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After a spontaneous intracerebral hemorrhage (ICH), hematoma expansion causes neurological deterioration and increases mortality. Hemostatic agents such as factor VIIa reduced hematoma expansion in randomized trials involving unselected patients with ICH, but clinical outcomes were unaffected. Reliable identification of patients at high risk for hematoma expansion might allow targeted use of these agents in patients who are more likely to receive benefit. Evidence of a “spot sign” on computed tomographic angiography (CTA) suggests active extravasation of contrast-bearing blood; the spot sign correlated with risk for hematoma expansion and poor outcome in single-center studies. To confirm the reliability of the CTA spot sign, researchers hav…