• David Rodriguez-Luna, Pilar Coscojuela, Marta Rubiera, Michael D Hill, Dar Dowlatshahi, Richard I Aviv, Yolanda Silva, Imanuel Dzialowski, Cheemun Lum, Anna Czlonkowska, Jean-Martin Boulanger, Carlos S Kase, Gord Gubitz, Rohit Bhatia, Vasantha Padma, Jayanta Roy, Alejandro Tomasello, Andrew M Demchuk, Carlos A Molina, and PREDICT/Sunnybrook ICH CTA Study Group.
• From the Stroke Unit, Departments of Neurology (D.R.-L., M.R., C.A.M.) and Neuroradiology (P.C., A.T.), Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain; Calgary Stroke Program (M.D.H., A.M.D.), Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary; Department of Medicine, Neurology (D.D.), and Department of Diagnostic Imaging, Neuroradiology Section (C.L.), The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute; Division of Neuroradiology and Department of Medical Imaging (R.I.A.), Sunnybrook Health Sciences Centre, University of Toronto, Canada; Department of Neurology (Y.S.), Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Spain; Department of Neurology (I.D.), University of Dresden, Germany; 2nd Department of Neurology (A.C.), Institute of Psychiatry and Neurology of Warsaw, Poland; Charles LeMoyne Hospital (J.-M.B.), University of Sherbrooke, Montreal, Canada; Department of Neurology (C.S.K.), Boston Medical Center, MA; Department of Neurology (G.G.), Dalhousie University, Halifax, Canada; Department of Neurology (R.B., V.P.), All India Institute of Medical Sciences, New Delhi; and AMRI Hospital Kolkata (J.R.), India. rodriguezluna@vhebron.net.
• Neurology. 2016 Jul 26; 87 (4): 357-64.

ObjectiveTo determine the association of ultraearly hematoma growth (uHG) with the CT angiography (CTA) spot sign, hematoma expansion, and clinical outcomes in patients with acute intracerebral hemorrhage (ICH).MethodsWe analyzed data from 231 patients enrolled in the multicenter Predicting Haematoma Growth and Outcome in Intracerebral Haemorrhage Using Contrast Bolus CT study. uHG was defined as baseline ICH volume/onset-to-CT time (mL/h). The spot sign was used as marker of active hemorrhage. Outcome parameters included significant hematoma expansion (>33% or >6 mL, primary outcome), rate of hematoma expansion, early neurologic deterioration, 90-day mortality, and poor outcome.ResultsuHG was higher in spot sign patients (p < 0.001) and in patients scanned earlier (p < 0.001). Both uHG >4.7 mL/h (p = 0.002) and the CTA spot sign (p = 0.030) showed effects on rate of hematoma expansion but not its interaction (2-way analysis of variance, p = 0.477). uHG >4.7 mL/h improved the sensitivity of the spot sign in the prediction of significant hematoma expansion (73.9% vs 46.4%), early neurologic deterioration (67.6% vs 35.3%), 90-day mortality (81.6% vs 44.9%), and poor outcome (72.8% vs 29.8%), respectively. uHG was independently related to significant hematoma expansion (odds ratio 1.06, 95% confidence interval 1.03-1.10) and clinical outcomes.ConclusionsuHG is a useful predictor of hematoma expansion and poor clinical outcomes in patients with acute ICH. The combination of high uHG and the spot sign is associated with a higher rate of hematoma expansion, highlighting the need for very fast treatment in ICH patients.© 2016 American Academy of Neurology.

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