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

In reply

We thank Drs Huynh and Aviv for their correspondence. There is great interest in the topic of hematoma expansion because it represents one of few therapeutic targets with the potential to reduce mortality and disability in patients with intracerebral hemorrhage (ICH). Our case report confirms that the onset of ICH is characterized by an active breach of the blood-brain barrier and the rapid expulsion of blood products into the parenchyma that continues until hematoma stabilization. It is believed that, in spontaneous ICH, hematoma growth occurs primarily in the first 6 hours. Thus, this narrow window may represent the only opportunity to intervene early enough to reduce the final size of the hematoma and, with it, the considerable morbidity and mortality associated with ICH. Contrast extravasation in the early hours after ICH onset, the “Spot Sign” in computed tomographic studies, may be a reliable marker of hematoma expansion and could be used to select patients with ICH who may benefit from hemostatic treatments such as recombinant factor VIIa.