Three-year prognosis of first-ever primary pontine hemorrhage in a hospital-based registry

Ye, Zusen; Huang, Xiaoya; Zhao, Han; Shao, Baiqi; Cheng, Jianhua; Wang, Zhen; Zhang, Zheng; Xiao, Mingzhao

doi:10.1016/j.jocn.2014.12.024

Cited by 27 publications

(24 citation statements)

References 22 publications

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“…Eight studies totalling 870 patients with PH demonstrated that haemorrhage size – ascertained by either volume or trans-axial diameter – is an independent predictor of mortality and outcome (Table 2). 10,17,19,22–26 In these studies, size threshold values above which predicted death or unfavourable outcome ranged between 4 and 5 mL for volume, or 20 and 27 mm for trans-axial diameter. 10,17,22,24,26 As previously mentioned, the pons itself constitutes a small dimensionality and therefore, the volume factor on the ICH score inadequately applies to PH.…”

Section: Resultsmentioning

confidence: 95%

“…1,22–24,26 Irrespective of an arbitrary GCS score threshold, the plurality of studies looking at variables influencing outcomes in PH have consistently identified depressed level of consciousness as the single, most reliable predictor of death and disability. 1,2,10,12,13,15–20,22–24 Eight studies, wherein multivariate regression analysis was conducted using either admission coma or GCS score as variables (a total of 968 patients) identified these factors as independent predictors of early mortality (Table 2). 10,17,19,22–26…”

Section: Resultsmentioning

confidence: 99%

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Prognostic factors in pontine haemorrhage: A systematic review

Behrouz

2018

European Stroke Journal

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Background: Pontine haemorrhage comprises approximately 10% of intracerebral haemorrhages. There is a common presumption that pontine haemorrhage is inherently associated with poor outcome. Purpose: The aim of the review was to identify chief predictors of prognosis in (pontine haemorrhage) through systematic review of published literature. Methods: A query of PubMed/MEDLINE was conducted in search of studies in English language since, 1980 focusing specifically on outcome in pontine haemorrhage. References for each publication were reviewed for additional studies not detected by the PubMed/MEDLINE probe. Surgical outcome studies were excluded from the review. Findings: The query identified 7867 titles, after removal of duplicates and irrelevant studies, 20 titles were included in the review. In a total of 1437 pontine haemorrhage patients included in the 20 studies, the overall rate for early all-cause mortality was 48.1%. Level of consciousness on admission and haemorrhage size were the most consistent predictors of mortality in patients with pontine haemorrhage. Haemorrhage localisation within the pons was also a prognostic factor, but not consistently. Age and intraventricular extension were not found to be powerful prognostic predictors. Discussion/Conclusion: Based on this review, level of consciousness on admission and haemorrhage size were the most influential prognostic factors in pontine haemorrhage, whereas age, haemorrhage localisation, and intraventricular haemorrhage did not consistently predict prognosis.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Prognostic factors in pontine haemorrhage: A systematic review

Behrouz

2018

European Stroke Journal

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“…[1][2][3] Various factors including coma at admission, location, and volume of the hematoma were found to associate with these diverse outcomes. However, inconsistent predictors were reported when different parameters and populations were brought into analysis.…”

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confidence: 99%

Development and Validation of a Grading Scale for Primary Pontine Hemorrhage

Huang

Zhong

Sun

et al. 2017

Stroke

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P rimary pontine hemorrhage (PPH) is the most devastating type of intracranial hemorrhage (ICH), with an acute mortality ranging from 30% to 60%. [1][2][3] Various factors including coma at admission, location, and volume of the hematoma were found to associate with these diverse outcomes. However, inconsistent predictors were reported when different parameters and populations were brought into analysis. [4][5][6][7] As a corollary, it would make cogent sense by combining significant factors into a grading scale to enhance predictive power and, meanwhile, provide a useful tool for physicians in decision-making when facing such patients. 8 Currently, there is no standard, widely accepted early prognostic model or clinical grading scale for outcome prediction in PPH patients. The ICH score, composed of age, Glasgow Coma Scale (GCS), infratentorial origin, intraventricular hemorrhage, and hemorrhage volume, has been widely validated in predicting acute mortality, as well as long-term functional outcome in spontaneous ICH.9,10 Easy to use though, the ICH score and its derivatives tended to deem infratentorial hemorrhage as an independent predictor of poor outcome. 11,12 Because of the small structure of the pons but severe manifestations caused by hemorrhagic impairment, the cutoff value Background and Purpose-We aimed to develop and validate a grading scale for predicting 30-day mortality and 90-day functional outcome in patients with primary pontine hemorrhage (PPH). Methods-We retrospectively reviewed records of consecutive patients with first-ever pontine hemorrhage from 3 teaching hospitals between 2005 and 2012. Independent factors associated with 30-day mortality were identified by logistic regression to establish a risk stratification scale, named the new PPH score. For validation of the new PPH score, we prospectively recruited subjects from 10 units between December 2014 and November 2015. The performance of the new PPH score was presented as discrimination and calibration, measured by area under the curve of the receiver operating characteristic and Hosmer-Lemeshow goodness-of-fit, respectively. Results-Data of 171 patients were available for scale development. The new PPH score consisted of 2 independent factors with individual points assigned as follows: Glasgow Coma Scale score 3 to 4 (=2 points), 5 to 7 (=1 point), and 8 to 15 (=0 point); PPH volume >10 mL (=2 points), 5 to 10 mL (=1 point), and <5 mL (=0 point). An independent cohort of 98 patients was applied as an external validation of the new PPH score. Results showed that the new PPH score was discriminative in predicting both 30-day mortality (area under the curve, 0.902) and 90-day good outcome (area under the curve, 0.927). Furthermore, the new PPH score revealed a good calibration (χ 2 =1.387; P=0.846) in 30-day mortality prediction. Conclusions-The

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“…12 In adults, hypertension is by far the most common cause of spontaneous brainstem hemorrhages; however, anticoagulation therapy, amyloid angiopathy, tumor apoplexy, infections, arteriovenous malformations, and CMs also present similarly. 9,17 General practice in the management of brainstem hemorrhages has been medical and conservative. This is due, in part, to the overall poor natural history and lack of a proven and effective surgical intervention.…”

Section: Discussionmentioning

confidence: 99%

Emergency resection of brainstem cavernous malformations

Tümtürk¹,

Li²,

Turan³

et al. 2018

Journal of Neurosurgery

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Brainstem cavernous malformations (CMs) pose significant challenges to neurosurgeons because of their deep locations and high surgical risks. Most patients with brainstem CMs present with sudden-onset cranial nerve deficits or ataxia, but uncommonly patients can present in extremis from an acute hemorrhage, requiring surgical intervention. However, the timing of surgery for brainstem CMs has been a controversial topic. Although many authors propose delaying surgery into the subacute phase, some patients may not tolerate waiting until surgery. To the best of the authors' knowledge, emergency surgery after a brainstem CM hemorrhage has not been described. In cases of rapidly progressive neurological deterioration, emergency resection may often be the only option. In this retrospectively reviewed small series of patients, the authors report favorable outcomes after emergency surgery for resection of brainstem CMs.

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Three-year prognosis of first-ever primary pontine hemorrhage in a hospital-based registry

Cited by 27 publications

References 22 publications

Prognostic factors in pontine haemorrhage: A systematic review

Prognostic factors in pontine haemorrhage: A systematic review

Development and Validation of a Grading Scale for Primary Pontine Hemorrhage

Emergency resection of brainstem cavernous malformations

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