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 outcomes 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 records 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 ¹⁾.