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Table of Contents    
Year : 2021  |  Volume : 69  |  Issue : 4  |  Page : 1119-1120

CT “Spot” and “Leakage” Signs Predicting Intracerebral Hematoma Expansion

Department of Neurology, Aster Medcity, Kochi, Kerala, India

Date of Submission08-Aug-2018
Date of Decision14-Dec-2019
Date of Acceptance20-Jan-2020
Date of Web Publication2-Sep-2021

Correspondence Address:
Boby V Maramattom
Department of Neurology, Aster Medcity, Kochi - 682 023, Kerala
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.325367

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How to cite this article:
Mathews DJ, Ram S A, Maramattom BV. CT “Spot” and “Leakage” Signs Predicting Intracerebral Hematoma Expansion. Neurol India 2021;69:1119-20

How to cite this URL:
Mathews DJ, Ram S A, Maramattom BV. CT “Spot” and “Leakage” Signs Predicting Intracerebral Hematoma Expansion. Neurol India [serial online] 2021 [cited 2021 Dec 5];69:1119-20. Available from:

A 56-year-old male patient presented with acute onset left hemiplegia of 1 h duration. He was on aspirin 75 mg daily for a coronary bypass surgery 5 years ago. A plain CT followed by CT angiogram (CTA) and delayed phase CTA at 3 and 5 min showed a spot sign and leakage signs, suggestive of an expanding hematoma [Figure 1]. At 2 h, his sensorium deteriorated further and a repeat CT scan showed a massive increase in the intracerebral bleed. He was taken up for decompressive craniectomy but remained comatose after surgery. Combining plain CT with CTA and delayed phase CTA sequences may demonstrate a “spot sign” or a “leakage sign” and increase the sensitivity of prediction of intracerebral hemorrhage expansion.[1],[2]
Figure 1: (a) Initial plain CT shows a 12 ml right basal ganglia ICH. (b) Initial CTA images show the “spot sign.” (c) Delayed phase CTA at 3 min shows contrast extravasation. (d) Delayed phase CTA at 5 min shows further contrast extravasation (“Leakage sign”). (e) Final plain CT at 2 h shows a 7-fold expanded ICH of 83 ml volume

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  References Top

Orito K, Hirohata M, Nakamura Y, Takeshige N, Aoki T, Hattori G, et al. Leakage sign for primary intracerebral hemorrhage: A novel predictor of hematoma growth. Stroke 2016;47:958-63.  Back to cited text no. 1
Chakraborty S, Alhazzaa M, Wasserman JK, Sun YY, Stotts G, Hogan MJ, et al. Dynamic characterization of the CT angiographic 'spot sign'. PLoS One 2014;9:e90431.  Back to cited text no. 2


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