CT Swirl Sign in intracranial hemorrhage and its association with hematoma expansion

Introduction & objective -One of the poor clinical outcomes in intracranial hemorrhage is hematoma expansion. We aimed to determine the association of the swirl sign with hematoma expansion.Methods-Fifty patients with spontaneous intracranial hemorrhage presenting between January 2021 to July 2023 who underwent an initial CT at presentation (CT1) and follow up CT (CT2) within next 96 hours at our hospital were retrospectively identified. The swirl sign was identified on non-contrast CT. The haematoma volume in initial and repeated CTs were calculated and correlated with descriptive analysis. Results -Amongst total of 50 patients, swirl sign was positive in 10 patients (20%) and negative in 40 patients (80%). In patients having swirl sign, mean age was 38 years. Mean initial and follow up hematoma volumes were 25.49 ml and 47.79 ml respectively. Significant hematoma expansion was noted with an approximate 88% increase in volume. In patients without swirl sign, mean age was 49 years. Mean initial and follow up hematoma volumes were 28.55 ml and 24.96 ml with no significant increase in hematoma volume.Conclusions-Thus, swirl sign is associated with hematoma expansion in patients with intracranial hemorrhage and can be used as a predictor of functional outcome of patients. Hematoma expansion must be kept in mind while reporting CTs of patients having swirl sign.