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The Spot Sign and Intraventricular Hemorrhage are Associated with Baseline Coagulopathy and Outcome in Intracerebral Hemorrhage

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Author(s)
Sung-Ho AhnJeong-Ho HongGlenda L. TorresJude P. SavarrajChang Hyeun KimYoung Ha KimArthur L. DayH. Alex ChoiJames C. GrottaKiwon LeeTiffany R. Chang
Keimyung Author(s)
Hong, Jeong Ho
Department
Dept. of Neurology (신경과학)
Journal Title
Neurocrit Care
Issued Date
2022
Volume
37
Issue
3
Keyword
Intracerebral hemorrhageSpot signIntraventricular hemorrhageHematoma expansionEarly neurological deteriorationOutcome
Abstract
Background:
Spontaneous intracerebral hemorrhage (ICH) is the second most prevalent subtype of stroke and has high mortality and morbidity. The utility of radiographic features to predict secondary brain injury related to hematoma expansion (HE) or increased intracranial pressure has been highlighted in patients with ICH, including the computed tomographic angiography (CTA) spot sign and intraventricular hemorrhage (IVH). Understanding the pathophysiology of spot sign and IVH may help identify optimal therapeutic strategies. We examined factors related to the spot sign and IVH, including coagulation status, hematoma size, and location, and evaluated their prognostic value in patients with ICH.

Methods:
Prospectively collected data from a single center between 2012 and 2015 were analyzed. Patients who underwent thromboelastography within 24 h of symptom onset and completed follow-up brain imaging and CTA within 48 h after onset were included for analysis. Multivariate logistic regression analyses were performed to identify determinants of the spot sign and IVH and their predictive value for HE, early neurological deterioration (END), in-hospital mortality, and functional outcome at discharge.

Results:
Of 161 patients, 50 (31.1%) had a spot sign and 93 (57.8%) had IVH. In multivariable analysis, the spot sign was associated with greater hematoma volume (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00–1.03), decreased white blood cell count (OR 0.88; 95% CI 0.79–0.98), and prolonged activated partial thromboplastin time (OR 1.14; 95% CI 1.06–1.23). IVH was associated with greater hematoma volume (OR 1.02; 95% CI 1.01–1.04) and nonlobar location of hematoma (OR 0.23; 95% CI 0.09–0.61). The spot sign was associated with greater risk of all adverse outcomes. IVH was associated with an increased risk of END and reduced HE, without significant impact on mortality or functional outcome.

Conclusions:
The spot sign and IVH are associated with specific hematoma characteristics, such as size and location, but are related differently to coagulation status and clinical course. A combined analysis of the spot sign and IVH can improve the understanding of pathophysiology and risk stratification after ICH.
Keimyung Author(s)(Kor)
홍정호
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1556-0961
Source
https://link.springer.com/article/10.1007/s12028-022-01537-9
DOI
10.1007/s12028-022-01537-9
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44726
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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