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Not a String, not a Tangle, not an Aneurysm : Emerging Pattern of Large Parenchymal Bleeding in Younger Patients Associated with Abnormal Vessels on Imaging.
Nicholson, Patrick; Gao, Meah; Radovanovic, Ivan; Mendes-Pereira, Vitor; Hodaie, Mojgan; Pikula, Aleksandra; Krings, Timo.
  • Nicholson P; Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst, M5T 2S8, Toronto, Ontario, Canada. patrick.nicholson@uhn.ca.
  • Gao M; Division of Neurology, Department of Medicine, Toronto Western Hospital, University Health Networks, Toronto, Ontario, Canada.
  • Radovanovic I; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
  • Mendes-Pereira V; Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst, M5T 2S8, Toronto, Ontario, Canada.
  • Hodaie M; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
  • Pikula A; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
  • Krings T; Division of Neurology, Department of Medicine, Toronto Western Hospital, University Health Networks, Toronto, Ontario, Canada.
Clin Neuroradiol ; 31(3): 653-659, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-723015
Semantic information from SemMedBD (by NLM)
1. blood vessel abnormal COEXISTS_WITH parenchymal hemorrhage
Subject
blood vessel abnormal
Predicate
COEXISTS_WITH
Object
parenchymal hemorrhage
2. parenchymal hemorrhage PROCESS_OF Patients
Subject
parenchymal hemorrhage
Predicate
PROCESS_OF
Object
Patients
3. Physical findings PREDISPOSES Poor outcome
Subject
Physical findings
Predicate
PREDISPOSES
Object
Poor outcome
4. Cerebral Hemorrhage PROCESS_OF Patients
Subject
Cerebral Hemorrhage
Predicate
PROCESS_OF
Object
Patients
5. CAT scan of brain ADMINISTERED_TO Patients
Subject
CAT scan of brain
Predicate
ADMINISTERED_TO
Object
Patients
6. Computed Tomography Angiography ADMINISTERED_TO Patients
Subject
Computed Tomography Angiography
Predicate
ADMINISTERED_TO
Object
Patients
7. Physical findings PROCESS_OF Patients
Subject
Physical findings
Predicate
PROCESS_OF
Object
Patients
8. Wakefulness PROCESS_OF Patients
Subject
Wakefulness
Predicate
PROCESS_OF
Object
Patients
9. blood vessel abnormal COEXISTS_WITH parenchymal hemorrhage
Subject
blood vessel abnormal
Predicate
COEXISTS_WITH
Object
parenchymal hemorrhage
10. parenchymal hemorrhage PROCESS_OF Patients
Subject
parenchymal hemorrhage
Predicate
PROCESS_OF
Object
Patients
11. Physical findings PREDISPOSES Poor outcome
Subject
Physical findings
Predicate
PREDISPOSES
Object
Poor outcome
12. Cerebral Hemorrhage PROCESS_OF Patients
Subject
Cerebral Hemorrhage
Predicate
PROCESS_OF
Object
Patients
13. CAT scan of brain ADMINISTERED_TO Patients
Subject
CAT scan of brain
Predicate
ADMINISTERED_TO
Object
Patients
14. Computed Tomography Angiography ADMINISTERED_TO Patients
Subject
Computed Tomography Angiography
Predicate
ADMINISTERED_TO
Object
Patients
15. Physical findings PROCESS_OF Patients
Subject
Physical findings
Predicate
PROCESS_OF
Object
Patients
16. Wakefulness PROCESS_OF Patients
Subject
Wakefulness
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PROCESS_OF
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Patients
ABSTRACT

PURPOSE:

Intracerebral hemorrhage (ICH) accounts for up to 20% of all strokes, and there is a high rate of associated morbidity and mortality. Computed tomography (CT) findings, such as a spot sign have been shown to be an independent predictor of poor outcome. We have recently encountered a succession of ICH patients who presented with a peculiar imaging finding, which we term the spot on a string sign. This is a rare imaging finding, and interestingly, all these patients presented to our institution over the last few weeks.

METHODS:

This was a single high-volume center series of patients who presented to our institution between 1 April and 21 May 2020. All patients underwent initial non-contrast CT brain and subsequent CT angiography (CTA). We also present laboratory and clinical data. Our primary measure was the presence of the spot on a string sign on the CTA. We also report the clinical course of these patients.

RESULTS:

In this study seven large-volume ICH patients with this imaging sign were identified, with a median age of 48 years (range 30-68 years). All had tested negative for coronavirus disease 19 (COVID-19).

CONCLUSION:

We have described an unusual imaging finding in a cohort of younger patients with large-volume ICH, all of whom presented in a 2-month period to a high-volume neurovascular unit. The cause of these ICH presentations and associated imaging findings are unclear, but we encourage other clinicians to be aware of and vigilant for this rare phenomenon, especially in younger patients with such a bleeding pattern.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Cerebral Hemorrhage / COVID-19 / Aneurysm Type of study: Cohort study / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Clin Neuroradiol Journal subject: Neurology / Radiology Year: 2021 Document Type: Article Affiliation country: S00062-020-00944-9

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Cerebral Hemorrhage / COVID-19 / Aneurysm Type of study: Cohort study / Observational study / Prognostic study Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Clin Neuroradiol Journal subject: Neurology / Radiology Year: 2021 Document Type: Article Affiliation country: S00062-020-00944-9