Spot sign and live-imaged dramatic intracerebral hematoma expansion
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To the Editor: Garcia Bermejo et al.1 report a patient with deep intracerebral hemorrhage (ICH) and a positive spot sign that dramatically expanded from less than 1 mL/min on average in the first hour (45 mL/60 min) to an average of 4 mL/min over the 10 minutes between the noncontrast CT and CT angiogram scans.
We speculate that this abrupt expansion resulted from a pressure gradient caused by the sudden decompression of the hematoma into the ventricular space. The hematoma did not further expand in subsequent hours, suggesting that the expansion rate rapidly slowed when the ventricles filled with blood and …
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