Secondary Hematoma Expansion and Perihemorrhagic Edema after Intracerebral Hemorrhage: From Bench Work to Practical Aspects

Lim-Hing, Krista; Rincón, Fred

doi:10.3389/fneur.2017.00074

Cited by 68 publications

(71 citation statements)

References 142 publications

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“…Delayed perihematomal edema is likely to be a clinical indicator for poor prognosis or a higher MRS score in our study, of which proves to be a problem that clinicians should be highly aware. Prior study in 2016 identified that PHE volume increases with time, and increasing studies founded that PHE is responsible for the prognosis of sICH patients, as well as DHE . Hence, it is quite prerequisite to analyze the possible risk factors that may lead to DHE so that physicians could take better treatment as early as possible in order to reduce the subsequent deterioration and improve patients' functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Prior study in 2016 identified that PHE volume increases with time, 2 and increasing studies founded that PHE is responsible for the prognosis of sICH patients, 3,13,14 as well as DHE. 15 Hence, it is quite prerequisite to analyze the possible risk factors that may lead to DHE so that physicians could take better treatment as early as possible in order to reduce the subsequent deterioration and improve patients' functional outcomes. Results from our patients in the DHE multifactor analysis study showed that initial hematoma volume and the effects of age are risk factors for DHE after sICH, concluding that the larger the initial hematoma volume, the more prone to DHE, which is in accordance with the results of previous studies.…”

Section: Discussionmentioning

confidence: 99%

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The risk factors and prognosis of delayed perihematomal edema in patients with spontaneous intracerebral hemorrhage

Peng

Tang

et al. 2019

CNS Neurosci Ther

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Purpose We hypothesize delayed perihematomal edema (DHE) leads to secondary injury after spontaneous intracerebral hemorrhage (sICH) with a poor prognosis. Hence, we need to investigate the risk factors of DHE and identify whether DHE will predict the poor outcome of sICH. Methods We retrospectively recruited 121 patients with sICH admitted to the Department of Neurology from January 2014 to August 2018. After dividing all these patients into DHE group and non‐DHE group, we analyzed the potential risk factors and outcome of DHE using a multivariate logistic regression model. Results We conclude DHE after sICH associates with age, hospitalization time, hematoma shape, blood pressure upon admission, alcohol consumption, blood sodium level, and baseline hematoma volume within 24 hours after symptom onset, among which differences were statistically significant (P < .05). Logistic regression analysis finally identified that age (OR = 0.958, 95% CI = 0.923‐0.995) and the baseline hematoma volume (OR = 1.161, 95% CI = 1.089‐1.238) were the most significant risk factors for DHE, and moreover, the DHE (OR = 3.062, 95% CI = 1.196‐7.839) was also a risk factor for poor prognosis in sICH patients. Conclusion We suggest DHE is a clinical predictor of secondary injury following sICH and poor prognosis. In addition, age and baseline hematoma volume are considered significant high‐risk factors for DHE in patients with sICH.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The risk factors and prognosis of delayed perihematomal edema in patients with spontaneous intracerebral hemorrhage

Peng

Tang

et al. 2019

CNS Neurosci Ther

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“…In fact, neuroimaging is considered mandatory [1]. Hematoma and hemorrhage growth correlates with neurological deterioration and increased morbidity and mortality [7–9]. Therefore, follow up of intracranial hemorrhage with imaging has become an important element in treatment of brain injuries [10] and is part of the clinical routine [1].…”

Section: Introductionmentioning

confidence: 99%

Radar based technology for non-contact monitoring of accumulation of blood in the head: A numerical study

2017

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BackgroundThis theoretical study examines the use of radar to continuously monitor “accumulation of blood in the head” (ACBH) non-invasively and from a distance, after the location of a hematoma or hemorrhage in the brain was initially identified with conventional medical imaging. Current clinical practice is to monitor ABCH with multiple, subsequent, conventional medical imaging. The radar technology introduced in this study could provide a lower cost and safe alternative to multiple conventional medical imaging monitoring for ACBH.Materials and methodsThe goal of this study is to evaluate the feasibility of using radar to monitor changes in blood volume in the brain through a numerical simulation of ACBH monitoring from remote, with a directional spiral slot antennae, in 3-D models of the brain. The focus of this study is on evaluating the effect of frequencies on the antennae reading. To that end we performed the calculations for frequencies of 100 MHz, 500 MHz and 1 GHz.Results and discussionThe analysis shows that the ACBH can be monitored with radar and the monitoring resolution improves with an increase in frequency, in the range studied. However, it also appears that when typical clinical dimensions of hematoma and hemorrhage are used, the variable ratio of blood volume radius and radar wavelength can bring the measurements into the Mie and Rayleigh regions of the radar cross section. In these regions there is an oscillatory change in signal with blood volume size. For some frequencies there is an increase in signal with an increase in volume while in others there is a decrease.ConclusionsWhile radar can be used to monitor ACBH non-invasively and from a distance, the observed Mie region dependent oscillatory relation between blood volume size and wavelength requires further investigation. Classifiers, multifrequency algorithms or ultra-wide band radar are possible solutions that should be explored in the future.

