The spot sign predicts hematoma expansion, outcome, and mortality in patients with primary intracerebral hemorrhage.
OBJECTIVE
The purpose of this study was to retrospectively review cases of intracerebral hemorrhage (ICH) medically treated at our institution to determine if the CT angiography (CTA) 'spot sign' predicts in-hospital mortality and clinical outcome at 3 months in patients with spontaneous ICH.


METHODS
We conducted a retrospective review of all consecutive patients who were admitted to the department of neurosurgery. Clinical data of patients with ICH were collected by 2 neurosurgeons blinded to the radiological data and at the 90-day follow-up.


RESULTS
Multivariate logistic regression analysis identified predictors of poor outcome; we found that hematoma location, spot sign, and intraventricular hemorrhage were independent predictors of poor outcome. In-hospital mortality was 57.4% (35 of 61) in the CTA spot-sign positive group versus 7.9% (10 of 126) in the CTA spot-sign negative group. In multivariate logistic analysis, we found that presence of spot sign and presence of volume expansion were independent predictors for the in-hospital mortality of ICH.


CONCLUSIONS
The spot sign is a strong independent predictor of hematoma expansion, mortality, and poor clinical outcome in primary ICH. In this study, we emphasized the importance of hematoma expansion as a therapeutic target in both clinical practice and research.
Department of Neurosurgery, Chonbuk National University Hospital and Medical School, Jeonju, Korea.
Ju-Hee
JH
Han
Department of Neurosurgery, Chonbuk National University Hospital and Medical School, Jeonju, Korea.
Jong-Myong
JM
Lee
Department of Neurosurgery, Chonbuk National University Hospital and Medical School, Jeonju, Korea.
Eun-Jeong
EJ
Koh
Department of Neurosurgery, Chonbuk National University Hospital and Medical School, Jeonju, Korea.
Ha-Young
HY
Choi
Intracerebral hemorrhage; Mortality; Outcome; Spot sign