Black hole sign (intracerebral hemorrhage)

Last revised by Frank Gaillard on 4 Oct 2022

The black hole sign refers to the non-contrast CT appearance of acute extravasation of blood into a hematoma, for example, an intracerebral hemorrhage, and therefore is a predictor of hemorrhage expansion 3. It can be thought of as an encapsulated swirl sign.

Radiographic features

The black hole sign represents a well-defined hypodense region within a hyperdense hematoma that is not connected to the nearby brain parenchyma 1,3. It may have variable shapes (round, oval, rod-like).

There should be at least a 28 Hounsfield unit (HU) difference between the black hole and the surrounding hemorrhage 1,3.

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Cases and figures

  • Case 1
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  • Case 2
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