Different criteria for defining “spot sign” in intracerebral hemorrhage show different abilities to predict hematoma expansion and clinical outcomes: a systematic review and meta-analysis

Background Intracerebral hemorrhage (ICH) remains the deadliest form of stroke worldwide, inducing neuronal death through a wide variety of pathways. Therapeutic hypothermia (TH) is a robust and well studied neuroprotectant widely used across a variety of specialties. Aims This review summarizes results from preclinical and clinical studies to highlight the overall effectiveness of TH to improve long-term ICH outcomes while also elucidating optimal protocol regimens to maximize therapeutic effect. Summary of Review A systematic review was conducted across three databases to identify trials investigating the use of TH to treat ICH. A random-effects meta-analysis was conducted on preclinical studies, looking at neurobehavioral outcomes, blood brain barrier breakdown (BBB), cerebral edema, hematoma volume, and tissue loss. Several mixed-methods meta-regression models were also performed to adjust for variance and variations in hypothermia induction procedures. 21 preclinical studies and 5 human studies were identified. The meta-analysis of preclinical studies demonstrated a significant benefit in behavioral scores (ES=-0.43, p=0.02), cerebral edema (ES=1.32, p=0.0001), and BBB (ES=2.73, p=<0.00001). TH was not found to significantly affect hematoma expansion (ES=-0.24, p=0.12) or tissue loss (ES=0.06, p=0.68). Clinical study outcome reporting was heterogeneous, however there was recurring evidence of TH-induced edema reduction. Conclusions The combined preclinical evidence demonstrates that TH reduced multiple cell death mechanisms initiated by ICH, yet there is no definitive evidence in clinical studies. The cooling strategies employed in both preclinical and clinical studies were highly diverse, and focused refinement of cooling protocols should be developed in future preclinical studies. The current data for TH in ICH remains questionable despite the highly promising indications in preclinical studies. Definitive randomized controlled studies are still required to answer this therapeutic question.

Download Full-text

Accuracy of Shape Irregularity and Density Heterogeneity on Noncontrast Computed Tomography for Predicting Hematoma Expansion in Spontaneous Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis

World Neurosurgery ◽

10.1016/j.wneu.2017.09.022 ◽

2017 ◽

Vol 108 ◽

pp. 347-355 ◽

Cited By ~ 12

Author(s):

Zhiyuan Yu ◽

Jun Zheng ◽

Zhao Xu ◽

Mou Li ◽

Xiaoze Wang ◽

...

Keyword(s):

Computed Tomography ◽

Systematic Review ◽

Intracerebral Hemorrhage ◽

Meta Analysis ◽

Hematoma Expansion ◽

Spontaneous Intracerebral Hemorrhage ◽

Shape Irregularity ◽

Noncontrast Computed Tomography

Download Full-text

Mortality and functional outcome after pediatric intracerebral hemorrhage: cohort study and meta-analysis

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.9.peds20608 ◽

2021 ◽

pp. 1-7

Author(s):

Grégoire Boulouis ◽

Sarah Stricker ◽

Sandro Benichi ◽

Jean-François Hak ◽

Florent Gariel ◽

...

Keyword(s):