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“…In the acute phase, during the first few days, PHE is sustained by coagulation cascade, thrombin production, immune reaction, and inflammatory cells . Finally, beginning from approximately 72 hours after ICH, PHE formation involves erythrocyte lysis and hemoglobin‐induced toxicity . PHE may contribute to an overall increase in peri‐hematoma volume by 75%, and several studies associated it with an increased risk of poor outcome …”

Section: Primary and Secondary Brain Injury Following Cerebral Hematomamentioning

confidence: 99%

“…Finally, beginning from approximately 72 hours after ICH, PHE formation involves erythrocyte lysis and hemoglobin‐induced toxicity . PHE may contribute to an overall increase in peri‐hematoma volume by 75%, and several studies associated it with an increased risk of poor outcome …”

Section: Primary and Secondary Brain Injury Following Cerebral Hematomamentioning

confidence: 99%

Managing blood pressure in acute intracerebral hemorrhage

Lattanzi

Brigo

Silvestrini

2019

J of Clinical Hypertension

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| INTRODUC TI ONIntracerebral hemorrhage (ICH) results from the rupture of cerebral vessels leading to the development of a hematoma in the brain. It comprises approximately 15%-30% of all strokes and affects more than 1 million people every year worldwide. 1 Hypertension is the most common cause of ICH, and less frequent etiologies include coagulopathies, cerebral amyloid angiopathy, vascular abnormalities, brain trauma or tumors, and infections.Cerebral hemorrhage is the stroke subtype characterized by the highest mortality and morbidity: the fatality rate is about 40% at 1 month from bleeding and most survivors retain a severe residual disability, with only 20%-40% of patients living independently at 1 year. 2 Currently, medical and surgical strategies have substantially failed to improve outcome, and the management of ICH consists mainly of supportive therapies. The understanding of the mechanisms underlying the course of hematoma and the progression of the injury in surrounding parenchyma is, hence, of paramount relevance to identify therapeutic targets and effective treatment approaches. | PRIMARY AND S ECONDARY B R AIN INJ URY FOLLOWING CEREB R AL HEMATOMASeveral mechanisms are involved in brain injury related to ICH. Primary brain injury, which occurs at the time of hemorrhage, is due to the mass effect caused by extravasation of blood, physical disruption of adjacent tissue and mechanical compression of local structures. The hematoma can also increase the intracranial pressure, impair cerebral blood flow, and lead to brain herniation. 3 Although damage occurring immediately after ICH is untreatable, it is worth noticing that around one third of patients undergo hematoma expansion (HE) within the first days after stroke. 4 Hematoma growth contributes to midline shift and early neurological deterioration, and is consistently associated with higher fatality and poorer clinical outcome. 5 Remarkably, the intensive blood pressure reduction in acute cerebral hemorrhage trial (INTERACT-1) demonstrated that each 1 mL increase in HE is associated with a raise in the risk of death and dependency by 5%. 6 Secondary brain injury is due either to the body and tissue response to the hematoma or to the toxic effects of clot components, and includes a cascade of events, as inflammation, iron-mediated oxidative stress, apoptosis, necrosis, and autophagy, which mainly result in the development of peri-hemorrhagic edema (PHE). 7Cerebral edema occurs within hours of ICH, peaks several days later and can last for weeks. 5 In the hyperacute phase, PHE involves clot retraction, trans-capillary efflux of electrolytes, water and osmotically active serum proteins, and cytotoxic edema from neuronal energy failure. In the acute phase, during the first few days, PHE is sustained by coagulation cascade, thrombin production, immune reaction, and inflammatory cells. 8,9 Finally, beginning from approximately 72 hours after ICH, PHE formation involves erythrocyte lysis and hemoglobin-induced toxicity. 10 PHE may contribute to an overall ...

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Secondary Hematoma Expansion and Perihemorrhagic Edema after Intracerebral Hemorrhage: From Bench Work to Practical Aspects

Cited by 68 publications

References 142 publications

The risk factors and prognosis of delayed perihematomal edema in patients with spontaneous intracerebral hemorrhage

The risk factors and prognosis of delayed perihematomal edema in patients with spontaneous intracerebral hemorrhage

Radar based technology for non-contact monitoring of accumulation of blood in the head: A numerical study

Managing blood pressure in acute intracerebral hemorrhage

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