spontaneous_intracerebral_hemorrhage_expansion_case_series [Neurosurgery Wiki]

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Among [[stroke]] patients, [[primary]] [[intracerebral hemorrhage]] (ICH) has the highest [[mortality rate]]. [[Expansion]] of [[hematoma]] plays a prognostic [[role]] in these patients. Although [[fluid]] levels have been shown to predict subsequent [[hematoma expansion]], there are mimics of fluid levels that may confuse [[interpretation]]. Ratnayake et al. hypothesized that patients with true fluid levels on [[head CT]] have higher hematoma [[progression]] rates and worse [[outcome]]s compared to patients who have fluid level mimics on CT.

Adult patients presenting with ICH described as a "fluid level" on initial CT interpretation were included. [[Medical record]]s were reviewed to extract relevant clinical variables. A CAQ-certified [[neuroradiologist]] retrospectively determined whether there was a true fluid level or mimic on CT, and then evaluated follow-up CTs for radiologic progression. They compared radiologic progression, [[mortality]], and [[anticoagulation]] status between true fluid level patients and fluid level mimics.

Twelve patients were included, 8 with true fluid levels and 4 with radiologic mimics. The true fluid level patients had a significantly higher likelihood of radiographic progression (p = .014). Differences in outcome, use of [[anticoagulation]] [[therapy]], and average [[INR]] were not significant.

A fluid level within [[intraparenchymal hemorrhage]] on head CT scan is associated with higher likelihood of [[intracerebral hemorrhage]] [[progression]]. However, this only applies to true fluid levels, with mimics having a lower likelihood of progression. A careful analysis of potential fluid levels is necessary before assigning prognostic implications
((Ratnayake C, Okonkwo D, Branstetter B. Hematoma Progression Rates on Head CT for Fluid Levels Versus Mimics in Patients with Primary Intracerebral Hemorrhage. World Neurosurg. 2022 Nov 2:S1878-8750(22)01528-5. doi: 10.1016/j.wneu.2022.10.112. Epub ahead of print. PMID: 36334718.)).