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

Rodríguez‐Luna, David; Dowlatshahi, Dar; Kosior, Jayme C.; Aviv, Richard I.; Molina, Carlos A.; Silva, Yolanda; Dzialowski, Imanuel; Lum, Cheemun; Członkowska, Anna; Boulanger, Jean-Martin; Kase, Carlos S.; Gubitz, Gord; Bhatia, Rohit; Padma, Vasantha; Roy, Jayanta; Subramaniam, Suresh; Hill, Michael D.; Demchuk, Andrew M.

doi:10.1161/strokeaha.115.011295

Cited by 19 publications

(34 citation statements)

References 33 publications

(59 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We confirmed findings from recent studies reporting ICH volume as a strong predictor of clinical outcomes after ICH [12][13][14][15] .…”

Section: Discussionsupporting

confidence: 90%

“…However, relatively few studies have investigated the association between risk factors and ICH volume [9][10][11] . The volume of ICH measured at hospital admission is the strongest predictor of clinical outcome in ICH [12][13][14][15] . Despite the high incidence rate of ICH in Asians and the finding that admission ICH volume is a strong predictor of patient outcomes, there are very few studies on the factors associated with initial ICH volume in Asia.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Predictors of Supratentorial Deep Intracerebral Hemorrhage Volume and Their Effect on Short-Term Mortality in Asians

Han

Kim²,

Yi³

et al. 2016

Cerebrovasc Dis

View full text Add to dashboard Cite

Background: The volume of intracerebral hemorrhage (ICH) measured at hospital admission is the strongest predictor of clinical outcomes in patients with ICH. Despite the high incidence rate of ICH in Asians, there is lack of data regarding predictors of ICH volume in this ethnic group. The purpose of this study was to determine predictors of deep ICH volume and examine their effect on short-term mortality in Asians. Methods: Hematoma volume was measured using the ABC/2 method. ICH volume was transformed to the natural log scale to normalize distributions for all analyses. We estimated the coefficients of ICH volume based on relevant predictors using multivariable linear regression. We also determined the association between body mass index (BMI) and ICH volume using a regression line and a line determined by a locally weighted scatter plot smoothing. Results: A total of 1,039 patients from 2 twin hospitals in Korea who were admitted with primary spontaneous supratentorial deep ICH over a 12-year period were enrolled in this study. The median ICH volume was 19.7 ml. The average patient age was 59.2, and 62.4% of patients were men. The mean ICH volume showed a gradual, approximately 2% decrease per 1 BMI increase in the current study, after adjusting for all relevant variables (β = -0.024; SE 0.004; p < 0.001). In addition, patients with frequent alcohol consumption showed a 10% increase in mean ICH volume (β = 0.098; SE 0.041; p = 0.016), and patients undergoing warfarin treatment showed a 30% increase in mean ICH volume after full adjustment of all relevant variables (β = 0.296; SE 0.050; p < 0.001). Relative to overweight patients, there was a 47, 11, and 18% increase in admission mean ICH volume in underweight, normal weight and obese patients, respectively. Patients in the first quartile and underweight BMI groups had 1.45-fold (hazard ratio (HR) 1.45; 95% CI 1.03-2.03; p = 0.035) and 1.77-fold (HR 1.77; 95% CI 1.10-2.84; p = 0.019) higher increased risk of death during the first 3 months after ICH, retrospectively. In addition, patients in groups with frequent alcohol consumption and warfarin use both showed a significant association with mortality 90 days after ICH. Conclusions: We demonstrated the association between various predictors and admission ICH volume with short-term mortality in Asians. Further studies are needed to account for these observations and determine their underlying mechanisms.

show abstract

“…We confirmed findings from recent studies reporting ICH volume as a strong predictor of clinical outcomes after ICH [12][13][14][15] .…”

Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Predictors of Supratentorial Deep Intracerebral Hemorrhage Volume and Their Effect on Short-Term Mortality in Asians

Han

Kim²,

Yi³

et al. 2016

Cerebrovasc Dis

View full text Add to dashboard Cite

show abstract

“…In 21 included studies, 14 studies evaluated functional outcome (1,2,8,11,19,23,30,32,39,40,(45)(46)(47)52). Modified Rankin Scale (mRS) was used in all these 14 studies.…”

Section: █ Resultsmentioning

confidence: 99%

“…Death was accessed in 11 studies (2,3,18,21,23,27,35,40,45,47,52). Early neurological deterioration (END) was evaluated in 2 studies (30,36). Discharge disposition was used in 1 study (31).…”

Section: █ Resultsmentioning

confidence: 99%

Prognostic role of perihematomal edema in intracerebral hemorrhage: a systematic review

