Acute intracerebral haemorrhage: diagnosis and management

McGurgan, Iain; Ziai, Wendy; Werring, David J.; Salman, Rustam Al-Shahi; Parry‐Jones, Adrian

doi:10.1136/practneurol-2020-002763

Cited by 44 publications

(62 citation statements)

References 107 publications

(123 reference statements)

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“…Suporta-se historicamente a prevalência do AVC isquêmico entre as populações, em detrimento do AVCh (Hemphill et al, 2015). Já em relação ao predomínio feminino, a variabilidade está presente entre as amostras (Hemphill et al, 2015;Pereira, Godoy e Ferreira, 1977;Sociedade Brasileira de Doenças Cerebrovasculares, 2021;McGurgan et al, 2021;Shoamaneh et al, 2021;Wallis et al, 2017) apesar de que de forma consensual o sexo masculino é predominante (Hemphill et al, 2015;McGurgan et al, 2021;Shoamaneh et al, 2021;Wallis et al, 2017).…”

Section: Discussionunclassified

Perfil epidemiológico de pacientes com Acidente Vascular Encefálico Hemorrágico em um hospital de atenção terciária do Oeste do Paraná

Ledur

Sehn

Bottega

et al. 2021

RSD

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O Acidente Vascular Cerebral hemorrágico (AVCh) consiste no extravasamento de sangue dos vasos sanguíneos para o parênquima, espaço subaracnoide ou ventrículo cerebral. Apresenta uma grande relação com patologias pregressas como Hipertensão Arterial Sistêmica (HAS) e possui alta taxa de morbi-mortalidade. O objetivo deste estudo foi traçar o perfil epidemiológico de pacientes que se apresentam com AVCh, ratificar dados sobre a patologia, verificando tempo de internação, taxa de mortalidade, fatores de agravo e desfechos. Foi realizado um estudo retrospectivo através de coleta de dados obtidos de prontuários médicos de pacientes que sofreram AVCh entre os anos de 2018 e 2019 e que foram assistidos em um hospital terciário de referência em tratamento a pacientes neurológicos. Foram excluídos os pacientes pediátricos e os com história prévia da doença, as etiologias traumáticas e as hemorragias secundárias (transformação hemorrágica de isquemia cerebral, aneurisma intracraniano, neoplasias intracranianas, trombose venosa cerebral, malformação arteriovenosa, cavernoma, coagulopatia, vasculite ou outras), sendo elegíveis 26 pacientes. Verificou-se que a maioria dos pacientes eram do sexo masculino (57,69%), com idade média de 61 anos. A maioria apresentou Escore de AVCh (ICH) de 1 (26,92%), permaneceu até 10 dias hospitalizada (57,69%) e não necessitou de evacuação cirúrgica do hematoma (57,69%). Houve predominância na localização lobar (80,79%) e a mortalidade foi maior no sexo feminino (63,63%). O desvio de linha média foi significativamente correlacionado com a mortalidade (p=0,04). Pacientes com núcleos da base acometidos permaneceram mais de 20 dias hospitalizados (p=0,052). Apresentar ICH 4-5 representou 100% de mortalidade (p=0,039) e ICH 2-3 configurou permanência hospitalar maior que 10 dias (p=0,001). O estudo identificou o perfil geral dos pacientes de AVCh. Também avaliou e ratificou o ICH elevado como um fator associado a um pior desfecho em pacientes de AVCh.

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Section: Discussionunclassified

Perfil epidemiológico de pacientes com Acidente Vascular Encefálico Hemorrágico em um hospital de atenção terciária do Oeste do Paraná

Ledur

Sehn

Bottega

et al. 2021

RSD

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“…Spontaneous ICH (s-ICH) is largely due to cerebral small vessel disease, predominantly deep perforator arteriopathy (also termed hypertensive arteriopathy) and cerebral amyloid angiopathy. 2 ICH is the deadliest form of stroke. 3 Almost 40% of patients admitted with ICH die within 30 days of admission.…”

Section: Introductionmentioning

confidence: 99%

Validity of Simple Algorithms to Identify Recurrence of Intracerebral Hemorrhage in Two Danish Nationwide Registries

