Computed Tomography Angiography Spot Sign, Hematoma Expansion, and Functional Outcome in Spontaneous Cerebellar Intracerebral Hemorrhage
The computed tomography angiography spot sign is associated with hematoma expansion, case fatality, and poor functional outcome in spontaneous supratentorial intracerebral hemorrhage (ICH). However, no data are available on the spot sign in spontaneous cerebellar ICH. We investigated consecutive pat...
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| Veröffentlicht in: | Stroke (1970) 2021-09, Vol.52 (9), p.2902-2909 |
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| creator | Singh, Sanjula D. Pasi, Marco Schreuder, Floris H.B.M. Morotti, Andrea Senff, Jasper R. Warren, Andrew D. McKaig, Brenna N. Schwab, Kristin Gurol, M. Edip Rosand, Jonathan Greenberg, Steven M. Viswanathan, Anand Klijn, Catharina J.M. Rinkel, Gabriel J.E. Goldstein, Joshua N. Brouwers, H. Bart |
| description | The computed tomography angiography spot sign is associated with hematoma expansion, case fatality, and poor functional outcome in spontaneous supratentorial intracerebral hemorrhage (ICH). However, no data are available on the spot sign in spontaneous cerebellar ICH.
We investigated consecutive patients with spontaneous cerebellar ICH at 3 academic hospitals between 2002 and 2017. We determined patient characteristics, hematoma expansion (>33% or 6 mL), rate of expansion, discharge and 90-day case fatality, and functional outcome. Poor functional outcome was defined as a modified Rankin Scale score of 4 to 6. Associations were tested using univariable and multivariable logistic regression.
Three hundred fifty-eight patients presented with cerebellar ICH, of whom 181 (51%) underwent a computed tomography angiography. Of these 181 patients, 121 (67%) were treated conservatively of which 15 (12%) had a spot sign. Patients with a spot sign treated conservatively presented with larger hematoma volumes (median [interquartile range]: 26 [7–41] versus 6 [2–13], P=0.001) and higher speed of expansion (median [interquartile range]: 15 [24–3] mL/h versus 1 [5–0] mL/h, P=0.034). In multivariable analysis, presence of the spot sign was independently associated with death at 90 days (odds ratio, 7.6 [95% CI, 1.6–88], P=0.037). With respect to surgically treated patients (n=60, [33%]), 14 (23%) patients who underwent hematoma evacuation had a spot sign. In these 60 patients, patients with a spot sign were older (73.5 [9.2] versus 66.6 [15.4], P=0.047) and more likely to be female (71% versus 37%, P=0.033). In a multivariable analysis, the spot sign was independently associated with death at 90 days (odds ratio, 2.1 [95% CI, 1.1–4.3], P=0.033).
In patients with spontaneous cerebellar ICH treated conservatively, the spot sign is associated with speed of hematoma expansion, case fatality, and poor functional outcome. In surgically treated patients, the spot sign is associated with 90-day case fatality. |
| doi_str_mv | 10.1161/STROKEAHA.120.033297 |
| format | Article |
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We investigated consecutive patients with spontaneous cerebellar ICH at 3 academic hospitals between 2002 and 2017. We determined patient characteristics, hematoma expansion (>33% or 6 mL), rate of expansion, discharge and 90-day case fatality, and functional outcome. Poor functional outcome was defined as a modified Rankin Scale score of 4 to 6. Associations were tested using univariable and multivariable logistic regression.
Three hundred fifty-eight patients presented with cerebellar ICH, of whom 181 (51%) underwent a computed tomography angiography. Of these 181 patients, 121 (67%) were treated conservatively of which 15 (12%) had a spot sign. Patients with a spot sign treated conservatively presented with larger hematoma volumes (median [interquartile range]: 26 [7–41] versus 6 [2–13], P=0.001) and higher speed of expansion (median [interquartile range]: 15 [24–3] mL/h versus 1 [5–0] mL/h, P=0.034). In multivariable analysis, presence of the spot sign was independently associated with death at 90 days (odds ratio, 7.6 [95% CI, 1.6–88], P=0.037). With respect to surgically treated patients (n=60, [33%]), 14 (23%) patients who underwent hematoma evacuation had a spot sign. In these 60 patients, patients with a spot sign were older (73.5 [9.2] versus 66.6 [15.4], P=0.047) and more likely to be female (71% versus 37%, P=0.033). In a multivariable analysis, the spot sign was independently associated with death at 90 days (odds ratio, 2.1 [95% CI, 1.1–4.3], P=0.033).
