Can a Non-Contrast CT Scan of Brain Predict Hematoma Expansion in Acute Intracerebral Hemorrhage?
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IMAGES IN SURGERY
Can a Non-Contrast CT Scan of Brain Predict Hematoma Expansion in Acute Intracerebral Hemorrhage? Ripenmeet Salhotra 1 Received: 8 May 2019 / Accepted: 21 February 2020 # Association of Surgeons of India 2020
Abstract A 52-year-old male presented with acute intracerebral hemorrhage. The non-contrast CT scan of brain was suggestive of the “CT blend sign” which predicts early hematoma expansion and poor prognosis. Despite appropriate management, hematoma growth was seen in repeat CT scan of brain. Other signs which predict hematoma growth are swirl sign, black hole sign, and fluid levels on non-contrast CT scan and spot sign on contrast-enhanced CT scan. Keywords Neurosurgery . Intracerebral hemorrhage . Blend sign . Radiology
Case Presentation
Discussion
A 52-year-old hypertensive male was admitted with acute onset headache followed by a fall in sensorium and decreased movement of right side of body after 2 h. An urgent non-contrast CT scan of brain was suggestive of a left parieto-temporal hematoma (max diameter 3.4 cm) (Fig. 1), showing a peculiar pattern of hemorrhage density heterogeneity known as “CT blend sign.” It is characterized by blending of relatively hypodense and hyperdense regions, lying adjacent to each other, with well-defined margins between them. The patient was treated with intravenous anti-hypertensives and other supportive care. His sensorium however dipped in the next 6 h. A repeat CT scan of brain performed at this time showed increase in size of hematoma (max diameter 5.1 cm) (Fig. 2). Patient was managed conservatively with good recovery over the next week.
The CT blend sign has previously demonstrated a good capacity to predict early hematoma expansion in acute intracerebral hemorrhage with a sensitivity and specificity of 39.3%
* Ripenmeet Salhotra [email protected] 1
Department of Critical Care, Fortis Escorts Hospital, Neelam bata Road, Faridabad, Haryana 121002, India
Fig. 1 CT scan of brain showing intracerebral hemorrhage with “CT blend sign”
Indian J Surg
coagulopathy which prevents clot formation. Early hematoma growth is associated with poor functional outcome. Prompt identification of predictors for hematoma growth may lead to its early diagnosis and management, which can impact patient outcome.
Compliance with Ethical Standards Conflict of Interest The author declares no conflict of interest. Informed Consent Informed consent was obtained from all individual participants for whom identifying information is included in this article.
References 1. Fig. 2 Repeat non-contrast CT scan showing hematoma expansion 2.
and 95.5%, respectively [1]. Other signs predicting hematoma expansion are “swirl sign,” “black hole sign,” and “fluid levels” on non-contrast CT and “spot sign” on contrastenhanced CT [2, 3]. Black hole sign is defined as relatively hypoattenuated area encapsulated within the hyper attenuating hematoma. Contrast enhancement within an acute primary intracranial hemorrhage is known as spot sign, representing a site of active dynamic h
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