Background and Purpose-To investigate whether molecular markers of inflammation and endothelial injury are associated with early growth of intracerebral hemorrhage (ICH). Methods-In a multicenter prospective study, we determined concentrations of interleukin-6 (IL-6), tumor necrosis factor-␣ (TNF-␣), matrix metalloproteinase-9 (MMP-9), and cellular fibronectin (c-Fn) in blood samples obtained on admission from 183 patients with primary hemispheric ICH of Ͻ12 hours' duration. Patients had a neurological evaluation and a computed tomography (CT) scan performed at baseline and at 48Ϯ6 hours. Early growth of the ICH was defined as a volume increase Ͼ33% between the 2 CT examinations for ICH with a baseline volume Ͻ20 mL and Ͼ10% for ICH Ն20 mL. Clinical, radiological, and biochemical predictive factors of ICH enlargement were analyzed by logistic regression analysis. Results-Fifty-four (29.5%) patients showed a relevant early growth of ICH. High leukocyte count and fibrinogen levels, low platelet count, and intraventricular bleeding were associated with early ICH growth in bivariate analyses.

PURPOSE To compare the late complications in the Ahmed Baerveldt Comparison Study during 5 years of follow-up. DESIGN Multicenter, prospective, randomized clinical trial. METHODS SETTINGS Sixteen international clinical centers. STUDY POPULATION Two hundred seventy six subjects aged 18 to 85 years with previous intraocular surgery or refractory glaucoma with intraocular pressure of > 18 mmHg. INTERVENTIONS Ahmed Glaucoma Valve FP7 or Baerveldt Glaucoma Implant BG 101-350. MAIN OUTCOME MEASURES Late postoperative complications (beyond 3 months), reoperations for complications, and decreased vision from complications. RESULTS Late complications developed in 56 subjects (46.8 ± 4.8 5 year cumulative % ± SE) in the Ahmed Glaucoma Valve group and 67 (56.3 ± 4.7 5 year cumulative % ± SE) in the Baerveldt Glaucoma Implant group (P = 0.082). The cumulative rates of serious complications were 15.9% and 24.7% in the Ahmed Glaucoma Valve and Baerveldt Glaucoma Implant groups respectively (P = 0.034) although this was largely driven by subjects who had tube occlusions in the two groups (0.8% in the Ahmed Glaucoma Valve group and 5.7% in the Baerveldt Glaucoma Implant group, P = 0.037). Both groups had a relatively high incidence of persistent diplopia (12%) and corneal edema (20%), although half of the corneal edema cases were likely due to pre-existing causes other than the aqueous shunt. The incidence of tube erosion was 1% and 3% in the Ahmed Glaucoma Valve and Baerveldt Glaucoma Implant groups, respectively (P = 0.04). CONCLUSIONS Long term rates of vision threatening complications and complications resulting in reoperation were higher in the Baerveldt Glaucoma Implant than the Ahmed Glaucoma Valve group over 5 years of follow-up.

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Background and Purpose-Iron plays a detrimental role after experimental intracerebral hemorrhage (ICH). This study investigates whether high-serum ferritin levels are associated with poor outcome in patients with ICH. Methods-We studied 92 consecutive patients with primary hemispheric ICH within the first 12 hours from onset of symptoms (median, 3.3 hours). National Institute of Health Stroke Scale score, ICH, and peripheral edema volumes were measured at admission, 72 hours, and 7 days. Serum levels of ferritin and biomarkers of the inflammatory response were determined. The adjusted effect of ferritin on the full range of Rankin scale was analyzed by a general linear model. Results-Fifty-one patients (55.4%) had poor outcome (Rankin score Ͼ2). Older age, higher stroke severity, larger hematoma volume, intraventricular extension, mass effect, and higher IL-6 and ferritin levels at baseline (270. ron has been involved in cerebral injury after intracerebral hemorrhage (ICH) in experimental studies. Free iron released after erythrocyte lyses and from ferritin stores may have a role in oxidative stress, glutamate release, and inflammatory response after a hemorrhagic brain injury. 1-3 Iron chelators like deferoxamine can reduce brain edema and improve neurological function in experimental models of ICH. 4 Few data exist about clinical evidence of iron toxicity in ICH patients. 5 We collected our data with the objective to test if serum ferritin levels are associated with poor outcome in patients with ICH. Subjects and MethodsWe prospectively evaluated 100 consecutive patients with a primary supratentorial ICH admitted within the first 12 hours from onset of symptoms in 3 hospitals during 1 year. Exclusion criteria were previous disability, severe alcohol consumption, inflammatory or infectious liver, renal, hematologic diseases or cancer, secondary intracerebral hemorrhage, and coma. We further excluded 3 patients lost to follow-up and 5 patients in whom admission cranial CT was not available for volume calculations. The study was approved by the ethics committees of the participating centers and informed consent was signed by patients or their relatives. All patients were admitted at an acute stroke unit and treated according to the guidelines of the European Stroke Initiative. 6 Stroke severity was quantified using the National Institute of Health Stroke Scale score. Functional outcome was evaluated at 3 months using the modified Rankin scale, and poor outcome was defined as modified Rankin scale score Ͼ2.Cranial CT was performed at admission, 72 hours, and 7 days. ICH and peripheral hypodensity volume were measured using the formula of the ellipsoid, and edema volume was calculated by subtracting the volume of the ICH from that of the total lesion. Mass effect was considered when ventricular asymmetry or shifting of the midline structures was observed. All CT scans were centrally evaluated by an investigator who was masked to clinical data. ICH and edema growth ratios were calculated as: final volumeϪinitial vo...

