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|Year : 2021 | Volume
| Issue : 4 | Page : 1119-1120
CT “Spot” and “Leakage” Signs Predicting Intracerebral Hematoma Expansion
Dhinu J Mathews, S Ananth Ram, Boby V Maramattom
Department of Neurology, Aster Medcity, Kochi, Kerala, India
|Date of Submission||08-Aug-2018|
|Date of Decision||14-Dec-2019|
|Date of Acceptance||20-Jan-2020|
|Date of Web Publication||2-Sep-2021|
Boby V Maramattom
Department of Neurology, Aster Medcity, Kochi - 682 023, Kerala
Source of Support: None, Conflict of Interest: None
|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
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.,
|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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