Background: Primary intracerebral haemorrhage occurs in 10-30% of patients with stroke and is the deadliest and disabling type of stroke. Early hematoma expansion is an independent predictor of neurologic worsening and mortality. Early hematoma expansion can be found out by spot sign in CT-Angiography done within 24 hrs .Hematoma expansion and poor outcome is correlated with the size and location of the initial bleeding. Deep haemorrhages are associated with high mortality rates. The spot sign is defined as 1mm to 2mm foci of enhancement within the hematoma on CTA source images typically located in the periphery of the hematomas and suggest the likelihood of expansion. The pathologic basis remains unclear but may represent primary vessel pathology such as micro aneurysms.

Objectives

1) To find out the predictive value of CT-Angiography spot sign with hematoma expansion.

2) To find clinical profile and its relationship with development of spot sign.

Materials and Methods: A prospective study was conducted after obtaining institutional ethical committee clearance. Patients having primary intracerebral haemorrhage were included and analysed according to the Performa. CT angiography spot sign was assessed within in 24 hours after ictus and evaluated for hematoma expansion. 

Results: 52 study subjects were enrolled in the study predominantly males around age group of 40-60 years. There was significant association between Hematoma expansion and Spot sign with (P value <0.001) with positive predictive value of 88 % and specificity of 70%.Calculated Kappa value was 76.71 showed it is a relative good tool for assessment. There was no significant association with any other variables of hematoma expansion except hematoma volume which showed Linear by linear association with p value <0.05. Spot sign frequency seen with moderate to large hematomas.

Conclusion: As in previous studies CT Angiography spot sign was a good independent predictive tool for accessing hematoma expansion with good sensitivity and specificity. In our study spot sign in CT-Angiography was found to be helpful in moderate to large hematomas which are life threatening and require close monitoring of patient condition. However, absence of Spot sign doesn’t rule out hematoma expansion.

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Sujin Koshy

DM Neurology Final Year Resident,

Department of Neurology, PSG Hospitals, Coimbatore