Volume-dependent effect of perihaematomal oedema on outcome for spontaneous intracerebral haemorrhages

Appelboom, Geoffrey; Bruce, Samuel S.; Hickman, Zachary L.; Zacharia, Brad E.; Carpenter, Amanda; Vaughan, Kerry A.; Duren, Andrew; Hwang, Richard Y.; Piazza, Matthew; Lee, Ki-Won; Claassen, Jan; Mayer, Stephan A.; Badjatia, Neeraj; Connolly, E. Sander

doi:10.1136/jnnp-2012-303160

Cited by 103 publications

(75 citation statements)

References 29 publications

(18 reference statements)

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“…Patients were subsequently divided into PHE‐Low versus PHE‐High subgroups based on their peak PHE volume. Previous studies have correlated a greater than 10 cm 3 increase in absolute PHE with poorer functional outcome 17. Similarly, we defined our PHE‐High population as those patients whose peak PHE was >10 cm 3 higher than their initial PHE estimate, whereas the PHE‐Low population had a less than 10 cm 3 increase in edema.…”

Section: Methodsmentioning

confidence: 99%

Soluble CD163 in intracerebral hemorrhage: biomarker for perihematomal edema

Roy-O’Reilly

Zhu

Atadja

et al. 2017

Ann Clin Transl Neurol

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ObjectivePatients with intracerebral hemorrhage (ICH) may elaborate varying degrees of perihematomal edema (PHE), requiring closer monitoring and a higher intensity of treatment. Here, we explore whether the soluble form of CD163, a scavenger receptor responsible for hemoglobin sequestration, can serve as a prognostic biomarker of PHE development and poor outcome after ICH.MethodsOur study cohort was comprised of 51 primary age‐ and sex‐matched ICH patients with moderate‐sized, hypertensive deep hemorrhages. Patients were part of a prospective ICH registry cataloguing admission data along with functional outcomes. We measured sCD163 levels in serial serum and cerebrospinal fluid (CSF) samples obtained at prespecified timepoints. Descriptive statistics, including a generalized estimating equation for longitudinal data, were used to analyze sCD163 in relation to ICH outcomes.ResultsAcute serum sCD163 (<48 h postictus) was significantly elevated in ICH patients compared to both acute neurological event controls (P = <0.001) and healthy controls (P = 0.003). As predicted, acute serum sCD163 levels were significantly associated with both hematoma volume expansion (P = 0.009) and PHE expansion (P = 0.002). Further examination determined that patients with high PHE expansion had poorer modified Rankin Scale scores at discharge (P = 0.024), and circulating sCD163 levels were found to be significantly lower in patients with high‐level PHE expansion.InterpretationAcute sCD163 levels may be a useful biomarker for the acute identification of patients at risk for hematoma expansion, perihematomal edema expansion and poorer short‐term outcomes.

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Section: Methodsmentioning

confidence: 99%

Soluble CD163 in intracerebral hemorrhage: biomarker for perihematomal edema

Roy-O’Reilly

Zhu

Atadja

et al. 2017

Ann Clin Transl Neurol

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“…Mean age was 67.8±15.2 years, 58.6% of patients were male, and median NIHSS score on admission was 14 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Nearly all patients (98%) had measurable perihematomal edema on the baseline CT scan.…”

Section: Cta Spot Sign Ich Volume and Perihematomal Edema Volumementioning

confidence: 99%

“…19 Although perihematomal edema growth has been consistently associated with poorer clinical outcomes, 5,7,11,27,28 conflicting results showing no effect, [10][11][12] positive effect, 13 and negative effect 14 on the relationship between perihematomal edema volume at baseline and clinical outcomes have been reported. Our results show that baseline perihematomal edema volume is a surrogate for ICH volume with no prognostic significance by itself.…”

Section: February 2016mentioning

confidence: 99%

“…Both initial ICH volume and hematoma expansion have been shown to be determinants of poor outcome, 8,9 yet the influence of baseline perihematomal edema on clinical outcome remains controversial. [10][11][12][13][14] The main objective of the present study was to determine the relationship among baseline perihematomal edema, the computed tomographic angiography (CTA) spot sign, and hematoma expansion in patients with acute ICH. We hypothesized that a small amount of perihematomal edema relative to ICH may suggest either a early time point from ICH onset or actively bleeding ICH and, therefore, have a high likelihood of both CTA spot sign positivity and hematoma expansion.…”

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confidence: 99%

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

Rodríguez‐Luna¹,

Dowlatshahi²,

Kosior³

et al. 2016

Stroke

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Intracerebral hemorrhage (ICH) initiates a secondary injury cascade inducing perihematomal edema development within 3 hours from symptom onset. 1 Perihematomal edema increases over time by ≈100% of absolute volume within the first 24 hours.2 However, the relationship among perihematomal edema, ICH volume, and hematoma expansion has not been well established.Background and Purpose-Perihematomal edema volume may be related to intracerebral hemorrhage (ICH) volume at baseline and, consequently, with hematoma expansion. However, the relationship between perihematomal edema and hematoma expansion has not been well established. We aimed to investigate the relationship among baseline perihematomal edema, the computed tomographic angiography spot sign, hematoma expansion, and clinical outcome in patients with acute ICH. Methods-Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) was a prospective observational cohort study of ICH patients presenting within 6 hours from onset. Patients underwent computed tomography and computed tomographic angiography scans at baseline and 24-hour computed tomography scan. A post hoc analysis of absolute perihematomal edema and relative perihematomal edema (absolute perihematomal edema divided by ICH) volumes was performed on baseline computed tomography scans (n=353). Primary outcome was significant hematoma expansion (>6 mL or >33%). Secondary outcomes were early neurological deterioration, 90-day mortality, and poor outcome. Results-Absolute perihematomal edema volume was higher in spot sign patients (24.5 [11.5-41.8

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“…Besides the initial hematoma volume [1], secondary hematoma expansion [3][4][5], intraventricular hemorrhage [6,7] and mechanisms of secondary brain injury-e.g. the development of a perihematomal edema (PHE) [8][9][10]-are responsible for the high morbidity and mortality. PHE, being part of the secondary brain damage in ICH, develops partly due to thrombin-mediated endothelial cell damage and inflammation [11][12][13][14][15] and red blood cell lysis [16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%