Presentation
90 minutes post-onset left-sided weakness.
Patient Data
Non-contrast CT (A) performed demonstrates a small right basal ganglia intracerebral hemorrhage.
CTA source image (B) demonstrates punctuate focus of contrast enhancement within the hemorrhage that was discontinuous from adjacent vessels on multi-planar reformats, and not present on the pre-contrast image, the CTA spot sign, reflecting active, dynamic hemorrhage.
Follow-up 24 hour non-contrast CT (C) demonstrates hematoma growth.
Case Discussion
The CTA Spot sign is defined as unifocal or multifocal contrast enhancement within an intracerebral hemorrhage, discontinuous from adjacent normal or abnormal vessels and not present on pre-contrast imaging. It is an independent predictor of intracerebral hemorrhage growth and poor outcome.
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