Jensen

Hald

Kristensen

et al. 2021

CLEP

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Purpose: Danish registries could be an attractive resource for studies of recurrent intracerebral hemorrhage (re-ICH). We developed and validated algorithms to identify re-ICH in the Danish Stroke Registry (DSR) and the Danish National Patient Registry (DNPR). Patients and Methods: Using multiple sources, we followed-up an inception cohort with verified first-ever spontaneous ICH (n = 2528) for their first re-ICH in 2009-2018 (study period). We used verified cases of re-ICH (n = 124) as the gold standard to assess the performance of register-based algorithms for identifying re-ICH. For each cohort member, we traced events of re-ICH (ICD-10-code I61) in the study period according to DSR and DNPR, respectively. For each registry, we tested algorithms with a blanking period (BP) -ie, a period immediately following the index ICH during which outcome events were ignoredof varying length (7 days-360 days). The algorithm with the shortest BP that returned a positive predictive value (PPV) of ≥80% was considered optimal. We also calculated negative predictive value (NPV), sensitivity, and specificity of each algorithm and [95% confidence intervals] for all proportions. Results: The optimal algorithm for DSR (BP 30 days) had a PPV of 89.

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“…Although non-Traumatic intracerebral hemorrhage (ICH) affects 1 in 10 patients, case fatality and severe disability are very high among them (1)(2)(3). The incidence and the 30-day mortality of ICH are high (∼40%), in elderly patients (4,5). In addition, hemorrhage in the brain stem, intraventricular dissection, hematoma volume ≥30 cm 3 and Glasgow Coma Scale (GCS) score < 5 are also poor prognostic factors (5,6).…”

Section: Introductionmentioning

confidence: 99%

“…The incidence and the 30-day mortality of ICH are high (∼40%), in elderly patients (4,5). In addition, hemorrhage in the brain stem, intraventricular dissection, hematoma volume ≥30 cm 3 and Glasgow Coma Scale (GCS) score < 5 are also poor prognostic factors (5,6).…”

Section: Introductionmentioning

confidence: 99%

Neurophysiological Examinations as Adjunctive Tool to Imaging Techniques in Spontaneous Intracerebral Hemorrhage: IRONHEART Study

et al. 2021

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Introduction: Intracerebral hemorrhage (ICH) is a devastating disease, which may lead to severe disability or even death. Although many factors may influence the outcome, neurophysiological examinations might also play a role in its course. Our aim was to examine whether the findings of electroencephalography (EEG) and transcranial magnetic stimulation (TMS) can predict the prognosis of these patients.Methods: Between June 1 2017 and June 15 2021, 116 consecutive patients with ICH were enrolled prospectively in our observational study. Clinical examinations and non-Contrast computed tomography (NCCT) scan were done on admission for ICH; follow-up NCCT scans were taken at 14 ± 2 days and at 3 months ± 7 days after stroke onset. EEG and TMS examinations were also carried out.Results: Of the patients in the study, 65.5% were male, and the mean age of the study population was 70 years. Most patients had a history of hypertension, 50.8% of whom had been untreated. In almost 20% of the cases, excessive hypertension was measured on admission, accompanied with >10 mmol/L blood glucose level, whereas their Glasgow Coma Scale was 12 on average. Presence of blood in the ventricles or subarachnoid space and high blood and perihematomal volumes meant poor prognosis. Pathological EEG was prognostic of a worse outcome. With TMS examination at 14 days, it might be possible to estimate outcome in a univariate model and the absence, or reduction of the amplitude of the motor evoked potentials was associated with poor prognosis.Conclusion: Together with the clinical symptoms, the volume of bleeding, perihematomal edema (or their combined volume), and neurophysiological examinations like EEG and TMS play an important role in the neurological outcome of patients with ICH. This might affect the patients' rehabilitation plans in the future, since with the help of the examinations the subset of patients with potential for recovery could be identified.

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Acute intracerebral haemorrhage: diagnosis and management

Cited by 44 publications

References 107 publications

Perfil epidemiológico de pacientes com Acidente Vascular Encefálico Hemorrágico em um hospital de atenção terciária do Oeste do Paraná

Perfil epidemiológico de pacientes com Acidente Vascular Encefálico Hemorrágico em um hospital de atenção terciária do Oeste do Paraná

Validity of Simple Algorithms to Identify Recurrence of Intracerebral Hemorrhage in Two Danish Nationwide Registries

Neurophysiological Examinations as Adjunctive Tool to Imaging Techniques in Spontaneous Intracerebral Hemorrhage: IRONHEART Study

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