Background and Purpose-Space-occupying brain edema is a life-threatening complication in patients with large hemispheric stroke. The aim of the study was to determine whether molecular markers of endothelial damage may help to predict secondary brain edema and, secondly, to identify patients who could benefit from aggressive therapies such as decompressive hemicraniectomy or hypothermia. Methods-We studied 40 consecutive patients with malignant middle cerebral artery (MCA) infarction and 35 controls with massive MCA infarctions Ͻ70 years of age and matched by stroke severity on admission. Cranial computed tomography (CT) was performed at entry and repeated between days 4 and 7, or earlier if there was neurological worsening. Malignant MCA (m-MCA) infarction was diagnosed when follow-up CT detected a more than two-thirds space-occupying MCA infarction with midline shift, compression of the basal cisterns, and neurological deterioration. Plasma concentrations of glutamate, glycine, ␥-aminobutyric acid, interleukin-6 (IL-6), IL-10, tumor necrosis factor-␣, matrix metalloproteinase-9 (MMP-9), and cellular-fibronectin (c-Fn) were determined in blood samples obtained at admission. Results-Mean time from stroke onset to blood sampling was 6.3Ϯ4.8 in m-MCA and 7.7Ϯ6.0 hours in the control group (Pϭ0.63). Baseline characteristics were comparable in both groups. c-Fn and MMP-9 levels were significantly higher in patients with m-MCA than in controls (all PϽ0.001). c-Fn Ͼ16.6 g/mL had the highest sensitivity (90%), specificity (100%), and negative and positive predictive values (89% and 100%, respectively) for the prediction of m-MCA infarction. Conclusions-A plasma c-Fn concentration Ͼ16.6 g/mL at admission is associated with the development of m-MCA infarction with high sensitivity and specificity, suggesting that c-Fn might be useful in therapeutic decision making.

The studied biomarkers were not sufficient for an accurate differential diagnosis of stroke in the hyperacute setting. Additional discovery of new biomarkers and improvement on laboratory techniques seem necessary for achieving a molecular diagnosis of stroke.

Background and Purpose-Hospitalization as a result of stroke provides an opportunity to stop smoking that is often not taken up. The present study analyzes sociodemographic, psychological, and lesion-related variables to identify associated factors for smoking cessation during the first year after stroke. Methods-We conducted a prospective longitudinal study with a 1-year follow-up of a cohort of 110 patients with acute stroke who were smokers at the time of diagnosis and were admitted consecutively between January 2005 and July 2007. Results-On hospital release, 69.1% had given up smoking but at 1 year, only 40% had stopped smoking. Of the 110 patients, 27 (24.5%) had an acute stroke lesion in the insular cortex, of which 19 (70.3%) were nonsmokers at 1 year. Strongly associated factors in giving up smoking were the location of the lesion in the insular cortex (OR, 5.42; 95% CI, 1.95-15.01; Pϭ0.001) and having the intention of giving up before the stroke, comparing precontemplating patients (without intention of giving up in the near future) with contemplating and prepared patients (intention of stopping in the near future; OR, 7.29; 95% CI, 1.89 -28.07; Pϭ0.004). Conclusions-Of patients with stroke who were smokers, only 4 of 10 patients had stopped smoking 1 year after admission. Our results show that the variables best predicting smoking cessation in patients with a stroke diagnosis 1 year after hospital discharge are insular damage and the prestroke intention to stop. (Stroke. 2012;43:131-136.)

Background and Purpose— Variability in computed tomography angiography (CTA) acquisitions may be one explanation for the modest accuracy of the spot sign for predicting intracerebral hemorrhage expansion detected in the multicenter Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) study. This study aimed to determine the frequency of the spot sign in intracerebral hemorrhage and its relationship with hematoma expansion depending on the phase of image acquisition. Methods— PREDICT study was a prospective observational cohort study of patients with intracerebral hemorrhage presenting within 6 hours from onset. A post hoc analysis of the Hounsfield units of an artery and venous structure were measured on CTA source images of the entire PREDICT cohort in a core laboratory. Each CTA study was classified into arterial or venous phase and into 1 of 5 specific image acquisition phases. Significant hematoma expansion and total hematoma enlargement were recorded at 24 hours. Results— Overall (n=371), 77.9% of CTA were acquired in arterial phase. The spot sign, present in 29.9% of patients, was more frequently seen in venous phase as compared with arterial phase (39% versus 27.3%; P =0.041) and the later the phase of image acquisition ( P =0.095). Significant hematoma expansion ( P =0.253) and higher total hematoma enlargement ( P =0.019) were observed more frequently among spot sign–positive patients with earlier phases of image acquisition. Conclusions— Later image acquisition of CTA improves the frequency of spot sign detection. However, spot signs identified in earlier phases may be associated with greater absolute enlargement. A multiphase CTA including arterial and venous acquisitions could be optimal in patients with intracerebral hemorrhage.