Extravasation of radiographic contrast is an independent predictor of death in primary intracerebral hemorrhage

Background and Purpose-Hematomas that enlarge following presentation with p rimary intracerebral hemorrhage (ICH) are associated with increased mortali ty, but the mechanisms of hematoma enlargement are poorly understood. We in terpreted the presence of contrast extravasation into the hematoma after CT angiography (CTA) as evidence of ongoing hemorrhage and sought to identify the clinical significance of contrast extravasation as well as factors ass ociated with the risk of extravasation. Methods-We reviewed the clinical records and radiographic studies of all pa tients with intracranial hemorrhage undergoing CTA from 1994 to 1997. Only patients with primary ICH were included in this study. Univariate and multi variate logistic regression analyses were performed to determine the associ ations between clinical and radiological variables and the risk of hospital death or contrast extravasation. Results-Data were available for 113 patients. Contrast extravasation was se en in 46% of patients at the time of CTA, and the presence of contrast extr avasation was associated with increased fatality: 63.5% versus 16.4% in pat ients without extravasation (P=0.011). There was a trend toward a shorter t ime (median+/-SD) from symptom onset to CTA in patients with extravasation (4.6+/-19 hours) than in patients with no evidence of extravasation (6.6+/- 28 hours; P=0.065). Multivariate analysis revealed that hematoma size (P=0. 022), Glasgow Coma Scale (GCS) score (P=0.016), extravasation of contrast ( P=0.006), infratentorial ICH (P=0.014), and lack of surgery (P<0.001) were independently associated with hospital death. Variables independently assoc iated with contrast extravasation were hematoma size (P=0.024), MABP >120 m m Bg (P=0.012), and GCS score of less than or equal to 8 (P<0.005). Conclusions-Contrast extravasation into the hematoma after ICH is associate d with increased fatality. The risk of contrast extravasation is increased with extreme hypertension, depressed consciousness, and large hemorrhages. If contrast extravasation represents ongoing hemorrhage, the findings in th is study may have implications for therapy of ICH, particularly with regard to blood pressure management.