Spontaneous intracerebral hemorrhage during computed tomography scanning—assessment of hyperacute hematoma growth

• DOI: 10.1007/s11357-025-01696-5
• Publication Date: 2025-05-10T02:12:55Z
• Authors: Bence Gunda; Péter Böjti; Tímea Takács; Esra Zhubi; Dániel Bereczki; Andrea Varga; Lajos R. Kozák
• Keywords: Bleed

Abstract Pathophysiological mechanisms underlying hematoma expansion in spontaneous intracerebral hemorrhage (ICH) remain poorly understood, and most data are derived from postmortem studies or serial neuroimaging performed over hours to days onset. Our unique case report of a hypertensive ICH serendipitously captured by CT provides valuable vivo the very onset formation an aging individual. A 76-year-old man underwent elective carotid angiography evaluate previously known asymptomatic right stenosis. During scanning, he developed severe hemispheric neurological deficit signs. Immediate rescanning subsequent follow-up imaging revealed hyperacute evolution putaminal ICH. We co-registered four scans (from 00 h:00 min, h:06 h:21 24 h:58 min) common template 3D made volumetric measurements growing also assessing spatial relationship with sources bleed seen as contrast extravasation (“spot signs”). found that spot signs appeared on periphery initial hematoma, further was directions determined these Most final volume first 20 min post-onset, highlighting nature growth. findings support hypothesis ICH, particularly individuals, results multiple bleeding due cascade secondary vessel ruptures eccentric rather than single source continuous concentric reflecting global fragility cerebral vasculature. The therapeutic time window for prevention is narrow.