Background and Purpose: The computed tomography angiography (CTA) spot sign is a validated predictor of hematoma expansion and poor outcome in supratentorial intracerebral hemorrhage (ICH), but patients with brainstem ICH have typically been excluded from analyses. We investigated the frequency of spot sign and its relationship with hematoma expansion and outcome in patients with primary pontine hemorrhage (PPH).
Methods: We performed a retrospective analysis of a prospectively collected cohort of consecutive PPH patients who underwent CTA. CTA first pass readings for spot sign presence were analyzed by two trained readers. Baseline and follow-up hematoma volumes on noncontrast CT scans were assessed by semi-automated computer-assisted volumetric analysis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratio and accuracy of spot sign in predicting in-hospital mortality were calculated.
Results: 49 subjects met the inclusion criteria of whom 11 (22.4%) showed a spot sign. In-hospital mortality was higher in spot sign positive versus negative subjects (90.9% vs 47.4%, p=0.020). Spot sign showed excellent specificity (95%) and PPV (91%) in predicting in-hospital mortality. Absolute hematoma growth, defined as parenchymal and intraventricular hematoma expansion of any amount, was significantly higher in spot sign positive versus negative subjects (3.76 ± 8.55 vs 13.72 ± 20.93 mL, p=0.045).
Conclusions: As with supratentorial ICH, spot sign presence is a common finding and is associated with higher risk of hematoma expansion and mortality in PPH.