title: Time course of early postadmission hematoma expansion in spontaneous intracerebral hemorrhage.
abstract: OBJECTIVE
  Early hematoma expansion (EHE) in patients with intracerebral hematoma is a promising treatment target. To date, the time course of EHE has remained poorly described. We prospectively investigated the time course of EHE.
  
  
  METHODS
  We included consecutive patients presenting spontaneous intracerebral hematoma within 4.5 hours. On admission, patients underwent noncontrast computed tomography (CT) and CT angiography. Serial hematoma volume estimations by transcranial B-mode ultrasound were effected through the contralateral transtemporal bone window by obtaining sagittal, transversal, and coronal diameter and calculating the ABC/2-formula. National Institute of Health Stroke Scale and transcranial B-mode ultrasound were performed consecutively every 30 minutes during the first 6 hours and from 6 to 12 hours every 2 hours. Follow-up CT and ultrasound were performed after ≈24 hours.
  
  
  RESULTS
  Twenty-five patients with intracerebral hematoma were included; mean (SD) time from onset to CT was 108.6 (45.7) minutes. Ten (40%) patients had EHE. In patients with a final clinically significant hematoma expansion >12.5 mL, all EHE occurred within 6 hours after admission scan. EHE in spot sign positive patients continued during the first 5 hours after CT angiography. In spot sign-negative patients, no significant EHE was observed (Friedman test, P=0.476). Neurological deterioration occurred in 5 (20%) patients and was well temporally correlated with EHE. Transcranial B-mode ultrasound demonstrated good volume estimation compared with the follow-up CT with a maximum absolute volume deviation within 7 mL and minimal systematic error (mean deviation, 1.3 [confidence interval, -0.1 to 2.6] mL).
  
  
  CONCLUSIONS
  EHE was reliably reflected by transcranial B-mode ultrasound and mainly occurred within the first 7 to 8 hours after symptom onset.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT01472224.
authors.affiliation: From the Department of Neurology (C.O., S.R., H.C.) and Radiology (A.F.C., I.H.), Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark; and Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark (D.W.K.).
authors.forename: Christian
authors.initials: C
authors.lastname: Ovesen
authors.forename: Anders Fogh
authors.initials: AF
authors.lastname: Christensen
authors.forename: Derk W
authors.initials: DW
authors.lastname: Krieger
authors.forename: Sverre
authors.initials: S
authors.lastname: Rosenbaum
authors.forename: Inger
authors.initials: I
authors.lastname: Havsteen
authors.forename: Hanne
authors.initials: H
authors.lastname: Christensen
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D020521:Stroke / Q000000981:diagnostic imaging*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods* / Q000592:standards*
keywords: cerebral hemorrhage; ultrasonography, Doppler, transcranial