Perihematomal Edema Expansion Rates and Patient Outcomes in Deep and Lobar Intracerebral Hemorrhage

Abstract

Background and Purpose Perihematomal edema (PHE) expansion rate may predict functional outcome following spontaneous intracerebral hemorrhage (ICH). We hypothesized that the effect of PHE expansion rate on outcome is greater for deep versus lobar ICH. Methods Subjects (n=115) were retrospectively identified from a prospective ICH cohort enrolled from 2000–2013. Inclusion criteria were age ≥18 years, spontaneous supratentorial ICH, and known onset time. Exclusion criteria were primary intraventricular hemorrhage (IVH), trauma, subsequent surgery, or warfarin-related ICH. ICH and PHE volumes were measured from CT scans and used to calculate expansion rates. Logistic regression assessed the association between PHE expansion rates and 90-day mortality or poor functional outcome (modified Rankin Scale >2). Odds ratios are per 0.04 mL/h. Results PHE expansion rate from baseline to 24 hours (PHE24) was associated with mortality for deep (p=0.03, OR 1.13[1.02–1.26]) and lobar ICH (p=0.02, OR 1.03[1.00–1.06]) in unadjusted regression, and in models adjusted for age (deep: p=0.02, OR 1.15[1.02–1.28]; lobar: p=0.03, OR 1.03[1.00–1.06]), Glasgow Coma Scale (deep: p=0.03, OR 1.13[1.01–1.27]; lobar: p=0.02, OR 1.03[1.01–1.06]), or time to baseline CT (deep: p=0.046, OR 1.12[1.00–1.25]; lobar: p=0.047, OR 1.03[1.00–1.06]). PHE expansion rate from baseline to 72 hours (PHE72) was associated with mRS>2 for deep ICH in models that were unadjusted (p=0.02, OR 4.04[1.25–13.04]) or adjusted for ICH volume (p=0.02, OR 4.3[1.25–14.98]), age (p=0.03, OR 5.4[1.21–24.11]), GCS (p=0.02, OR 4.19[1.2–14.55]), or time to first CT (p=0.03, OR 4.02[1.19–13.56]). Conclusions PHE72 was associated with poor functional outcomes after deep ICH, whereas PHE24 was associated with mortality for deep and lobar ICH.

Rapid neuroinflammatory changes in human acute intracerebral hemorrhage

“…Edema in the peri‐hematoma region was detected from day 1 post‐ICH and was a consistent feature in all ICH cases. Our observation is consistent with peri‐hematoma edema reported from head scans of ICH patients within 1 day of the hemorrhage and in association with poorer outcome . Red neurons indicative of ischemic neuronal damage were present within the peri‐hematoma area in most (88%) of the subjects within 3 days of the ICH and up to 12 days post‐ICH.…”

Antihyperthermic treatment decreases perihematomal hypodensity

“…10 The latest prospective studies showed a strong relationship between PHHD volume and higher mortality and morbidity. 8,9,[33][34][35][36] This prognostic capacity is higher during the first 24 hours, progressively decreasing its value during the subacute phase of ICH. 9 Although the prognostic capacity of the PHHD volume over the clinical outcome was not the main objective of our study, we initially showed that PHHD volume was significantly higher in patients with a worse outcome at 3 months, and a PHHD volume <6 mL was 4 times more frequent in patients with a good outcome.…”

“…6 Clinical trials aimed at halting hematoma growth have failed to show efficacy so far 7 and new therapeutic targets are being sought, now focusing on other secondary mechanisms associated with brain damage, such as the perihematomal hypodensity (PHHD) volume. [8][9][10] Hyperthermia has been associated with poor outcome in ICH 11 and with the increase of PHHD volume, 12 especially by hypertensive mechanisms. 13 Hypothermia has been proposed as a treatment for ICH that is associated with a decrease in PHHD.…”

Rehmannia and Rhubarb Decoction Exerts Neuroprotective Effects on the Blood-brain barrier during Acute Intracerebral Hemorrhage by Downregulating the HMGB1/TLR4/MMP9 signaling pathway

“…Cytotoxicity, excitotoxicity, oxidative stress and the in ammatory response, all of which can be induced following ICH, can lead to the destruction of the BBB [5]. One of the events following the disruption of BBB is brain edema, which adversely affect the outcome and prognosis of patients with ICH [6,32]. Therefore, protecting the integrity of the BBB is crucial for attenuating secondary brain injury following ICH.…”