Background: The presence of spot sign on computed tomography angiogram (CTA) source images is a sign of active bleeding and can predict hematoma expansion in intraparenchymal hemorrhage (IPH). The purpose of this study is to estimate the prevalence of spot sign in intraventricular hemorrhage (IVH), whether isolated or combined with IPH, and its prediction of hematoma expansion.
Methods: We retrieved data of hemorrhagic stroke patients seen at our medical center from January 2015 to June 2017- total of 293 patients. We excluded 61 patients who did not have CTA. All medical records were reviewed to obtain the patients demographics and factors associated with hemorrhagic stroke. Patients were grouped into three groups based on the location of hemorrhage-based (IPH, isolated IVH or combined IPH and IVH), and the presence or absence of spot sign in each subgroup was evaluated. The prevalence and rates of hematoma expansion were compared between groups using Pearson chi-square test.
Results: Among 232 subjects included in our analysis, 28 patients (12.1%) had a positive spot sign. A positive spot sign was identified in 11.8% of patients with IPH and 16.4% of patients with combined IPH and IVH. Only 7.8% of patients with isolated IVH had positive spot sign. A total of 68% of patients with a positive spot sign developed hematoma expansion. Among IPH, combined IPH and IVH and isolated IVH groups with a spot sign, 72%, 77% and 100% respectively demonstrated hematoma expansion. On the contrary, 35%, 44% and 31% of patient without a spot sign developed hematoma expansion (P value: <0.0001).
Conclusion: Our study showed that the prevalence of spot sign in intraventricular hemorrhage is comparable to intraparenchymal hemorrhage despite its lower incidence in patients with isolated intraventricular hemorrhage. Nonetheless, spot sign in patients with IVH could be a good predictor of hematoma expansion.