Predictors of hematoma growth?

welcomes Letters to the Editor and will publish them, if suitable, as space permits. They should not exceed 1000 words (excluding references) and may be subject to editing or abridgment. Please submit letters in duplicate, typed double-spaced. Include a fax number for the corresponding author and a completed copyright transfer agreement form (published in the January and July issues). To the Editor: I read with much interest the article, " Multivariate Analysis of Predictors of Hematoma Enlargement in Spontaneous Intracere-bral Hemorrhage, " by Fujii and colleagues. 1 I fully agree with the authors on the importance of identifying factors responsible for the increase in volume of intracerebral hemorrhage, since the hematoma " growth " is common 1,2 and because this is associated with neurological deterioration. 2 While their multivariate analyses revealed 5 independent " predictors " for hematoma enlargement , Fujii and colleagues pointed out in their Discussion section that 3 of the 5 factors (ie, a short time interval from onset, the presence of disturbed consciousness, and irregularly shaped hematoma) were related to the natural time course rather than acting as risk factors. 1 The authors further postulated that the stabilization of hematoma formation takes some time, that disturbed consciousness can be a consequence of hematoma enlargement rather than a cause, and that irregularly shaped hematomas may indicate bleeding from multiple arterioles. 1 Regarding their findings and interpretations, I would like to make the following comments. First, the great majority of intracerebral hematomas are caused by bleeding from arteries or arterioles under systemic arterial pressure, and so hematomas will " grow " for some time, until the hematoma enlargement is counteracted by increasing regional intracranial pressure; eventually, bleeding ceases because of hemostasis. 3 In a similar study, Brott and colleagues 2 performed baseline CT scans in patients with intracerebral hemorrhage within 3 hours of onset and repeated the scans at regular intervals after the first scans. Brott and colleagues reported 26% of substantial hematoma growth between the baseline and 1-hour CT scans and 12% of substantial hematoma growth between the 1-and 20-hour CT scans. 2 In the article by Fujii and colleagues, the patients had their first CT scans within 24 hours of onset of symptoms and their second scans within 24 hours of admission. 1 Considering the postulation by Fujii and colleagues that active bleeding of hematoma formation largely stabilizes within 6 hours of onset, the study by …