A practical prediction model for early hematoma expansion in spontaneous deep ganglionic intracerebral hemorrhage

Takeda, Ririko; Ogura, Takeshi; Ooigawa, Hidetoshi; Fushihara, Goji; Yoshikawa, Shingo; Okada, Daisuke; Araki, Ryuichiro; Kurita, Hiroki

doi:10.1016/j.clineuro.2012.10.016

Cited by 53 publications

(33 citation statements)

References 24 publications

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“…The observation that smaller hematomas are more stable is supported by data from the Recombinant Activated Factor VII ICH Trial (48, 49) along with other individual publications (50, 51). In addition to a decreased rate of post-admission hematoma expansion, smaller hematomas are in general associated with a lower likelihood of early neurological deterioration – and thus a more stable acute course of illness (35, 47, 52).…”

Section: Non-contrast Computed Tomographymentioning

confidence: 72%

Prediction and Observation of Post-Admission Hematoma Expansion in Patients with Intracerebral Hemorrhage

et al. 2014

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Post-admission hematoma expansion in patients with intracerebral hemorrhage (ICH) comprises a simultaneous major clinical problem and a possible target for medical intervention. In any case, the ability to predict and observe hematoma expansion is of great clinical importance. We review radiological concepts in predicting and observing post-admission hematoma expansion. Hematoma expansion can be observed within the first 24 h after symptom onset, but predominantly occurs in the early hours. Thus capturing markers of on-going bleeding on imaging techniques could predict hematoma expansion. The spot sign observed on computed tomography angiography is believed to represent on-going bleeding and is to date the most well investigated and reliable radiological predictor of hematoma expansion as well as functional outcome and mortality. On non-contrast CT, the presence of foci of hypoattenuation within the hematoma along with the hematoma-size is reported to be predictive of hematoma expansion and outcome. Because patients tend to arrive earlier to the hospital, a larger fraction of acute ICH-patients must be expected to undergo hematoma expansion. This renders observation and radiological follow-up investigations increasingly relevant. Transcranial duplex sonography has in recent years proven to be able to estimate hematoma volume with good precision and could be a valuable tool in bedside serial observation of acute ICH-patients. Future studies will elucidate, if better prediction and observation of post-admission hematoma expansion can help select patients, who will benefit from hemostatic treatment.

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Section: Non-contrast Computed Tomographymentioning

confidence: 72%

Prediction and Observation of Post-Admission Hematoma Expansion in Patients with Intracerebral Hemorrhage

et al. 2014

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“…The authors concluded that density heterogeneity independently predicted hematoma growth in patients with ICH. In another study of 201 patients with acute deep ICH, Takeda et al 18 validated the association between hematoma heterogeneity and early hematoma expansion. However, evaluation of hematoma heterogeneity was based on subjective judgment and these studies failed to establish a reliable imaging marker for assessment of heterogeneity of hematoma.…”

Section: Discussionmentioning

confidence: 99%

“…The degree or extent of heterogeneity was not defined based on the previous definition of heterogeneous hematoma. 18,20 In our study, we have attempted to develop a CT-based sign that could improve the reliability and subjectivity of the heterogeneous hematoma. We have defined the black hole sign as relatively hopoattenuating area encapsulated by adjacent hyperattenuating area.…”

Section: Strokementioning

confidence: 99%

Black Hole Sign

Zhang

Xiong

et al. 2016

Stroke

226

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Background and Purpose-Early hematoma growth is a devastating neurological complication after intracerebral hemorrhage. We aim to report and evaluate the usefulness of computed tomography (CT) black hole sign in predicting hematoma growth in patients with intracerebral hemorrhage. Methods-Patients with intracerebral hemorrhage were screened for the presence of CT black hole sign on admission head CT performed within 6 hours after onset of symptoms. The black hole sign was defined as hypoattenuatting area encapsulated within the hyperattenuating hematoma with a clearly defined border. The sensitivity, specificity, and positive and negative predictive values of CT black hole sign in predicting hematoma expansion were calculated. Logistic regression analyses were used to assess the presence of the black hole sign and early hematoma growth. Results-A total of 206 patients were enrolled. Black hole sign was found in 30 (14.6%) of 206 patients on the baseline CT scan. The black hole sign was more common in patients with hematoma growth (31.9%) than those without hematoma growth (5.8%; P<0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of back hole sign in predicting early hematoma growth were 31.9%, 94.1%, 73.3%, and 73.2%, respectively. The time-to-admission CT scan, baseline hematoma volume, and the presence of black hole sign on admission CT independently predict hematoma growth in multivariate model. Conclusions-The CT black hole sign could be used as a simple and easy-to-use predictor for early hematoma growth in patients with intracerebral hemorrhage.

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“…Although the precise mechanism of hematoma expansion is unclear, it may be attributable to persistent bleeding or re-bleeding from the initial blood vessel rupture or new foci of bleeding at the periphery of the lesion, often attributed to ischemia, poor venous flow, and local coagulopathy [80,81]. Large hematoma and a heterogeneous pattern can also be predictive of potential expansion [82,83]. The higher volume of hematoma expansion is associated with worse outcomes [79].…”

Section: Hematoma Expansionmentioning

confidence: 99%

Clinical and Radiographic Predictors of Intracerebral Hemorrhage Outcome

et al. 2018

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Background: Intracerebral hemorrhage (ICH) represents 10-15% of all stroke cases in the US annually. Fewer than 40% of these patients ever reach long-term functional independence, and mortality rate is roughly 40% at 1 month. Due to the high morbidity and mortality rates after ICH, early detection of high-risk patients would be beneficial in directing the management course and goals of care. This review aims to discuss relevant clinical and radiographic characteristics that can serve as predictors of poor prognosis and examine their efficacy in predicting patient outcomes after ICH. Summary: A literature review was conducted on various clinical and radiographic factors. They were examined for their predictive value in relation to ICH outcome. Studies that focused on each of these factors were included, and their results analyzed for trends with regard to incidence, patient outcome, and mortality rate. Key Message: In this review, we examined clinical and radiographic characteristics that have been found to be significantly associated to a varying degree with poor outcome. Clinical and radiographic predictors of poor patient outcome are invaluable when it comes to identifying high-risk patients and triaging accordingly as well as guiding decision-making.

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A practical prediction model for early hematoma expansion in spontaneous deep ganglionic intracerebral hemorrhage

Cited by 53 publications

References 24 publications

Prediction and Observation of Post-Admission Hematoma Expansion in Patients with Intracerebral Hemorrhage

Prediction and Observation of Post-Admission Hematoma Expansion in Patients with Intracerebral Hemorrhage

Black Hole Sign

Clinical and Radiographic Predictors of Intracerebral Hemorrhage Outcome

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