Influence of black hole sign on prognosis in intracerebral hemorrhage and its correlation with cerebral microbleeds
Abstract
INTRODUCTION: In this study, we aimed to evaluate the relationship between cranial computed tomography (CT) black hole sign (BHS) and cerebral microbleeds (CMB) detected on cranial magnetic resonance imaging (MRI), and the relationship between BHS and poor prognosis in patients with spontaneous intracerebral hemorrhage (ICH). METHODS: Our study is designed as a prospective observational study. Patients admitted to our hospital between September 2018 and October 2019 were evaluated. Patients older than 18 years old and whose cranial CT were performed within 6 hours of onset were included. The patients divided into two groups according to BHS presence. After exclusion of the patients who underwent surgery, demographic, clinical, laboratory, and imaging characteristics were compared between the two groups. The effect of BHS on poor prognosis were evaluated using multivariable logistic regression analysis. RESULTS: Sixty six of 88 patients admitted to our hospital were included. 47 of the patients (71.2%) were male, and mean age was 63.08 ± 14.33 years. BHS was found in 16 patients (24.2%). Anticoagulant use, hemorrhage volume on initial CT scan, presence of midline shift, and presence of pineal gland shift were significantly higher in BHS positive patients (p0.05). DISCUSSION AND CONCLUSION: BHS was shown to be associated with in-hospital and 90-day mortality. Negative relationship between BHS and CMB number may support the microbleeding-macrobleeding concept in ICH patients.
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