Systematic Review ◽

Cohort Study ◽

Clinical Outcome ◽

Intracerebral Hemorrhage ◽

Clinical Outcomes ◽

Meta Analysis ◽

Case Fatality ◽

Complete Recovery ◽

Neurological Deficits

OBJECTIVE The clinical outcome of pediatric intracerebral hemorrhage (pICH) is rarely reported in a comprehensive way. In this cohort study, systematic review, and meta-analysis of patients with pICH, the authors aimed to describe the basic clinical outcomes of pICH. METHODS Children who received treatment for pICH at the authors’ institution were prospectively enrolled in the cohort in 2008; data since 2000 were retrospectively included, and data through October 2019 were analyzed. The authors then searched PubMed and conducted a systematic review of relevant articles published since 1990. Data from the identified populations and patients from the cohort study were pooled into a multicategory meta-analysis and analyzed with regard to clinical outcomes. RESULTS Among 243 children screened for inclusion, 231 patients were included. The median (IQR) age at ictus was 9.6 (4.6–12.5) years, and 128 patients (53%) were male. After a median (IQR) follow-up of 33 (13–63) months, 132 patients (57.4%) had a favorable clinical outcome, of whom 58 (44%) had no residual symptoms. Nineteen studies were included in the meta-analysis. Overall, the proportion of children with complete recovery was 27% (95% CI 19%–36%; Q = 49.6; I2 = 76%); of those with residual deficits, the complete recovery rate was 48.1% (95% CI 40%–57%; Q = 75.3; I2 = 81%). When pooled with the cohort study, the aggregate case-fatality rate at the last follow-up was 17.3% (95% CI 12%–24%; Q = 101.6; I2 = 81%). CONCLUSIONS Here, the authors showed that 1 in 6 children died after pICH, and the majority of children had residual neurological deficits at the latest follow-up. Results from the cohort study also indicate that children with vascular lesions as the etiology of pICH had significantly better clinical functional outcomes.

Download Full-text

Effects of Prior Antiplatelet Therapy on Mortality, Functional Outcome, and Hematoma Expansion in Intracerebral Hemorrhage: An Updated Systematic Review and Meta-Analysis of Cohort Studies

Frontiers in Neurology ◽

10.3389/fneur.2021.691357 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yujie Wu ◽

Donghang Zhang ◽

Hongyang Chen ◽

Bin Liu ◽

Cheng Zhou

Keyword(s):

Systematic Review ◽

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Antiplatelet Therapy ◽

Meta Analysis ◽

Hematoma Expansion ◽

Chi Squared ◽

Meta Regression ◽

Meta Regression Analysis ◽

Trim And Fill

Background and Objective: Antiplatelet therapy (APT) is widely used and believed to be associated with increased poor prognosis by promoting bleeding in patients with intracerebral hemorrhage (ICH). We performed a systematic review and meta-analysis to determine whether prior APT is associated with mortality, functional outcome, and hematoma expansion in ICH patients.Methods: The PubMed, Embase, and Web of Science databases were searched for relevant published studies up to December 11, 2020. Univariate and multivariable adjusted odds ratios (ORs) were pooled using a random effects model. Cochran's chi-squared test (Cochran's Q), the I2 statistic, and meta-regression analysis were used to evaluate the heterogeneity. Meta-regression models were developed to explore sources of heterogeneity. Funnel plots were used to detect publication bias. A trim-and-fill method was performed to identify possible asymmetry and assess the robustness of the conclusions.Results: Thirty-one studies fulfilled the inclusion criteria and exhibited a moderate risk of bias. Prior APT users with intracerebral hemorrhage (ICH) had a slightly increased mortality in both univariate analyses [odds ratio (OR) 1.39, 95% CI 1.24–1.56] and multivariable adjusted analyses (OR 1.41, 95% CI 1.21–1.64). The meta-regression indicated that for each additional day of assessment time, the adjusted OR for the mortality of APT patients decreased by 0.0089 (95% CI: −0.0164 to −0.0015; P = 0.0192) compared to that of non-APT patients. However, prior APT had no effects on poor function outcome (pooled univariate OR: 0.99, 95% CI 0.59–1.66; pooled multivariable adjusted OR: 0.93, 95% CI 0.87–1.07) or hematoma growth (pooled univariate OR: 1.23, 95% CI 0.40–3.74, pooled multivariable adjusted OR: 0.94, 95% CI 0.24–3.60).Conclusions: Prior APT was not associated with hematoma expansion or functional outcomes, but there was modestly increased mortality in prior APT patients. Higher mortality of prior APT patients was related to the strong influence of prior APT use on early mortality.Systematic Review Registration:PROSPERO Identifier [CRD42020215243].

Download Full-text