Ma²,

Zheng³

et al. 2017

Turkish Neurosurgery

View full text Add to dashboard Cite

Although several studies have suggested perihematomal edema(PHE) is associated with prognosis in intracerebral hemorrhage(ICH), the results are different in other studies. The purpose of this study to evaluate the prognostic role of PHE in ICH. According to PRISMA guidelines, a systematic literature search of PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library was performed. Published clinical studies reporting association between PHE and prognosis in ICH were included. Data were extracted including sample size, patient characteristics, PHE measures, outcome measures and follow-up. A total of 21 studies were included with 6 prospective studies and 15 retrospective studies. PHE measures included perihamatomal edema absolute volume (PHEAV), relative prihematomal edema volume (rPHE), perihematomal edema absolute volume growth (PHEAV growth), perihematomal edema expansion rate(PHEER), relative prihematomal edema growth (relative PHE growth), cytotoxic edema(CE) and perihamatomal edema absolute area (PHEAA). The association of PHEAV/ rPHE /PHEAV growth and outcome are conflicting in different studies. Meta-analysis showed 72h PHEER at 72 hours was significantly associated with poor clinical outcome at 90 days (OR=1.54, 95%CI 1.04-2.22, P 0.001). This study suggests the measures and time points for PHE and outcome are various in previous studies. The prognostic values of PHEAV, rPHE, PHEAV growth and other measures are still controversial. PHEER is likely a prognostic predictor for ICH. Further studies with larger sample size, more accurate measures and more time points are needed to investigate the prognostic role of PHE in ICH and the optimal PHE measure to predict outcome in ICH.

show abstract

“…The ABC/2 ([length × width × height]/2) method was used to determine hematoma volume at the bedside by the neurologist or neurosurgeon both on admission and at 24 h. Hematoma growth was defined as absolute growth ≥6 mL from baseline to the second imaging, according to previous studies [18,19]. When we performed logistic regression analysis for analyzing whether time indices to target SBP were independently associated with hematoma growth, we also used other definitions of hematoma growth, namely, hematoma growth > 33% [20] and hematoma growth > 6 mL or > 33% [21].…”

Section: Imaging Analysis and Definition Of Hematoma Growthmentioning

confidence: 99%

Early Achievement of Blood Pressure Lowering and Hematoma Growth in Acute Intracerebral Hemorrhage: Stroke Acute Management with Urgent Risk-Factor Assessment and Improvement-Intracerebral Hemorrhage Study

et al. 2018

View full text Add to dashboard Cite

Background: Previous studies have revealed that hematoma growth mainly occurs during the first 6 h after the onset of spontaneous intracerebral hemorrhage (ICH). Early lowering of blood pressure (BP) may be beneficial for preventing hematoma growth. However, relationships between timing of BP lowering and hematoma growth in ICH remain unclear. We investigated associations between timing of BP lowering and hematoma growth for ICH. Methods: The Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI)-ICH Study was a multicenter, prospective, observational study investigating the safety and feasibility of early (within 3 h from onset) reduction of systolic BP (SBP) to < 160 mm Hg with intravenous nicardipine for acute hypertension in cases of spontaneous ICH. The present study was a post hoc analysis of the SAMURAI-ICH study. We examined relationships between time from onset, imaging, and initiation of treatment to target SBP achievement and hematoma growth (absolute growth ≥6 mL) in ICH patients. Target SBP achievement was defined as the time at which SBP first became < 160 mm Hg. Results: Among 211 patients, hematoma growth was seen in 31 patients (14.7%). The time from imaging to target SBP and time from treatment to target SBP were significantly shorter in patients without hematoma growth than in those with (p = 0.043 and p = 0.032 respectively), whereas no significant difference was seen in time from onset to SBP < 160 mm Hg between groups (p = 0.177). Patients in the lower quartiles of time from imaging to target SBP and time from treatment to target SBP showed lower incidences of hematoma growth (p trend = 0.023 and 0.037 respectively). The lowest quartile of time from imaging to target SBP (< 38 min) was negatively associated with hematoma growth on multivariable logistic regression (OR 0.182; 95% CI 0.038–0.867; p = 0.032). Conclusions: Early achievement of target SBP < 160 mm Hg is associated with a lower risk of hematoma growth in ICH.

show abstract

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

Cited by 19 publications

References 33 publications

Predictors of Supratentorial Deep Intracerebral Hemorrhage Volume and Their Effect on Short-Term Mortality in Asians

Predictors of Supratentorial Deep Intracerebral Hemorrhage Volume and Their Effect on Short-Term Mortality in Asians

Prognostic role of perihematomal edema in intracerebral hemorrhage: a systematic review

Early Achievement of Blood Pressure Lowering and Hematoma Growth in Acute Intracerebral Hemorrhage: Stroke Acute Management with Urgent Risk-Factor Assessment and Improvement-Intracerebral Hemorrhage Study

Contact Info

Product

Resources

About