Article Figures & Data
Figures
- FIGURE.
Noncontrast brain CT of a 73-year-old woman who presented with right-sided weakness. Initial brain CT (A–C) demonstrates a left parietal hematoma measuring 33 mL, demonstrating hypodense hematoma with hypodense foci, the swirl sign. Follow-up CT (D–F) performed 8 hours later demonstrates increased hematoma volume, 46 mL.
Tables
Patient Characteristics Patients with Spontaneous ICH (n = 212) Patients Excluded (n = 460) P Value Age (median) (IQR) (yr) 68 (61–77.5) 75 (64.5–83) <.001 Male sex (No.) (%) 86 (40.6) 210 (45.7) .21 Time to initial CT (median) (IQR) (hr) 4.5 (2.29–17.5) 4.4 (2.0–11.6) [n = 299] .06 Time to second CT (median) (IQR) (hr) 11.92 (5.38–29.27) 19.9 (4.6–56.64) [n = 287] .005 PMHx (No.) (%) Hypertension 166 (78.3) 329 (71.8) .09 Hypercholesterolemia 68 (32.1) 114 (30.6) .71 Statin use 68 (32.1) 145 (31.5) .92 Diabetes 54 (25.6) 108 (23.8) .32 Ischemic heart disease 39 (18.4) 79 (17.6) .83 Atrial fibrillation 47 (22.2) 93 (20.7) .68 Previous stroke Transient ischemic attack 13 (6.2) 29 (6.5) 1.00 Ischemic stroke (n = 207) 21 (9.9) 43 (11.5) .68 Hemorrhagic stroke 12 (5.8) 35 (9.4) .15 Anticoagulant (No.) (%) Warfarin 42 (19.8) 87 (18.9) .83 Antiplatelet 70 (33.0) 164 (35.6) .54 GCS on presentation (median) (IQR) 14 (11–15) [n = 207] 14 (10–15) [n = 355] .52 Radiologic (No.) (%) Location supratentorial 173 (81.6) 309 (67.2) .42 IV extension (n = 326) 88 (41.5) 60 (52.6) .06 Midline shift (n = 499) 78 (36.8) 142 (49.5) .006 Note:—GCS indicates Glasgow Coma Scale; PMHx, past medical history; IV, intraventricular.
Patient Characteristics Swirl Sign −ve (n = 121) Swirl +ve (n = 91) P Value Age (median) (IQR) (yr) 69 (51–76) 68 (51–72) .4 Male sex (No.) (%) 50 (41.3) 36 (39.6) .89 Time to initial CT (median) (IQR) (hr) 16.1 (1.1–95.3) 8.0 (0.37–94) <.001 Time to second CT (median) (IQR) (hr) 21.0 (10.3–28.5) 16.5(5.9–29.5) .12 Initial hematoma volume (median) (IQR) (mL) 8.56 (3.83–14.95) 23.2 (11.65–43.3) <.001 PMHx (No.) (%) Hypertension 99 (81.8) 67 (73.6) .18 Hypercholesterolemia 45 (37.3) 23 (25.3) .08 Statin use 40 (33.1) 28 (30.8) .77 Diabetes 33 (27.5) 21 (23.1) .52 Ischemic heart disease 21 (17.4) 18 (19.8) .72 Atrial fibrillation 21 (17.4) 26 (28.6) .06 Previous stroke Transient ischemic attack 9 (7.5) 4 (4.4) .40 Ischemic stroke (n = 207) 10 (8.5) 11 (12.2) .49 Hemorrhagic stroke 8 (6.8) 4 (4.4) .56 Anticoagulant (No.) (%) Warfarin 19 (15.7) 23 (25.3) .12 Antiplatelet 42 (34.7) 28 (30.8) .56 GCS on presentation (median) (IQR) (n = 207) 14 (12–15) 13 (11–14) .018 INR (median) (IQR) 1.1 (1.0–1.2) 1.1 (1.0–1.4) .13 Radiologic (No.) (%) Location supratentorial 95 (78.5) 78 (85.7) .21 IV extension (n = 145) 50 (63.3) 38 (57.6) 1.00 Midline shift 27 (22.3) 51 (56.0) <.001 Note:—INR indicates international normalized ratio; −ve, negative; +ve, positive; PMHx, past medical history; GCS, Glasgow Coma Scale; IV, intraventricular.
- Table 3:
Comparison of patients positive for the swirl sign with and without hematoma growth
Patient Characteristics Increased Hematoma Volume (n = 65) Stable/Reduced Hematoma Volume (n = 26) P Value Age (median) (IQR) (yr) 71 (63–76) 66 (55–72) .06 Male sex (No.) (%) 25 (38.5) 11 (42.3) .81 Time to initial CT (median) (IQR) (hr) 3 (1.7–6.6) 4 (2.6–12.7) .01 Time to second CT (median) (IQR) (hr) 12 (4.2–23.8) 26.8 (14.7–36.0) <.001 Initial hematoma volume (median) (IQR) (mL) 24 (12.2–49.6) 21.6 (10.3–38.5) .37 PMHx (No.) (%) Hypertension 46 (70.7) 21 (80.8) .43 Hypercholesterolemia 17 (26.2) 6 (23.8) 1.00 Statin use 22 (33.9) 6 (23.8) .45 Diabetes 16 (24.6) 5 (19.2) .78 Ischemic heart disease 15 (23.1) 3 (11.5) .26 Atrial fibrillation 23 (35.4) 3 (11.5) .018 Previous stroke Transient ischemic attack 3 (4.6) 1 (3.9) 1.00 Ischemic stroke (n = 207) 8 (12.3) 3 (11.5) 1.00 Hemorrhagic stroke 3 (4.6) 1 (3.9) 1.00 Anticoagulant (No.) (%) Warfarin 22 (33.9) 1 (3.9) .003 Antiplatelet 22 (33.9) 6 (23.8) .45 GCS on presentation (median) (IQR) 14 (9.8–14) 13 (11–14) .13 INR (median) (IQR) 1.2 (1.0–1.8) 1.1 (1.0–1.1) .01 Radiologic (No.) (%) Location supratentorial 55 (84.6) 23 (88.5) .75 IV extension 17 (26.2) 11 (42.3) .35 Midline shift 33 (50.8) 18 (69.2) .16 Note:—GCS indicates Glasgow Coma Scale; PMHx, past medical history; IV, intraventricular; INR, international normalized ratio.
Follow-Up Volume Median Absolute Growth (mL) P Value 95% CI Swirl sign 5.77 .001 2.37 to 9.18 Initial hematoma volume (mL) 1.01 .000 0.95 to 1.06 Time between CT1 and CT2 (hr) −0.07 .028 −0.12 to −0.007 Time between onset and CT1 (hr) −0.0003 .251 −0.0008 to 0.0002 Relative Hematoma Volume Change Median Relative Growth (%) P Value 95% CI Swirl sign 35.6 <.001 18.5 to 52.6 Initial hematoma volume (mL) −0.23 .158 −0.56 to 0.09 Time between CT1 and CT2 (hr) −0.42 .008 −0.73 to −0.11 Time between onset and CT1 (hr) 0.0 .424 −0.01 to 0.00
