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We thank Ye et al. for their comments on our article,1 and for providing interesting data on non-contrast CT (NCCT) markers of hematoma expansion in patients with acute intracerebral hemorrhage (ICH) undergoing surgery. NCCT hypodensities, blend sign, and irregular hematoma density and shape have been consistently associated with active bleeding leading to hematoma enlargement.2 Therefore, a higher risk of rebleeding after surgery in ICH patients with these imaging markers appears biologically plausible. Ye et al. also report a reduced mortality rate in blend-sign positive patients treated with intensive blood pressure reduction before surgery. It would be interesting to investigate whether this association is mediated by a reduced risk of hematoma expansion or rehemorrhage after surgery. If prospectively confirmed on a larger sample size, all these findings may have relevant clinical implications, which could influence the indication and timing of surgery in ICH patients with evidence of these NCCT signs.
Footnotes
Author disclosures are available upon request (journal{at}neurology.org).
- © 2018 American Academy of Neurology
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