The most potent predictor of outcome in intracerebral hemorrhage is the size of the hematoma that ultimately accumulates. While ongoing bleeding and hematoma expansion had been frequently recognized, there was at the time no way of identifying which patients were still bleeding when they presented to the emergency department. The discovery of the spot sign on CT angiography changed that. It is now clear that patients whose CT angiograms demonstrate a spot sign are much more likely to be bleeding and are therefore in greatest need of treatments to arrest that bleeding. Through international collaborations and the analysis of data from clinical trials, we seek to develop ways of limiting the damage done by the bleeding and improving the recovery of these patients.

Related Publications

1. CT Angiography Spot Sign, Hematoma Expansion, and Outcome in Primary Pontine Intracerebral Hemorrhage
   

   The computed tomography angiography (CTA) spot sign is a validated predictor of hematoma expansion and poor outcome in supratentorial intracerebral hemorrhage (ICH), but patients with brainstem ICH have typically been excluded from the analyses. We investigated the frequency of spot sign and its relationship with hematoma expansion and outcome in patients with primary pontine hemorrhage (PPH).

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2. CT Angiography Spot Sign in Intracerebral Hemorrhage Predicts Active Bleeding During Surgery
   

   Brouwers B, Raffeld M, van Nieuwenhuizen K, Falcone G, Ayres A, McNamara K, Schwab K, Romero J, Velthuis B, Viswanathan A, Greenberg S, Ogilvy C, van der Zwan A, Rinkel G, Goldstein J, Klijn C, Rosand J. CT Angiography Spot Sign in Intracerebral Hemorrhage Predicts Active Bleeding During Surgery. Neurology 2014, Sep 2;83(10):883-9. PMID: 25098540; PMCID: PMC4153853.

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3. Burden of Blood Pressure-Related Alleles Is Associated With Larger Hematoma Volume and Worse Outcome in Intracerebral Hemorrhage.
   

   Falcone GJ, Biffi A, Devan WJ, Brouwers HB, Anderson CD, Valant V, Ayres AM, Schwab K, Rost NS, Goldstein JN, Viswanathan A, Greenberg SM, Selim M, Meschia JF, Brown DL, Worrall BB, Silliman SL, Tirschwell DL, Rosand J. Burden of Blood Pressure-Related Alleles Is Associated With Larger Hematoma Volume and Worse Outcome in Intracerebral Hemorrhage. Stroke 2013;44(2):321-6. PMID: 23321443; PMCID: PMC3560332

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4. Apolipoprotein E genotype is associated with CT angiography spot sign in lobar intracerebral hemorrhage
   

   Brouwers HB, Biffi A, Ayres AM, McNamara KA, Ayres AM, Valant V, Schwab K, Romero JM,  Viswanathan A, Greenberg SM, Rosand J, Goldstein JN. Apolipoprotein E genotype is associated with CT angiography spot sign in lobar intracerebral hemorrhage. Stroke. 2012 Aug;43(8):2120-5. PMID: 22621984; PMCID: PMC3426364.

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5. CT angiography for intracerebral hemorrhage does not increase risk of acute nephropathy
   

   Oleinik A, Romero JM, Schwab K, Lev MH, Jhawar N,  Delgado-Almondoz JE, Smith EE, Greenberg SM, Rosand J, Goldstein J. CT angiography for intracerebral hemorrhage does not increase risk of acute nephropathy. Stroke 2009; 40(7): 2393-2397. PMID: 19461032; PMCID: PMC2726774

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6. Contrast extravasation on CT angiography predicts hematoma expansion in intracerebral hemorrhage
   

   Goldstein JN, Fazen LE, Snider R, Schwab K, Greenberg SM, Smith EE, Lev MH, Rosand J. Contrast extravasation on CT angiography predicts hematoma expansion in intracerebral hemorrhage. Neurology. 2007;68(12):889-94. PMID: 17372123.

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