Location-specific differences in hematoma volume predict outcomes in patients with spontaneous intracerebral hemorrhage

Ironside, Natasha; Chen, Ching-Jen; Dreyer, Victoria; Christophe, Brandon R.; Buell, Thomas J.; Connolly, E. Sander

doi:10.1177/1747493019830589

“…Consistent with previous studies [ 11 , 21 ], advanced age, GCS score, presence of IVH, and PLIC involvement were also associated with mRS > 3. In our study, 95.95% (403/420) of the patients were found with hypertension.…”

Section: Discussionsupporting

confidence: 91%

Different Effects of Hematoma Expansion on Short-Term Functional Outcome in Basal Ganglia and Thalamic Hemorrhages

Deng

¹

,

Chen

²

,

Yang

³

et al. 2021

BioMed Research International

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Purpose. To investigate the impact of hematoma expansion (HE) on short-term functional outcome of patients with thalamic and basal ganglia intracerebral hemorrhage. Methods. Data of 420 patients with deep intracerebral hemorrhage (ICH) that received a baseline CT scan within 6 hours from symptom onset and a follow-up CT scan within 72 hours were retrospectively analyzed. The poor functional outcome was defined as modified Rankin score mRS > 3 at 30 days. Receiver operating characteristic (ROC) curves for relative and absolute growth of HE were generated and compared. Multivariable logistic regression models were used to analyze the impact of HE on the functional outcome in basal ganglia and thalamic hemorrhages. The predictive values for different thresholds of HE were calculated, and correlation coefficient matrices were used to explore the correlation between the covariables. Results. Basal ganglia ICH showed a higher possibility of absolute hematoma growth than thalamic ICH. The area under the curve (AUC) for absolute and relative growth of thalamic hemorrhage was lower than that of basal ganglia hemorrhage (AUC 0.71 and 0.67, respectively) in discriminating short-term poor outcome with an AUC of 0.59 and 0.60, respectively. Each threshold of HE independently predicted poor outcome in basal ganglia ICH ( P < 0.001 ), with HE > 3 ml and > 6 ml showing higher positive predictive values and accuracy compared to HE > 33 % . In contrast, thalamic ICH had a smaller baseline volume (BV, 9.55 ± 6.85 ml ) and was more likely to initially involve the posterior limb of internal capsule (PLIC) (85/153, 57.82%), and the risk of HE was lower without PLIC involvement (4.76%, P = 0.009 ). Therefore, in multivariate analysis, the effect of thalamic HE on poor prognosis was largely replaced by BV and the involvement of PLIC, and the adjusted odds ratios (ORs) of HE was not significant ( P > 0.05 ). Conclusion. Though HE is a high-risk factor for short-term poor functional outcome, it is not an independent risk factor in thalamic ICH, and absolute growth is more predictive of poor outcome than relative growth for basal ganglia ICH.

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“…One study demonstrated that baseline hematoma size categories of <10 mL had the same ability to predict outcome regardless of the HE de nition [21]. Ironsideet al modi ed the original ICH score and the volume cutoff was less than 10 mL in the deep and brainstem location [8].Therefore, it is meaningful to discriminate hematomas with a benign clinical course from those with a malignant course so the effects of interventions could be improved. Our results showed that very small hematomas (<3 mL) had a higher rate of HE compared to those with a volume of 3-10 mL, but with a more benign outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Intracerebral hemorrhage (ICH) is the most devastating subtype of stroke with high morbidity and mortality [1]. Baseline hematoma volume is an independent predictor of hematoma expansion (HE) and poor outcome in patients with ICH [2,3].Although patients with smaller hematomas are more likely to have a benign clinical course [4,5], some studies reported that small hemorrhage in deep locations caused functional dependence or mortality, and the volume cutoff to predict poor outcome was less than the widely used of 30 mL [6][7][8]. In a prior study, small ICH was de ned as benign or malignant, and patients with the latter experienced HE and had worse outcomes [5].…”

Section: Introductionmentioning

confidence: 99%

Radiomics for intracerebral hemorrhage: are all small hematomas benign?

