Natural Course of Perihemorrhagic Edema After Intracerebral Hemorrhage

Staykov, Dimitre; Wagner, Ingrid; Volbers, Bastian; Hauer, Eva-Maria; Doerfler, Arnd; Schwab, Stefan; Bardutzky, Juergen

doi:10.1161/strokeaha.111.618611

Cited by 150 publications

(131 citation statements)

References 17 publications

(39 reference statements)

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“…23 Interestingly, development of shuntdependent hy drocephalus was more likely in those patients with a tha lamic hemorrhage, but independent of other hemorrhage locations or IVH volume, despite the fact that IVH is known to predict worse outcomes in patients with ICH in a volumedependent manner. 18,25 Given the anatomical relationship of thalamic hemorrhages to the third ven tricle and the foramen of Monro, it is intuitive that he matoma formation in this location more easily results in obstruction of CSF flow independent of IVH volume than in hemorrhages occurring in other locations. Reports of thalamic cavernomas and hemorrhages without intraven tricular extension have documented the development of hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

Predictors of long-term shunt-dependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion

Zacharia¹,

Vaughan²,

Hickman³

et al. 2012

FOC

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Object Intracerebral hemorrhage (ICH) is frequently complicated by acute hydrocephalus, necessitating emergency CSF diversion with a subset of patients, ultimately requiring long-term treatment via placement of permanent ventricular shunts. It is unclear what factors may predict the need for ventricular shunt placement in this patient population. Methods The authors performed a retrospective analysis of a prospective database (ICH Outcomes Project) containing patients with nontraumatic ICH admitted to the neurological ICU at Columbia University Medical Center between January 2009 and September 2011. A multiple logistic regression model was developed to identify independent predictors of shunt-dependent hydrocephalus after ICH. The following variables were included: patient age, admission Glasgow Coma Scale score, temporal horn diameter on admission CT imaging, bicaudate index, admission ICH volume and location, intraventricular hemorrhage volume, Graeb score, LeRoux score, third or fourth ventricle hemorrhage, and intracranial pressure (ICP) and ventriculitis during hospital stay. Results Of 210 patients prospectively enrolled in the ICH Outcomes Project, 64 required emergency CSF diversion via placement of an external ventricular drain and were included in the final cohort. Thirteen of these patients underwent permanent ventricular CSF shunting prior to discharge. In univariate analysis, only thalamic hemorrhage and elevated ICP were significantly associated with the requirement for permanent CSF diversion, with p values of 0.008 and 0.033, respectively. Each remained significant in a multiple logistic regression model in which both variables were present. Conclusions Of patients with ICH requiring emergency CSF diversion, those with persistently elevated ICP and thalamic location of their hemorrhage are at increased odds of developing persistent hydrocephalus, necessitating permanent ventricular shunt placement. These factors may assist in predicting which patients will require permanent CSF diversion and could ultimately lead to improvements in the management of this disorder and the outcome in patients with ICH.

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Section: Discussionmentioning

confidence: 99%

Predictors of long-term shunt-dependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion

Zacharia¹,

Vaughan²,

Hickman³

et al. 2012

FOC

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“…[3][4][5][6][7] Conversely, another study did not find any relationship between perihematomal edema volume and ICH volume or hematoma expansion. 2 Moreover, because of the different timing of hematoma and edema enlargement, the potential relationship between perihematomal edema and ICH volumes at baseline may vary depending on the time from symptom onset to baseline computed tomography (CT) scan.…”

mentioning

confidence: 89%

Perihematomal Edema Is Greater in the Presence of a Spot Sign but Does Not Predict Intracerebral Hematoma Expansion

Rodríguez‐Luna¹,

Dowlatshahi²,

Kosior³

et al. 2016

Stroke

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Intracerebral hemorrhage (ICH) initiates a secondary injury cascade inducing perihematomal edema development within 3 hours from symptom onset. 1 Perihematomal edema increases over time by ≈100% of absolute volume within the first 24 hours.2 However, the relationship among perihematomal edema, ICH volume, and hematoma expansion has not been well established.Background and Purpose-Perihematomal edema volume may be related to intracerebral hemorrhage (ICH) volume at baseline and, consequently, with hematoma expansion. However, the relationship between perihematomal edema and hematoma expansion has not been well established. We aimed to investigate the relationship among baseline perihematomal edema, the computed tomographic angiography spot sign, hematoma expansion, and clinical outcome in patients with acute ICH. Methods-Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) was a prospective observational cohort study of ICH patients presenting within 6 hours from onset. Patients underwent computed tomography and computed tomographic angiography scans at baseline and 24-hour computed tomography scan. A post hoc analysis of absolute perihematomal edema and relative perihematomal edema (absolute perihematomal edema divided by ICH) volumes was performed on baseline computed tomography scans (n=353). Primary outcome was significant hematoma expansion (>6 mL or >33%). Secondary outcomes were early neurological deterioration, 90-day mortality, and poor outcome. Results-Absolute perihematomal edema volume was higher in spot sign patients (24.5 [11.5-41.8

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“…This is not in line with the observation to StyStaykov D. et al They said that perihaematomal oedema developed early after ICH and double after 7 to 11 days. 13 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of Role of Mannitol in the Assessment of Change of Intracranial Haematoma Volume by Neuroimaging Ct in Acute Intracerebral Haemorrhage

Ghosh¹,

Nag²

2017

jebmh

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Natural Course of Perihemorrhagic Edema After Intracerebral Hemorrhage

Cited by 150 publications

References 17 publications

Predictors of long-term shunt-dependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion

Predictors of long-term shunt-dependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion

Perihematomal Edema Is Greater in the Presence of a Spot Sign but Does Not Predict Intracerebral Hematoma Expansion

Evaluation of Role of Mannitol in the Assessment of Change of Intracranial Haematoma Volume by Neuroimaging Ct in Acute Intracerebral Haemorrhage

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