September 23, 2013: CTA Spot Sign

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September 23, 2013

Predicting outcomes after intracerebral hemorrhage can be challenging. Hematoma size and hematoma expansion are two of the most important predictors of morbidity and mortality. Computed tomography angiography (CTA) is often performed to rule out secondary causes of acute intracerebral hemorrhage. In these patients, the presence of a tiny focus of "spot-like" enhancement within the margin of the hemorrhage without connection to adjacent vessels has been termed the CTA spot sign. If present, this finding is strongly associated with risk of hematoma expansion (1), functional outcome, and mortality (2).


  1. Wada R, Aviv RI, Fox AJ et al. CR angiography "spot sign" predicts hematoma expansion in acute cerebral hemorrhage. Stroke 2007; 38: 1257-1262.
  2. Brouwers HB, Goldstein JN, Romero JM, Rosand J. Clinical applications of the computed tomography spot sign in acute intracerebral hemorrhage: a review. Stroke 2012; 43: 3427-3432.

Submitted by Roy Strowd, MD, Resident Physician, Wake Forest School of Medicine, Winston Salem, NC.

Dr. Strowd is a member of the Resident and Fellow Section of Neurology.

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