Specific Lobar Affection Reveals a Rostrocaudal Gradient in Functional Outcome in Spontaneous Intracerebral Hemorrhage

Gerner, Stefan T.; Kuramatsu, Joji B.; Moeller, Sebastian; Huber, Angelika; Lücking, Hannes; Kloska, Stephan P.; Madžar, Dominik; Sembill, Jochen A.; Schwab, Stefan; Huttner, Hagen B.

doi:10.1161/strokeaha.116.015890

Cited by 11 publications

(13 citation statements)

References 41 publications

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“…This is of importance, as several recent studies have shown that particular locations within the lobes of the brain and thalamus have differing influence on clinical outcome. 25,26 In conclusion, we showed that haemorrhage location can predict haematoma expansion and clinical outcome in spontaneous ICH. In particular, we found that lobar ICH was associated with significant haematoma expansion and poor outcome.…”

Section: Discussionmentioning

confidence: 61%

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Location of intracerebral haemorrhage predicts haematoma expansion

Yogendrakumar

Demchuk

Aviv

et al. 2017

European Stroke Journal

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Introduction: The role of intracerebral haemorrhage location in haematoma expansion remains unclear. Our objective was to assess the effect of lobar versus non-lobar haemorrhage on haematoma expansion and clinical outcome. Patients and methods: We analysed data from the prospective PREDICT study where patients with intracerebral haemorrhage presenting to hospital under 6 h of symptom onset received baseline computed tomography (CT), CT angiogram, 24 h follow-up CT, and 90-day mRS. Intracerebral haemorrhage location was categorised as lobar versus nonlobar, and primary outcomes were significant haematoma expansion (>6 ml) and poor clinical outcome (mRS > 3). Multivariable regression was used to adjust for relevant covariates. The primary analysis population was divided by spot sign status and the effect of haemorrhage location was compared to haematoma expansion in exploratory post hoc analysis. Results: Among 302 patients meeting the inclusion criteria, lobar haemorrhage was associated with increased haematoma expansion >6 ml (p ¼ 0.003), poor clinical outcome (p ¼ 0.011) and mortality (p ¼ 0.017). When adjusted for covariates, lobar haemorrhage independently predicted significant haematoma expansion (aOR 2.2 (95% CI: 1.1-4.3), p ¼ 0.021) and poor clinical outcome (aOR 2.6 (95% CI: 1.2-5.6), p ¼ 0.019). Post hoc analysis showed that patients who were spot sign negative had a higher degree of haematoma expansion with baseline lobar haemorrhage (lobar 26% versus deep 11%; p ¼ 0.01). No significant associations were observed in spot-positive patients (lobar 52% versus deep 47%; p ¼ 0.69). Discussion and Conclusion: Haematoma expansion is more likely to occur with lobar intracerebral haemorrhage and haemorrhage location is associated with poor clinical outcome. As expansion is a promising therapeutic target, hemorrhage location may be helpful for prognostication and as a selection tool in future ICH clinical trials.

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Section: Discussionmentioning

confidence: 61%

“…This is of importance, as several recent studies have shown that particular locations within the lobes of the brain and thalamus have differing influence on clinical outcome. 25,26…”

Section: Discussionmentioning

confidence: 99%

Location of intracerebral haemorrhage predicts haematoma expansion

Yogendrakumar

Demchuk

Aviv

et al. 2017

European Stroke Journal

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“…Hematoma location and volume, the presence of the intraventricular extension (16), BHS (21), BS (20), island sign (23), and satellite sign (22) was assessed. Hematoma location was divided into deep, lobar, brain stem, and cerebellum (24), and deep ICH was defined as hematoma involving the thalamus or basal ganglia. Baseline hematoma volume was divided into four categories: <10, 10-20, 20-30, and ≥30 ml.…”

