authors.forename: Kristin
authors.initials: K
authors.lastname: Schwab
authors.forename: Javier M
authors.initials: JM
authors.lastname: Romero
authors.forename: Birgitta K
authors.initials: BK
authors.lastname: Velthuis
authors.forename: Catharina J M
authors.initials: CJ
authors.lastname: Klijn
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Ogilvy
authors.forename: Luca
authors.initials: L
authors.lastname: Regli
authors.forename: Steven M
authors.initials: SM
authors.lastname: Greenberg
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.forename: Gabriel J E
authors.initials: GJ
authors.lastname: Rinkel
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D015331:Cohort Studies; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000401:mortality*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed
keywords: CTA spot sign; in-hospital death; intracerebral hemorrhage; subarachnoid hemorrhage