In patients with spontaneous cerebellar ICH treated conservatively, the spot sign is associated with speed of hematoma expansion, case fatality, and poor functional outcome. In surgically treated patients, the spot sign is associated with 90-day case fatality.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.120.033297</identifier><identifier>PMID: 34126759</identifier><language>eng</language><publisher>United States: Lippincott Williams & Wilkins</publisher><subject>Aged ; Aged, 80 and over ; Cerebellar Diseases - diagnosis ; Cerebellar Diseases - physiopathology ; Cerebral Angiography - methods ; Cerebral Hemorrhage - diagnostic imaging ; Cerebral Hemorrhage - physiopathology ; Computed Tomography Angiography - methods ; Female ; Hematoma - diagnostic imaging ; Hematoma - physiopathology ; Humans ; Logistic Models ; Male ; Middle Aged ; Prognosis ; Tomography, X-Ray Computed - methods</subject><ispartof>Stroke (1970), 2021-09, Vol.52 (9), p.2902-2909</ispartof><rights>Lippincott Williams & Wilkins</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4644-86aef8a39be2fd8b0b74bb8ff35888aa7d9b98bd82da0468da360bf927ceedad3</citedby><cites>FETCH-LOGICAL-c4644-86aef8a39be2fd8b0b74bb8ff35888aa7d9b98bd82da0468da360bf927ceedad3</cites><orcidid>0000-0002-1014-9138 ; 0000-0003-1792-8887 ; 0000-0001-9304-8107 ; 0000-0002-7815-0207 ; 0000-0002-6558-1155 ; 0000-0002-8495-4578 ; 0000-0002-2169-4457 ; 0000-0001-9976-2459</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34126759$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Singh, Sanjula D.</creatorcontrib><creatorcontrib>Pasi, Marco</creatorcontrib><creatorcontrib>Schreuder, Floris H.B.M.</creatorcontrib><creatorcontrib>Morotti, Andrea</creatorcontrib><creatorcontrib>Senff, Jasper R.</creatorcontrib><creatorcontrib>Warren, Andrew D.</creatorcontrib><creatorcontrib>McKaig, Brenna N.</creatorcontrib><creatorcontrib>Schwab, Kristin</creatorcontrib><creatorcontrib>Gurol, M. Edip</creatorcontrib><creatorcontrib>Rosand, Jonathan</creatorcontrib><creatorcontrib>Greenberg, Steven M.</creatorcontrib><creatorcontrib>Viswanathan, Anand</creatorcontrib><creatorcontrib>Klijn, Catharina J.M.</creatorcontrib><creatorcontrib>Rinkel, Gabriel J.E.</creatorcontrib><creatorcontrib>Goldstein, Joshua N.</creatorcontrib><creatorcontrib>Brouwers, H. Bart</creatorcontrib><title>Computed Tomography Angiography Spot Sign, Hematoma Expansion, and Functional Outcome in Spontaneous Cerebellar Intracerebral Hemorrhage</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>The computed tomography angiography spot sign is associated with hematoma expansion, case fatality, and poor functional outcome in spontaneous supratentorial intracerebral hemorrhage (ICH). However, no data are available on the spot sign in spontaneous cerebellar ICH.
We investigated consecutive patients with spontaneous cerebellar ICH at 3 academic hospitals between 2002 and 2017. We determined patient characteristics, hematoma expansion (>33% or 6 mL), rate of expansion, discharge and 90-day case fatality, and functional outcome. Poor functional outcome was defined as a modified Rankin Scale score of 4 to 6. Associations were tested using univariable and multivariable logistic regression.
Three hundred fifty-eight patients presented with cerebellar ICH, of whom 181 (51%) underwent a computed tomography angiography. Of these 181 patients, 121 (67%) were treated conservatively of which 15 (12%) had a spot sign. Patients with a spot sign treated conservatively presented with larger hematoma volumes (median [interquartile range]: 26 [7–41] versus 6 [2–13], P=0.001) and higher speed of expansion (median [interquartile range]: 15 [24–3] mL/h versus 1 [5–0] mL/h, P=0.034). In multivariable analysis, presence of the spot sign was independently associated with death at 90 days (odds ratio, 7.6 [95% CI, 1.6–88], P=0.037). With respect to surgically treated patients (n=60, [33%]), 14 (23%) patients who underwent hematoma evacuation had a spot sign. In these 60 patients, patients with a spot sign were older (73.5 [9.2] versus 66.6 [15.4], P=0.047) and more likely to be female (71% versus 37%, P=0.033). In a multivariable analysis, the spot sign was independently associated with death at 90 days (odds ratio, 2.1 [95% CI, 1.1–4.3], P=0.033).
