Case Report
From Spot Sign to Bleeding on the Spot: Classic and Original Signs of Expanding Primary Spontaneous Intracerebral Hematoma
Table 1
Signs of hematoma heterogeneity or in predicting its expansion.
| Signs | Imaging modality | Author | Definition |
| Flood phenomenon | MRI | First reported in the current article | Increase in the size of the intracranial hematoma between the first and last MRI sequences during the same examination | Margin irregularity | NCCT or CTA | Blacquiere et al. [7] | Indicates bleeding multifocality | Mean CT attenuation value | NCCT | Chu et al. [12] | If <31 UH, it indicates an impaired coagulation and higher risk of expansion | Extension into the ventricles | NCCT or CTA | Deng et al. [13] | The parenchymal bleed dissects into the ventricles | Spot sign | Enhanced CT | Demchuk et al. [4] | >1.5 mm dot-like appearance without connection to an outside vessel or corresponding density on NCCT twice as dense as the remaining hematoma | Blend sign | NCCT | Li et al. [14] | The mixture of the fresh central hyperdense blood with the older peripheral blood | Black hole sign | NCCT or CTA | Li et al. [15] | Central hypodense streaming blood encapsulated within the hyperdense coagulating hematoma (minimum of 28 HU difference between both) | Island sign | NCCT or CTA | Li et al. [16] | Either at least 3 small hematomas totally separate from the main focus or 4 small foci that may bud from the initial hematoma | Satellite sign | NCCT or CTA | Shimoda et al. [17] | Single small , completely isolated from the initial bleed | Swirl sign | NCCT | Boulouis et al. [18] | Hypodense area found on 2 consecutive 5 mm axial CT slices | Leakage sign | Contrast-enhanced CT between arterial and delayed phase | Koculym et al. [19] | A 10% increase in the density of the hematoma over a region of interest of 1 cm diameter between the arterial and the delayed phase |
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