Zhan¹,

Chen²,

Zhang³

et al. 2020

Preprint

1

0

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Background: Radiomics is a valuable tool for predicting hematoma expansion (HE) but has not been used for small intracerebral hemorrhage (ICH). We hypothesized that not all small hematomas are benign and that radiomics could predict HE and short-term outcomes in small hematomas.Methods: We analyzed 313 patients with small ICH who underwent baseline noncontrast CT within 6 h of symptom onset between September 2013 and February 2019. Small ICH was defined as baseline hematoma volume <10 mL. A radiomic score (R-score) was developed in a training (n=218) and validated in a test cohort (n=95). Poor outcome was defined as a Glasgow Outcome Scale score ≤3. The relationship of the R-score with HE and outcomes was investigated using univariate and multivariate analyses. Predictive performance was assessed by the area under the receiver operating characteristic (ROC) curve (AUC).Results: R-score was an independent predictor of HE in the training (odds ratio [OR]: 2.557; 95% CI, 1.455–4.492) and test cohorts (OR, 3.985; 95% CI, 1.051–14.453). In the 3–10 mL subgroup, but not in the <3 ml subgroup, the R-score was independently associated with HE (OR, 4.293; 95% CI, 2.095–8.796) and poor outcome (OR, 1.297; 95%CI, 1.004–1.674) after adjusting for confounders. The R-score achieved good discrimination ability for HE in the training and test cohorts and the 3–10 mL subgroup (AUCs 0.728, 0.717, and 0.740, respectively).Conclusions: Radiomics provides an objective and effective approach for discriminating between benign and malignant course in patients with small ICH, particularly 3–10 mL hematomas.

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“…9 Despite intraventricular clot resolution, acute CSF flow obstruction can progress into persistent hydrocephalus and may require the placement of a VP shunt for permanent CSF diversion. 10 Few studies have been performed about the progression from acute to chronic hydrocephalus and related factors. In this study, we sought to investigate early predictors of long-term shunt dependency in patients with ICH who had received EVD placement for emergency CSF diversion.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with the Need for Ventriculoperitoneal Shunting in Patients with Spontaneous Intracerebral Hemorrhage Requiring Emergency Cerebrospinal Fluid Diversion

Alimohammadi

¹

,

Bagheri

²

,

Hadidi

³

et al. 2020

Indian Journal of Neurosurgery

0

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Introduction Intracerebral hemorrhage (ICH) is a serious medical condition that is frequently complicated by acute hydrocephalus, necessitating emergency cerebrospinal fluid (CSF) diversion in a subset of patients, ultimately requiring long-term treatment via placement of permanent ventricular shunts. The present study aimed to determine factors associated with the need for permanent ventricular shunt placement in these patients. Methods A total of 309 consecutive patients who underwent emergent CSF diversion with external ventricular drain (EVD) as a treatment for ICH between July 2009 and July 2018 were studied retrospectively to assess the factors that might be correlated with shunt-dependent chronic hydrocephalus. A binary logistic regression model was designed to identify independent related factors of shunt-dependent hydrocephalus after ICH. Results Of 309 patients included in this study, 102 (33.00%) required permanent ventricular CSF shunting before discharge. In univariate analysis, age,ventriculitis, ICP elevation >30 mm Hg, ICH evacuation, the Graeb score, days of EVD in place, and CSF protein levels were significantly associated with the requirement for permanent CSF diversion (p < 0.05). The age and ICH evacuation were protective variables and the ventriculoperitoneal (VP) shunt possibility was reduced by 22.6 and 63.5%, respectively. Conclusion Our results showed that higher Graeb score, ICP elevation >30 mm Hg, more days of EVD in place, and higher CSF protein levels were associated with permanent CSF diversion in these patients. Advanced age and ICH evacuation decreased the possibility of VP shunting in our study.These factors may help in predicting which patients will need permanent CSF diversion and could ultimately lead to improvements in the management of these patients.

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Location-specific differences in hematoma volume predict outcomes in patients with spontaneous intracerebral hemorrhage

Cited by 27 publications

References 44 publications

Different Effects of Hematoma Expansion on Short-Term Functional Outcome in Basal Ganglia and Thalamic Hemorrhages

Different Effects of Hematoma Expansion on Short-Term Functional Outcome in Basal Ganglia and Thalamic Hemorrhages

Radiomics for intracerebral hemorrhage: are all small hematomas benign?

Factors Associated with the Need for Ventriculoperitoneal Shunting in Patients with Spontaneous Intracerebral Hemorrhage Requiring Emergency Cerebrospinal Fluid Diversion

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