In patients with spontaneous cerebellar ICH treated conservatively, the spot sign is associated with speed of hematoma expansion, case fatality, and poor functional outcome. In surgically treated patients, the spot sign is associated with 90-day case fatality.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cerebellar Diseases - diagnosis</subject><subject>Cerebellar Diseases - physiopathology</subject><subject>Cerebral Angiography - methods</subject><subject>Cerebral Hemorrhage - diagnostic imaging</subject><subject>Cerebral Hemorrhage - physiopathology</subject><subject>Computed Tomography Angiography - methods</subject><subject>Female</subject><subject>Hematoma - diagnostic imaging</subject><subject>Hematoma - physiopathology</subject><subject>Humans</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Prognosis</subject><subject>Tomography, X-Ray Computed - methods</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkc2O0zAUhS0EYsrAGyDkJQtS_NfEXlZVh44YqRIta-s6dtpAEgfb0TBvwGPj0JlhZR_rnOOr-yH0npIlpSX9fDh-23_drnfrJWVkSThnqnqBFnTFRCFKJl-iBSFcFUwodYXexPiDEMK4XL1GV1xQVlYrtUB_Nr4fp-QsPvrenwKM5we8Hk7t0_0w-oQP7Wn4hHeuh-R7wNvfIwyx9fkNBotvpqFOWUGH91Oqfe9wO8zBIcHg_BTxxgVnXNdBwLdDClDPOmR_rvQhnOHk3qJXDXTRvXs8r9H3m-1xsyvu9l9uN-u7ohalEIUswTUSuDKONVYaYiphjGwavpJSAlRWGSWNlcwCEaW0wEtiGsWq2jkLll-jj5feMfhfk4tJ922s59n-jarZSlBOVd5ntoqLtQ4-xuAaPYa2h_CgKdEzA_3MQGcG-sIgxz48_jCZ3tnn0NPS__fe-y65EH92070L-uygS2edKZGqrEjBCKNEZVXM4AT_C6UPlms</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Singh, Sanjula D.</creator><creator>Pasi, Marco</creator><creator>Schreuder, Floris H.B.M.</creator><creator>Morotti, Andrea</creator><creator>Senff, Jasper R.</creator><creator>Warren, Andrew D.</creator><creator>McKaig, Brenna N.</creator><creator>Schwab, Kristin</creator><creator>Gurol, M. 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Bart</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1014-9138</orcidid><orcidid>https://orcid.org/0000-0003-1792-8887</orcidid><orcidid>https://orcid.org/0000-0001-9304-8107</orcidid><orcidid>https://orcid.org/0000-0002-7815-0207</orcidid><orcidid>https://orcid.org/0000-0002-6558-1155</orcidid><orcidid>https://orcid.org/0000-0002-8495-4578</orcidid><orcidid>https://orcid.org/0000-0002-2169-4457</orcidid><orcidid>https://orcid.org/0000-0001-9976-2459</orcidid></search><sort><creationdate>20210901</creationdate><title>Computed Tomography Angiography Spot Sign, Hematoma Expansion, and Functional Outcome in Spontaneous Cerebellar Intracerebral Hemorrhage</title><author>Singh, Sanjula D. ; Pasi, Marco ; Schreuder, Floris H.B.M. ; Morotti, Andrea ; Senff, Jasper R. ; Warren, Andrew D. ; McKaig, Brenna N. ; Schwab, Kristin ; Gurol, M. 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Edip</creatorcontrib><creatorcontrib>Rosand, Jonathan</creatorcontrib><creatorcontrib>Greenberg, Steven M.</creatorcontrib><creatorcontrib>Viswanathan, Anand</creatorcontrib><creatorcontrib>Klijn, Catharina J.M.</creatorcontrib><creatorcontrib>Rinkel, Gabriel J.E.</creatorcontrib><creatorcontrib>Goldstein, Joshua N.</creatorcontrib><creatorcontrib>Brouwers, H. Bart</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Singh, Sanjula D.</au><au>Pasi, Marco</au><au>Schreuder, Floris H.B.M.</au><au>Morotti, Andrea</au><au>Senff, Jasper R.</au><au>Warren, Andrew D.</au><au>McKaig, Brenna N.</au><au>Schwab, Kristin</au><au>Gurol, M. Edip</au><au>Rosand, Jonathan</au><au>Greenberg, Steven M.</au><au>Viswanathan, Anand</au><au>Klijn, Catharina J.M.</au><au>Rinkel, Gabriel J.E.</au><au>Goldstein, Joshua N.