• 1 From the Stroke Trials Unit, Division of Clinical Neuroscience (Z.K.L., A.A., A.B., J.P.A., P.S., L.W., S.P., T.J.E., N.S., P.M.B), University of Nottingham, United Kingdom
  • 2 Department of Stroke, Nottingham University Hospitals NHS Trust, United Kingdom (K.K., N.S., P.M.B)
  • 3 School of Medicine, University of Western Australia, Perth, Australia (L.A.C.)
  • 4 Radiological Sciences (S.P., R.A.D.), University of Nottingham, United Kingdom
  • 5 Department of Neurology, Selcuk University Medical Faculty, Konya, Turkey (S.O.)
  • 6 Institute for Applied Clinical Studies, Keele University, Staffordshire, Stoke-on-Trent, United Kingdom (C.R.)
  • 7 Department of Neurology, Semmelweis University, Budapest, Hungary (D.B.)
  • 8 Neurology Unit, Azienda Socio Sanitaria Territoriale di Mantova, Mantua, Italy (A.C.)
  • 9 Department of Neurology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen (C.O., H.C.)
Stroke, 2020 01;51(1):121-128.
PMID: 31735141 DOI: 10.1161/STROKEAHA.119.026128


Background and Purpose- Blend, black hole, island signs, and hypodensities are reported to predict hematoma expansion in acute intracerebral hemorrhage. We explored the value of these noncontrast computed tomography signs in predicting hematoma expansion and functional outcome in our cohort of intracerebral hemorrhage. Methods- The TICH-2 (Tranexamic acid for IntraCerebral Hemorrhage-2) was a prospective randomized controlled trial exploring the efficacy and safety of tranexamic acid in acute intracerebral hemorrhage. Baseline and 24-hour computed tomography scans of trial participants were analyzed. Hematoma expansion was defined as an increase in hematoma volume of >33% or >6 mL on 24-hour computed tomography. Poor functional outcome was defined as modified Rankin Scale of 4 to 6 at day 90. Multivariable logistic regression was performed to identify predictors of hematoma expansion and poor functional outcome. Results- Of 2325 patients recruited, 2077 (89.3%) had valid baseline and 24-hour scans. Five hundred seventy patients (27.4%) had hematoma expansion while 1259 patients (54.6%) had poor functional outcome. The prevalence of noncontrast computed tomography signs was blend sign, 366 (16.1%); black hole sign, 414 (18.2%); island sign, 200 (8.8%); and hypodensities, 701 (30.2%). Blend sign (adjusted odds ratio [aOR] 1.53 [95% CI, 1.16-2.03]; P=0.003), black hole (aOR, 2.03 [1.34-3.08]; P=0.001), and hypodensities (aOR, 2.06 [1.48-2.89]; P<0.001) were independent predictors of hematoma expansion on multivariable analysis with adjustment for covariates. Black hole sign (aOR, 1.52 [1.10-2.11]; P=0.012), hypodensities (aOR, 1.37 [1.05-1.78]; P=0.019), and island sign (aOR, 2.59 [1.21-5.55]; P=0.014) were significant predictors of poor functional outcome. Tranexamic acid reduced the risk of hematoma expansion (aOR, 0.77 [0.63-0.94]; P=0.010), but there was no significant interaction between the presence of noncontrast computed tomography signs and benefit of tranexamic acid on hematoma expansion and functional outcome (P interaction all >0.05). Conclusions- Blend sign, black hole sign, and hypodensities predict hematoma expansion while black hole sign, hypodensities, and island signs predict poor functional outcome. Noncontrast computed tomography signs did not predict a better response to tranexamic acid. Clinical Trial Registration- URL: Unique identifier: ISRCTN93732214.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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