Comparison of different noncontrast computed tomographic markers for predicting early perihematomal edema expansion in patients with intracerebral hemorrhage

Black hole sign migration in short-term brain CT scans: A possible link with clot evolution and histology

“…BHS presents as a hypointense area with well-defined margins within a hyperintense component, unrelated to the surrounding hematoma [12] . It is defined by a density 28 HU lower than the surrounding hemorrhage [6] . Although similar signs like the Swirl Sign (SS) is seen in rapidly expanding ICH, it is more typical of acute extradural hematomas, serving as a negative prognostic factor associated with an increased risk of death [13] .…”

“…This allows for the identification of various indicators of hyperacute bleeding [5] . Among these signs is the “black hole sign,” characterized as a rounded hypointense area within the hyperintense clot, exhibiting a density approximately 28 Hounsfield units (HU) lower than the surrounding hemorrhage [6] . Being a hyperacute radiological indicator, the “black hole sign” present a brief and variable duration, indicating different bleeding moments.…”