Severity of Intraventricular Extension Correlates With Level of Admission Glucose After Intracerebral Hemorrhage

Appelboom, Geoffrey; Piazza, Matthew; Hwang, Brian Y.; Carpenter, Amanda; Bruce, Samuel S.; Mayer, Stephan A.; Connolly, E. Sander

doi:10.1161/strokeaha.110.608166

Cited by 40 publications

(49 citation statements)

References 26 publications

(32 reference statements)

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“…The median ICH volume was 53 cm 3 (range 28-79 cm 3 ), with 3 of 5 patients having a hemorrhage greater than 50 cm 3 , the median midline shift was 7.6 mm (range 3.0-11.3 mm), and 2 of 5 ICHs extended into the ventricles.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 144 patients, 2 had DHC with clot evacuation and 6 underwent craniotomy for evacuation only. The median admission GCS score of this group was 9 (range 3-15) and the median ICH volume was 17 cm 3 (range 0.5-120 cm 3 ). At 6 months after hemorrhage, the mortality rate was 47%, and 24% of the patients were functionally independent.…”

Section: -5)mentioning

confidence: 87%

“…The particular ICHOP study characteristics have been outlined in detail in previous reports. 3,35 The study was approved by the CUMC Institutional Review Board, and written consent was obtained prior to enrollment in the study, either from the patient or from the appropriate surrogate representative when the patient lacked decision-making capacity. Patients with infratentorial ICH or ICH due to arteriovenous malformation or aneurysm were excluded from our current analysis.…”

Section: Methodsmentioning

confidence: 99%

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Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis

Heuts

Bruce

Zacharia

et al. 2013

FOC

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Object Large intracerebral hemorrhage (ICH), compounded by perihematomal edema, can produce severe elevations of intracranial pressure (ICP). Decompressive hemicraniectomy (DHC) with or without clot evacuation has been considered a part of the armamentarium of treatment options for these patients. The authors sought to assess the preliminary utility of DHC without evacuation for ICH in patients with supratentorial, dominant-sided lesions. Methods From September 2009 to May 2012, patients with ICH who were admitted to the neurological ICU at Columbia University Medical Center were prospectively enrolled in that institution's ICH Outcomes Project (ICHOP). Five patients with spontaneous supratentorial dominant-sided ICH underwent DHC without clot evacuation for recalcitrant elevated ICP. Data pertaining to the patients' characteristics and outcomes of treatment were prospectively collected. Results The patients' median age was 43 years (range 30–55 years) and the ICH etiology was hypertension in 4 of 5 patients, and systemic lupus erythematosus vasculitis in 1 patient. On admission, the median Glasgow Coma Scale (GCS) score was 7 (range 5–9). The median ICH volume was 53 cm3 (range 28–79 cm3), and the median midline shift was 7.6 mm (range 3.0–11.3 mm). One day after surgery, the median decrease in midline shift was 2.7 mm (range 1.5–4.6 mm), and the median change in GCS score was +1 (range −3 to +5). At discharge, all patients were still alive, and the median GCS score was 10 (range 9–11), the median modified Rankin Scale (mRS) score was 5 (range 5–5), and the median NIHSS (National Institutes of Health Stroke Scale) score was 22 (range 17–27). Six months after hemorrhage, 1 patient had died, 2 were functionally dependent (mRS Score 4–5), and 2 were functionally independent (mRS Score 0–3). Outcomes for the patients treated with DHC were good compared with 1) outcomes for all patients with spontaneous supratentorial ICH admitted during the same period (n = 144) and 2) outcomes for matched patients (dominant ICH, GCS Score 5–9, ICH volume 28–79 cm3, age < 60 years) whose cases were managed nonoperatively (n = 5). Conclusions Decompressive hemicraniectomy without clot evacuation appears feasible in patients with large ICH and deserves further investigation, preferably in a randomized controlled setting.

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Section: Resultsmentioning

confidence: 99%

Section: -5)mentioning

confidence: 87%

Section: Methodsmentioning

confidence: 99%

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Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis

Heuts

Bruce

Zacharia

et al. 2013

FOC

Self Cite

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“…A large number of observational studies (21 studies, total number of patients=12 145, Table S6)2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32 have examined the association between glucose with ICH outcome with the majority (15 studies, total n=11 161) defining hyperglycemia on the basis of single glucose measurement. One notable study was the post hoc analysis of the Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT) II study (n=2653) 30.…”

Section: Discussionmentioning

confidence: 99%

Persistent Hyperglycemia Is Associated With Increased Mortality After Intracerebral Hemorrhage

Putaala

Sharma

et al. 2017

JAHA

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BackgroundHyperglycemia may be associated with worse outcome after intracerebral hemorrhage (ICH). We assessed the association of early glycemic trajectory on ICH mortality and edema growth.Methods and ResultsWe included patients from the Helsinki ICH study with glucose measurements at least once between both 0 to 24 and 24 to 72 hours from onset. Hyperglycemia was defined as blood glucose ≥8 mmol/L (144 mg/dL) based on the local threshold for treatment. Glycemic trajectory was defined on maximum values 0 to 24 and 24 to 72 hours after ICH: (1) persistent normoglycemia in both epochs; (2) late hyperglycemia (only between 24 and 72 hours); (3) early hyperglycemia (only before 24 hours); and (4) persistent hyperglycemia in both epochs. Logistic regression with known predictors of outcome estimated the association of glycemic trajectory and 6‐month mortality. A generalized linear model assessed the association of glycemic trajectory and interpolated 72‐hour edema extension distance. A total of 576 patients met eligibility criteria, of whom 214 (37.2%) had persistent normoglycemia, 44 (7.6%) late hyperglycemia, 151 (26.2%) early hyperglycemia, and 167 (29.0%) persistent hyperglycemia. Six‐month mortality was higher in the persistent (51.1%) and early (26.3%) hyperglycemia groups than the normoglycemia (19.0%) and late hyperglycemia (3.6%) groups. Persistent hyperglycemia was associated with 6‐month mortality (odds ratio 3.675, 95% CI 1.989–6.792; P<0.001). Both univariate (P=0.426) and multivariable (P=0.493) generalized linear model analyses showed no association between glycemic trajectory and 72‐hour edema extension distance.ConclusionEarly hyperglycemia after ICH is harmful if it is persistent. Strategies to achieve glycemic control after ICH may influence patient outcome and need to be assessed in clinical trials.

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“…The underlying pathophysiology of these findings remains unclear. Hypotheses include a nonspecific stress response or hypothalamic nuclei irritation [88]. In an experimental setting, a hyperglycemic state predisposes diabetic mice and rats to hematoma expansion compared to nondiabetic controls [89].…”

Section: Supportive Carementioning

confidence: 99%

Therapeutic Strategies in Acute Intracerebral Hemorrhage

Brouwers

Goldstein

2012

Neurotherapeutics

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Severity of Intraventricular Extension Correlates With Level of Admission Glucose After Intracerebral Hemorrhage

Cited by 40 publications

References 26 publications

Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis

Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis

Persistent Hyperglycemia Is Associated With Increased Mortality After Intracerebral Hemorrhage

Therapeutic Strategies in Acute Intracerebral Hemorrhage

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