Abstract
Intracerebral hemorrhage (ICH) is the most devastating form of stroke. Intraoperative
imaging and management of intracavity bleeding during early endoscopic ICH evacuation
may mitigate rebleeding, hematoma expansion, and neurological worsening. Here we document
a case of intraoperative spot sign, detected in the angio suite using cone beam CT
with contrast protocol, in a patient with spontaneous supratentorial ICH undergoing
evacuation 13 hours after last known well. The spot sign was detected after endoscopic
evaluation of the evacuated hematoma cavity demonstrated sufficient hemostasis, but
before completion of the case and skin closure, prompting second-pass hematoma evacuation
as well as identification and cauterization of the specific correlating bleeding vessel,
resulting in near-complete evacuation of the hematoma. Spot sign detection on intraoperative
cone beam CT followed by endoscopic ICH evacuation may provide an opportunity to specifically
target and treat active bleeding and mitigate impending expansion and neurologic worsening,
especially in high-risk patients, including those undergoing early ICH evacuation.
Key Words
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Article info
Publication history
Published online: October 23, 2022
Accepted:
October 17,
2022
Received in revised form:
September 20,
2022
Received:
May 17,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106839
Copyright
© 2022 Elsevier Inc. All rights reserved.
