Prediction and Observation of Post-Admission Hematoma Expansion in Patients with Intracerebral Hemorrhage

Abstract

Post-admission hematoma expansion in patients with intracerebral hemorrhage (ICH) comprises a simultaneous major clinical problem and a possible target for medical intervention. In any case, the ability to predict and observe hematoma expansion is of great clinical importance. We review radiological concepts in predicting and observing post-admission hematoma expansion. Hematoma expansion can be observed within the first 24 h after symptom onset, but predominantly occurs in the early hours. Thus capturing markers of on-going bleeding on imaging techniques could predict hematoma expansion. The spot sign observed on computed tomography angiography is believed to represent on-going bleeding and is to date the most well investigated and reliable radiological predictor of hematoma expansion as well as functional outcome and mortality. On non-contrast CT, the presence of foci of hypoattenuation within the hematoma along with the hematoma-size is reported to be predictive of hematoma expansion and outcome. Because patients tend to arrive earlier to the hospital, a larger fraction of acute ICH-patients must be expected to undergo hematoma expansion. This renders observation and radiological follow-up investigations increasingly relevant. Transcranial duplex sonography has in recent years proven to be able to estimate hematoma volume with good precision and could be a valuable tool in bedside serial observation of acute ICH-patients. Future studies will elucidate, if better prediction and observation of post-admission hematoma expansion can help select patients, who will benefit from hemostatic treatment.

Early hematoma expansion in primary intracerebral hemorrhage: incidence and predictors

“…At the same time, higher SSS was associated with increased early mortality and degree of subsequent physical disability. These results are in accordance with the study of Yu and colleagues [28] as well as Ovesen and colleagues [29] who stated that CTA spot sign is associated with increased risk of re-bleeding and hematoma growth, poorer functional outcome, and higher mortality especially in supratentorial hematomas.…”

Methyltransferase 3 Mediated miRNA m6A Methylation Promotes Stress Granule Formation in the Early Stage of Acute Ischemic Stroke

“…Cerebral ischemia/reperfusion (I/R) injury rapidly triggers different types of programmed cell death in neurons, such as apoptosis, autophagy and programmed necrosis, and this injury is inevitable and irreversible (Li et al, 2018). Therefore, it is vital to increase the resistance of neurons to ischemic conditions in the early stage of AIS when mildly injured neurons have not entered the process of apoptosis or necrosis (Ovesen et al, 2014).…”

Increased Prognostic Yield by Combined Assessment of Non-Contrast Computed Tomography Markers of Antithrombotic-Related Spontaneous Intracerebral Hemorrhage Expansion

“…Notwithstanding the impact of hematoma expansion on worse ICH-related outcomes, it also constitutes an important clinical target for medical intervention [ 12 ]. The ability to identify patients at risk for hematoma expansion based on non-contrast CT features is not only of great clinical importance, to guide more careful monitoring and inform prognosis, but can also be used to refine the selection of participants that are at high risk for hematoma expansion in future therapeutic randomized trials [ 13 ].…”