Cerebral Atrophy is an Independent Risk Factor for Unfavorable Outcome After Spontaneous Supratentorial Intracerebral Hemorrhage

Herweh, Christian; Prager, Eric Peter; Sýkora, Marek; Bendszus, Martin

doi:10.1161/strokeaha.111.670901

Cited by 21 publications

(23 citation statements)

References 15 publications

(18 reference statements)

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“…With regard to brain atrophy, 1 study has shown an association with poor outcome in patients with ICH, using a complex approach to calculate brain volume loss that involved calculating the total bihemispheric volume subtracted by ICH volume and cerebrospinal fluid spaces divided by the total supratentorial intracranial volume using computer-assisted threshold-based planimetric techniques. 18 However, this approach of using planimetric measurements of both hemispheres could be confounded by perihematomal edema and mass effect of the ICH. Thus, we adopted both linear measurements and visual presentation template methods on the contralateral side of the ICH, which being simple and reliable, 11,13,19 could provide useful prognostic information across range of settings without the requirement for special imaging software.…”

Section: Discussionmentioning

confidence: 99%

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Significance of Cerebral Small-Vessel Disease in Acute Intracerebral Hemorrhage

Sato¹,

Delcourt²,

Heeley³

et al. 2016

Stroke

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N euroimaging abnormalities of cerebral white matter lesions (WML), lacunes, and brain atrophy are related to underlying cerebral small-vessel disease (SVD) and are more common in those with stroke and cardiovascular risk factors, in particular hypertension.1,2 Studies of patients with acute ischemic stroke report that WML and cerebral atrophy on baseline computed tomography (CT) are related to poor functional outcome, suggesting that the preexisting markers of Background and Purpose-The significance of structural changes associated with cerebral small-vessel disease (SVD), including white matter lesions (WML), lacunes, and brain atrophy, to outcome from acute intracerebral hemorrhage is uncertain. We determined associations of computed tomographic radiological manifestations of cerebral SVD and outcomes, and in terms of any differential effect of early intensive blood pressure-lowering treatment, in the large-scale Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). Methods-We graded WML (van Swieten scale), the presence of lacunes, and brain atrophy (2 linear measurements and visual rating) for 2069 of 2839 patients with available baseline brain computed tomography (<6 hours of intracerebral hemorrhage onset) by 3 independent neurologists blind to clinical data. Results-WML grade and 2 linear measurements of brain atrophy were associated with death or major disability at 90 days: multivariable-adjusted odds ratios for WML (grade 3 and 4 versus 0), frontal ratio, and third ventricle Sylvian fissure distance (most versus least severe atrophy quartile) were 1.42 (95% confidence interval, 1.02-1.98), 1.47 (1.08-1.99), and 1.64 (1.21-2.22), respectively (all P for trend <0.05). There was no association between lacunes and outcomes. There were no significant differences in the effects of intensive blood pressure-lowering across subgroups of cerebral SVD. Conclusions-Preexisting

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Section: Discussionmentioning

confidence: 99%

“…Achieved BP in the hyperacute phase was measured at 1,6,12,18, and 24 hours post randomization; the means of these 5 measurements were calculated.…”

Section: Methodsmentioning

confidence: 99%

Significance of Cerebral Small-Vessel Disease in Acute Intracerebral Hemorrhage

Sato¹,

Delcourt²,

Heeley³

et al. 2016

Stroke

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“…Finally, the choice of candidate variables for univariate and multivariate analyses was not always comprehensive. Ideally, all proposed HE determinants, such as initial haematoma volume [31], time from onset to imaging [32], presence of previous white matter lesions [33,34], haemorrhage location [35] and presence of cerebral atrophy, the latter independently associated with poor outcome [36], should be included not only for the radiological outcome but also for the clinical outcome. …”

Section: Discussionmentioning

confidence: 99%

Accuracy of the Spot Sign on Computed Tomography Angiography as a Predictor of Haematoma Enlargement after Acute Spontaneous Intracerebral Haemorrhage: A Systematic Review

