Toward rapid, practical risk stratification in spontaneous intracerebral hemorrhage

Core Tip

Core Tip: Early prediction of hematoma expansion is critical to improving outcomes in spontaneous intracerebral hemorrhage. While the computed tomography (CT) angiography “spot sign” is a strong predictor of hematoma expansion, its routine use is limited. Non-contrast CT markers such as the swirl, black hole, and island signs offer a practical alternative. Parry et al introduce a simple, five-point non-contrast CT grading system that integrates these imaging signs with hematoma volume and intraventricular hemorrhage. This easy-to-apply score can guide rapid risk stratification, inform blood-pressure management and anticoagulation reversal, and help select candidates for anti-expansion therapies, even in resource-limited settings.