Section: Image Acquisition and Analysismentioning

confidence: 99%

Blend Sign Is a Strong Predictor of the Extent of Early Hematoma Expansion in Spontaneous Intracerebral Hemorrhage

et al. 2020

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Background and Purpose: It is unclear which imaging marker is optimal for predicting the extent of hematoma expansion (EHE). We aimed to compare the usefulness of the blend sign (BS) with that of other non-contrast computed tomography (NCCT) markers for predicting the EHE in patients with spontaneous intracerebral hemorrhage (sICH). Methods: Patients with sICH admitted to our Neurology Emergency Department between September 2013 and January 2019 were enrolled. The EHE was calculated as the absolute increase in hematoma volume between baseline and follow-up CT (within 72 h). The EHE was categorized into four groups: "no growth," "minimal change" (≤5.1 ml), "moderate change" (5.1-12.5 ml), and "massive change" (>12.5 ml). Univariate and multivariate analyses were performed to investigate the relationship between the NCCT markers [BS, black hole sign (BHS), satellite sign, and island sign] and the EHE. Results: A total of 1,111 sICH patients were included (median age: 60 years; 66.5% males). Multiple linear regression analysis showed that the presence of the BS and BHS was independently associated with the EHE, after adjusting for confounders (P < 0.001 and P = 0.003, respectively). The presence of the BS and BHS was positively correlated with growth category (r = 0.285 and r = 0.199, both Ps < 0.001). The BS demonstrated a better predictive performance for the EHE than did the BHS [area under the curve (AUC): 0.67 vs. 0.57; both Ps < 0.001]. Conclusions: In patients with acute sICH, the BS showed a better performance in predicting the EHE compared with other NCCT markers. This imaging marker may help identify patients at a high risk of significant hematoma expansion and may facilitate its early management.

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“…In this retrospective study, the prevalence of occipital ICH was The prevalence and volume of occipital ICH in our study are equal to the findings of Gerner et al who discovered occipital location to be the rarest, even when adjusted for the size of the lobes. 11 The infrequency is even more pronounced considering that the occipital lobe is the preferred location of amyloid angiopathy. 16 Moreover, they reported that the occipital lobe harbored the smallest hematoma with the least growth, 11 which was hypothesized to stem from a higher gray/white-matter (GW) ratio 17 and lower arterial pressure gradient.…”

Section: Discussionmentioning

confidence: 99%

“…However, similar topological data on hemorrhage are scarce. In one study, isolated occipital hemorrhages were rare (4.6% of lobar ICH) and had better outcome than other lobar hemorrhages, 11 whereas another study did not find any occipital areas associating with lower acute mortality 12 …”

Section: Introductionmentioning

confidence: 99%

Occipital intracerebral hemorrhage—clinical characteristics, outcome, and post‐ICH epilepsy

et al. 2020

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The incidence of intracerebral hemorrhage (ICH) is approximately 25/100 000/y, 1 contributing to a cumulative lifetime risk of 8.2%. 2 Although the acute and 1-year mortality of ICH reaches 40% and 50%, respectively, 1,3 lobar location of bleeding seems to accompany a better prognosis. 4 Other factors associated with outcome include hematoma volume, severity, age, infratentorial origin, presence of intraventricular hemorrhage (IVH), and etiology. 5-8 In ischemic stroke, the location of the lesion impacts the severity, 9 outcome, 9 and risk of post-stroke epilepsy. 10 However, similar topological data on hemorrhage are scarce. In one study, isolated occipital hemorrhages were rare (4.6% of lobar ICH) and had better outcome than other lobar hemorrhages, 11 whereas another study did not find any occipital areas associating with lower acute mortality. 12 This retrospective observational registry-based study identifies occipital hemorrhages among consecutive spontaneous ICH patients treated in a single center. Our goal was to investigate the effect of

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Specific Lobar Affection Reveals a Rostrocaudal Gradient in Functional Outcome in Spontaneous Intracerebral Hemorrhage

Cited by 11 publications

References 41 publications

Location of intracerebral haemorrhage predicts haematoma expansion

Location of intracerebral haemorrhage predicts haematoma expansion

Blend Sign Is a Strong Predictor of the Extent of Early Hematoma Expansion in Spontaneous Intracerebral Hemorrhage

Occipital intracerebral hemorrhage—clinical characteristics, outcome, and post‐ICH epilepsy

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