The most important prognostic variable in determining outcome after ICH is the level of medical support provided. Withdrawal of support in patients felt likely to have a "poor outcome" biases predictive models and leads to self-fulfilling prophecies. Our data show that individual patients in traditionally "poor outcome" categories can have a reasonable neurologic outcome when treated aggressively.

Background and Purpose-Hematomas that enlarge following presentation with primary intracerebral hemorrhage (ICH) are associated with increased mortality, but the mechanisms of hematoma enlargement are poorly understood. We interpreted the presence of contrast extravasation into the hematoma after CT angiography (CTA) as evidence of ongoing hemorrhage and sought to identify the clinical significance of contrast extravasation as well as factors associated with the risk of extravasation. Methods-We reviewed the clinical records and radiographic studies of all patients with intracranial hemorrhage undergoing CTA from 1994 to 1997. Only patients with primary ICH were included in this study. Univariate and multivariate logistic regression analyses were performed to determine the associations between clinical and radiological variables and the risk of hospital death or contrast extravasation. Results-Data were available for 113 patients. Contrast extravasation was seen in 46% of patients at the time of CTA, and the presence of contrast extravasation was associated with increased fatality: 63.5% versus 16.4% in patients without extravasation (Pϭ0.011). There was a trend toward a shorter time (medianϮSD) from symptom onset to CTA in patients with extravasation (4.6Ϯ19 hours) than in patients with no evidence of extravasation (6.6Ϯ28 hours; Pϭ0.065).Multivariate analysis revealed that hematoma size (Pϭ0.022), Glasgow Coma Scale (GCS) score (Pϭ0.016), extravasation of contrast (Pϭ0.006), infratentorial ICH (Pϭ0.014), and lack of surgery (PϽ0.001) were independently associated with hospital death. Variables independently associated with contrast extravasation were hematoma size (Pϭ0.024), MABP Ͼ120 mm Hg (Pϭ0.012), and GCS score of Յ8 (PϽ0.005). Conclusions-Contrast extravasation into the hematoma after ICH is associated with increased fatality. The risk of contrast extravasation is increased with extreme hypertension, depressed consciousness, and large hemorrhages. If contrast extravasation represents ongoing hemorrhage, the findings in this study may have implications for therapy of ICH, particularly with regard to blood pressure management. (Stroke. 1999;30:2025-2032.)

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