Bilateral “Swirl Sign” : A Predictor of Rebleed
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“Swirl sign” is finding representing an area of low attenuation compared to hyperattenuating clotted blood. It has been described commonly in patients after head injury having large extra-axial collection like subdural or epidural hematoma.The hypoattenuation is due to fresh unclotted blood; surrounded by hyperattenuating clotted blood.Swirl sign is corollary of the spot sign caused by contrast extravasation on CT angiography representing the same phenomenon, Swirl sign” or angiographic “spot sign” represents hematoma expansion in acute cerebral hemorrhage. Patients with swirl sign exhibit large hematoma and predicts poor prognosis with intracerebral hemorrhage. Hypertension related intracerebral hemorrhage is common, but bilateral cerebral hemorrhage due to hypertension is rare. Bilateral swirl sign predicting rebleed carries poor prognosis.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5144477/
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