</au><au>Brouwers, H. Bart</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Computed Tomography Angiography Spot Sign, Hematoma Expansion, and Functional Outcome in Spontaneous Cerebellar Intracerebral Hemorrhage</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2021-09-01</date><risdate>2021</risdate><volume>52</volume><issue>9</issue><spage>2902</spage><epage>2909</epage><pages>2902-2909</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><abstract>The computed tomography angiography spot sign is associated with hematoma expansion, case fatality, and poor functional outcome in spontaneous supratentorial intracerebral hemorrhage (ICH). However, no data are available on the spot sign in spontaneous cerebellar ICH.
We investigated consecutive patients with spontaneous cerebellar ICH at 3 academic hospitals between 2002 and 2017. We determined patient characteristics, hematoma expansion (>33% or 6 mL), rate of expansion, discharge and 90-day case fatality, and functional outcome. Poor functional outcome was defined as a modified Rankin Scale score of 4 to 6. Associations were tested using univariable and multivariable logistic regression.
Three hundred fifty-eight patients presented with cerebellar ICH, of whom 181 (51%) underwent a computed tomography angiography. Of these 181 patients, 121 (67%) were treated conservatively of which 15 (12%) had a spot sign. Patients with a spot sign treated conservatively presented with larger hematoma volumes (median [interquartile range]: 26 [7–41] versus 6 [2–13], P=0.001) and higher speed of expansion (median [interquartile range]: 15 [24–3] mL/h versus 1 [5–0] mL/h, P=0.034). In multivariable analysis, presence of the spot sign was independently associated with death at 90 days (odds ratio, 7.6 [95% CI, 1.6–88], P=0.037). With respect to surgically treated patients (n=60, [33%]), 14 (23%) patients who underwent hematoma evacuation had a spot sign. In these 60 patients, patients with a spot sign were older (73.5 [9.2] versus 66.6 [15.4], P=0.047) and more likely to be female (71% versus 37%, P=0.033). In a multivariable analysis, the spot sign was independently associated with death at 90 days (odds ratio, 2.1 [95% CI, 1.1–4.3], P=0.033).
In patients with spontaneous cerebellar ICH treated conservatively, the spot sign is associated with speed of hematoma expansion, case fatality, and poor functional outcome. In surgically treated patients, the spot sign is associated with 90-day case fatality.</abstract><cop>United States</cop><pub>Lippincott Williams & Wilkins</pub><pmid>34126759</pmid><doi>10.1161/STROKEAHA.120.033297</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-1014-9138</orcidid><orcidid>https://orcid.org/0000-0003-1792-8887</orcidid><orcidid>https://orcid.org/0000-0001-9304-8107</orcidid><orcidid>https://orcid.org/0000-0002-7815-0207</orcidid><orcidid>https://orcid.org/0000-0002-6558-1155</orcidid><orcidid>https://orcid.org/0000-0002-8495-4578</orcidid><orcidid>https://orcid.org/0000-0002-2169-4457</orcidid><orcidid>https://orcid.org/0000-0001-9976-2459</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Aged Aged, 80 and over Cerebellar Diseases - diagnosis Cerebellar Diseases - physiopathology Cerebral Angiography - methods Cerebral Hemorrhage - diagnostic imaging Cerebral Hemorrhage - physiopathology Computed Tomography Angiography - methods Female Hematoma - diagnostic imaging Hematoma - physiopathology Humans Logistic Models Male Middle Aged Prognosis Tomography, X-Ray Computed - methods |
| title | Computed Tomography Angiography Spot Sign, Hematoma Expansion, and Functional Outcome in Spontaneous Cerebellar Intracerebral Hemorrhage |
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