title: Risk factors for computed tomography angiography spot sign in deep and lobar intracerebral hemorrhage are shared.
abstract: OBJECTIVE
  Patients with intracerebral hemorrhage (ICH) who present with a spot sign on computed tomography angiography are at increased risk of hematoma expansion and poor outcome. Because primary ICH is the acute manifestation of chronic cerebral small vessel disease, we investigated whether different clinical or imaging characteristics predict spot sign presence, using ICH location as a surrogate for arteriolosclerosis- and cerebral amyloid angiopathy-related ICH.
  
  
  METHODS
  Patients with primary ICH and available computed tomography angiography at presentation were included. Predictors of spot sign were assessed using uni- and multivariable regression, stratified by ICH location.
  
  
  RESULTS
  Seven hundred forty-one patients were eligible, 335 (45%) deep and 406 (55%) lobar ICH. At least one spot sign was present in 76 (23%) deep and 102 (25%) lobar ICH patients. In multivariable regression, warfarin (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.01-5.71; P=0.04), baseline ICH volume (OR, 1.20; 95% CI, 1.09-1.33, per 10 mL increase; P<0.001), and time from symptom onset to computed tomography angiography (OR, 0.89; 95% CI, 0.80-0.96, per hour; P=0.009) were associated with the spot sign in deep ICH. Predictors of spot sign in lobar ICH were warfarin (OR, 3.95; 95% CI, 1.87-8.51; P<0.001) and baseline ICH volume (OR, 1.20; 95% CI, 1.10-1.31, per 10 mL increase; P<0.001).
  
  
  CONCLUSIONS
  The most potent associations with spot sign are shared between deep and lobar ICH, suggesting that the acute bleeding process that arises in the setting of different chronic small vessel diseases shares commonalities.
authors.affiliation: From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.).
authors.forename: Farid
authors.initials: F
authors.lastname: Radmanesh
authors.affiliation: From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.).
authors.forename: Guido J
authors.initials: GJ
authors.lastname: Falcone
authors.affiliation: From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.).
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Anderson
authors.affiliation: From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.).
authors.forename: Thomas W K
authors.initials: TW
authors.lastname: Battey
authors.affiliation: From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.).
authors.forename: Alison M
authors.initials: AM
authors.lastname: Ayres
authors.affiliation: From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.).
authors.forename: Anastasia
authors.initials: A
authors.lastname: Vashkevich
authors.affiliation: From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.).
authors.forename: Kristen A
authors.initials: KA
authors.lastname: McNamara
authors.affiliation: From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.).
authors.forename: Kristin
authors.initials: K
authors.lastname: Schwab
authors.affiliation: From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.).
authors.forename: Javier M
authors.initials: JM
authors.lastname: Romero
authors.affiliation: From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.).
authors.forename: Anand
authors.initials: A
authors.lastname: Viswanathan
authors.affiliation: From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.).
authors.forename: Steven M
authors.initials: SM
authors.lastname: Greenberg
authors.affiliation: From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.).
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Goldstein
authors.affiliation: From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.).
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosand
authors.affiliation: From the Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., J.R., H.B.B.); J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Boston, MA (F.R., G.J.F., C.D.A., T.W.K.B., A.M.A., A. Vashkevich, K.A.M., K.S., A. Viswanathan, S.M.G., J.R., H.B.B.); Departments of Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston, MA; and Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.). brouwers@chgr.mgh.harvard.edu.
authors.forename: H Bart
authors.initials: HB
authors.lastname: Brouwers
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage*; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: cerebral amyloid angiopathy; cerebral small vessel disease; computed tomography angiography; hypertension; intracerebral hemorrhage; spot sign