0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence |

Contrast Extravasation: A Surrogate Marker of Primary Intracerebral Hemorrhage and Secondary Expansion

Thien J. Huynh, MD; Richard I. Aviv, MBChB
Arch Neurol. 2012;69(2):278. doi:10.1001/archneurol.2011.1213.
Text Size: A A A
Published online

Extract

Jeong et al1 report a patient who developed a hyperacute spontaneous intracerebral hemorrhage during a follow-up magnetic resonance imaging examination to evaluate a previously coiled posterior communicating artery aneurysm. Active contrast extravasation was identified and increased between the 2 postcontrast studies performed 3 minutes apart. This case exemplifies the role of contrast extravasation as a potent surrogate marker of primary hematoma formation. Contrast extravasation within a hematoma on arterial-phase computed tomographic angiography, referred to as the “Spot Sign,” has also been shown to be an important predictor of secondary hematoma expansion and poor clinical outcome.2 Hematomas demonstrating extravasation may undergo dramatic secondary expansion (ie, developing within minutes).3 Although the etiology of primary contrast extravasation is uncertain, it is likely that the causative lesion has the potential for further delayed extravasation, manifest as the Spot Sign. It is notable that, despite initial contrast extravasation, the hematoma did not undergo secondary expansion, with an improvement in the patient's National Institutes of Health Stroke Scale score reported at hospital discharge 4 days later. Smaller hematomas, however, are less likely to undergo secondary hematoma expansion.4 Two studies5,6 evaluating contrast extravasation as a target for recombinant factor VIIa treatment are currently under way and will provide guidance for future management of primary intracerebral hemorrhage. The present case demonstrates the importance of early therapeutic intervention to reduce both primary and secondary expansion.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

February 1, 2012
Shyam Prabhakaran, MD, MS
Arch Neurol. 2012;69(2):278. doi:10.1001/archneurol.2011.2130.
CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

67 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Supplemental Content

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Stroke, Hemorrhagic: Does This Patient Have a Hemorrhagic Stroke?

brightcove.createExperiences();