Giudice

D'Amico²,

Sobesky

et al. 2014

Cerebrovasc Dis

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Background: A common early complication of intracerebral haemorrhage (ICH) is haematoma enlargement (HE), a strong independent predictor of a poor outcome. Therapeutic options to limit haematoma progression are currently scarce. Haemostatic therapy may be effective in patients with ICH, but it carries the risk of thromboembolic events in unselected patients. Accurate patient selection would, therefore, be of key importance for delivering potentially successful therapeutic strategies. Currently, there is no gold standard to accurately predict HE. The presence of contrast extravasation within the haematoma on computed tomography angiography (CTA), the ‘spot sign', has been reported in several studies and seems a particularly promising marker but lacks a standardised evaluation so far. Summary: We conducted a systematic review of published data to address the research question: In adults with acute spontaneous ICH, how accurately does the spot sign predict HE on follow-up imaging and thus poor functional outcome or mortality? We searched PubMed and Embase databases (from 1980 to May 2012), using a highly sensitive search strategy and including all studies involving adult patients with spontaneous ICH evaluated with CTA and follow-up CT scans, reporting any measure of clinical outcome, and reporting or allowing calculation of accuracy measures of the spot sign in predicting HE and clinical outcome. Baseline characteristics, accuracy measures and effect measures, as well as bias assessment, were reported according to PRISMA recommendations. The quality of the studies was appraised using an adapted version of the REMARK reporting recommendations. From 259 potentially relevant studies, we finally selected 6 studies (1 of them was a multicentre cohort study) covering a total of 709 patients. Studies varied substantially in terms of size, methodological quality, definitions of terms, outcomes selected and results. In particular, definition of the spot sign was not consistent in all studies. Furthermore, the only outcome measure consistently available was HE, while definitions and analyses of clinical outcomes seemed not adequate. Lastly, the choice of candidate variables for univariate and multivariate analyses did not include all determinants of HE and poor functional outcome. High heterogeneity was demonstrated (I²: 94% for HE) with substantial potential of bias. Key Messages: Studies of the spot sign are diverse and therefore complex to interpret. Our research question could not be answered due to heterogeneity and potential of bias in the selected studies. Further appropriately powered studies using standardised definitions and taking all predictors of HE and poor clinical outcome into account are required for a proper clinical implementation.

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“…The levels of plasma Aβ may be the result of parenchymal and vessel injury. A recent study 27 found an association between cerebral atrophy and prognosis in patients with ICH and attributed this finding to a pre-existing neurodegenerative disease. Therefore, the clinical outcome is likely to be worse if the parenchymal or vessel amyloid concentrations are high.…”

Section: Strokementioning

confidence: 99%

Prognostic Value of Plasma β-Amyloid Levels in Patients With Acute Intracerebral Hemorrhage

Martí‐Fàbregas

Delgado‐Mederos

Marín

et al. 2014

Stroke

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Background and Purpose— It has been proposed that the deposition of the β-amyloid peptide (Aβ) in the brain parenchyma and brain blood vessels has deleterious effects. We tested the hypothesis that the levels of plasma Aβ are related to the outcome in patients with intracerebral hemorrhage. Methods— In a multicenter study, we prospectively included patients with spontaneous intracerebral hemorrhage within the first 24 hours after onset. At admission, we measured plasma Aβ40 and Aβ42 levels using ELISA techniques. Also, we recorded age, sex, vascular risk factors, National Institutes of Health Stroke Scale score, presence of intraventricular hemorrhage, localization, cause, and volume of the hematoma. We obtained the modified Rankin scale and defined a unfavorable outcome as modified Rankin scale >2 at 3 months. Bivariate and multivariate regression analyses were performed. Results— We studied 160 patients (mean age, 73.8±11.3 years; 59.4% of them were men). A favorable outcome was observed in 64 (40%) of the patients. In the bivariate analyses, unfavorable outcome was associated with high age, female sex, diabetes mellitus, presence of intraventricular hemorrhage, high blood glucose, high National Institutes of Health Stroke Scale score, high volume, and high plasma levels of Aβ42 and Aβ40. The multivariate analysis showed that increased age (odds ratio, 1.07; 95% confidence interval, 1.035–1.21; P <0.0001), high admission National Institutes of Health Stroke Scale score (odds ratio, 1.29, 95% confidence interval, 1.17–1.42; P <0.0001), presence of diabetes mellitus (odds ratio, 4.15; 95% confidence interval, 1.21–14.1; P =0.02), and Aβ42 levels >9.7 pg/mL (odds ratio, 4.11; 95% confidence interval, 1.65–10.1; P =0.02) were independently associated with an increased likelihood of an unfavorable outcome. Conclusions— High levels of plasma Aβ42 in patients with acute intracerebral hemorrhage are associated with a poor functional prognosis.

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Cerebral Atrophy is an Independent Risk Factor for Unfavorable Outcome After Spontaneous Supratentorial Intracerebral Hemorrhage

Cited by 21 publications

References 15 publications

Significance of Cerebral Small-Vessel Disease in Acute Intracerebral Hemorrhage

Significance of Cerebral Small-Vessel Disease in Acute Intracerebral Hemorrhage

Accuracy of the Spot Sign on Computed Tomography Angiography as a Predictor of Haematoma Enlargement after Acute Spontaneous Intracerebral Haemorrhage: A Systematic Review

Prognostic Value of Plasma β-Amyloid Levels in Patients With Acute Intracerebral Hemorrhage

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