scholarly journals Impact of Increased Hemoglobin on Spontaneous Intracerebral Hemorrhage

2021 ◽  
Author(s):  
Yuxuan Lu ◽  
Haiqiang Jin ◽  
Yuhua Zhao ◽  
Yuxian Li ◽  
Jun Xu ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intracerebral Hemorrhage ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Single Center Study ◽  
Tibet Autonomous Region ◽  
Basal Ganglia Hemorrhage ◽  
Lobar Hemorrhage ◽  
Hemorrhage Volume ◽  
The Mean ◽  
The Impact

Abstract Background Studies of the impact of increased hemoglobin on spontaneous intracerebral hemorrhage (ICH) are limited. The present study aimed to explore the effect of increased hemoglobin on ICH. Methods A retrospective single-center study using medical records from a database processed by univariate and multivariate analyses was performed in the People’s Hospital of Tibet Autonomous Region in Lhasa, Tibet, China. Results The mean hemoglobin level in 211 patients with ICH was 165.03 ± 34.12 g/l, and a median hematoma volume was 18.5 ml. Eighty-eight (41.7%) patients had large hematomas (supratentorial hematoma ≥ 30 ml; infratentorial hematoma ≥ 10 ml). No differences in ICH risk factors between the groups with different hemoglobin levels were detected. Increased hemoglobin was independently associated with large hematomas [odds ratio (OR) 1.013, P = 0.023]. Increased hemoglobin was independently associated with ICH with subarachnoid hemorrhage (OR 1.014, P = 0.016), which was more pronounced in men (OR 1.027, P = 0.002). Increased hemoglobin was independently associated with basal ganglia hemorrhage and lobar hemorrhage in men (OR 0.986, P = 0.022; OR 1.013, P = 0.044, respectively) but not in women (P > 0.1). Conclusions Increased hemoglobin was independently associated with large hemorrhage volume. Increased hemoglobin was independently associated with lobar hemorrhage in men and ICH with subarachnoid hemorrhage, which was more pronounced in men. Additional studies are needed to confirm our findings and explore potential mechanisms.

Volumetric quantification of aneurysmal subarachnoid hemorrhage independently predicts hydrocephalus and seizures

2021 ◽  
pp. 1-9
Author(s):  
Badih J. Daou ◽  
Siri Sahib S. Khalsa ◽  
Sharath Kumar Anand ◽  
Craig A. Williamson ◽  
Noah S. Cutler ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Characteristic Curve ◽  
Volumetric Analysis ◽  
Aneurysm Rupture ◽  
Mean Difference ◽  
Analysis Tool ◽  
Volume Data ◽  
Hemorrhage Volume ◽  
The Mean

OBJECTIVEHydrocephalus and seizures greatly impact outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH); however, reliable tools to predict these outcomes are lacking. The authors used a volumetric quantitative analysis tool to evaluate the association of total aSAH volume with the outcomes of shunt-dependent hydrocephalus and seizures.METHODSTotal hemorrhage volume following aneurysm rupture was retrospectively analyzed on presentation CT imaging using a custom semiautomated computer program developed in MATLAB that employs intensity-based k-means clustering to automatically separate blood voxels from other tissues. Volume data were added to a prospectively maintained aSAH database. The association of hemorrhage volume with shunted hydrocephalus and seizures was evaluated through logistic regression analysis and the diagnostic accuracy through analysis of the area under the receiver operating characteristic curve (AUC).RESULTSThe study population comprised 288 consecutive patients with aSAH. The mean total hemorrhage volume was 74.9 ml. Thirty-eight patients (13.2%) developed seizures. The mean hemorrhage volume in patients who developed seizures was significantly higher than that in patients with no seizures (mean difference 17.3 ml, p = 0.01). In multivariate analysis, larger hemorrhage volume on initial CT scan and hemorrhage volume > 50 ml (OR 2.81, p = 0.047, 95% CI 1.03–7.80) were predictive of seizures. Forty-eight patients (17%) developed shunt-dependent hydrocephalus. The mean hemorrhage volume in patients who developed shunt-dependent hydrocephalus was significantly higher than that in patients who did not (mean difference 17.2 ml, p = 0.006). Larger hemorrhage volume and hemorrhage volume > 50 ml (OR 2.45, p = 0.03, 95% CI 1.08–5.54) were predictive of shunt-dependent hydrocephalus. Hemorrhage volume had adequate discrimination for the development of seizures (AUC 0.635) and shunted hydrocephalus (AUC 0.629).CONCLUSIONSHemorrhage volume is an independent predictor of seizures and shunt-dependent hydrocephalus in patients with aSAH. Further evaluation of aSAH quantitative volumetric analysis may complement existing scales used in clinical practice and assist in patient prognostication and management.

The influence of aneurysm morphology on the volume of hemorrhage after rupture

2021 ◽  
pp. 1-9
Author(s):  
Pablo M. Munarriz ◽  
Blanca Navarro-Main ◽  
Jose F. Alén ◽  
Luis Jiménez-Roldán ◽  
Ana M. Castaño-Leon ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Univariate Analysis ◽  
Size Ratio ◽  
Computer Assisted ◽  
Data Set ◽  
Aneurysm Size ◽  
Risk Of Rupture ◽  
Morphological Variables ◽  
Hemorrhage Volume ◽  
The Impact

OBJECTIVE Factors determining the risk of rupture of intracranial aneurysms have been extensively studied; however, little attention is paid to variables influencing the volume of bleeding after rupture. In this study the authors aimed to evaluate the impact of aneurysm morphological variables on the amount of hemorrhage. METHODS This was a retrospective cohort analysis of a prospectively collected data set of 116 patients presenting at a single center with subarachnoid hemorrhage due to aneurysmal rupture. A volumetric assessment of the total hemorrhage volume was performed from the initial noncontrast CT. Aneurysms were segmented and reproduced from the initial CT angiography study, and morphology indexes were calculated with a computer-assisted approach. Clinical and demographic characteristics of the patients were included in the study. Factors influencing the volume of hemorrhage were explored with univariate correlations, multiple linear regression analysis, and graphical probabilistic modeling. RESULTS The univariate analysis demonstrated that several of the morphological variables but only the patient’s age from the clinical-demographic variables correlated (p < 0.05) with the volume of bleeding. Nine morphological variables correlated positively (absolute height, perpendicular height, maximum width, sac surface area, sac volume, size ratio, bottleneck factor, neck-to-vessel ratio, and width-to-vessel ratio) and two correlated negatively (parent vessel average diameter and the aneurysm angle). After multivariate analysis, only the aneurysm size ratio (p < 0.001) and the patient’s age (p = 0.023) remained statistically significant. The graphical probabilistic model confirmed the size ratio and the patient’s age as the variables most related to the total hemorrhage volume. CONCLUSIONS A greater aneurysm size ratio and an older patient age are likely to entail a greater volume of bleeding after subarachnoid hemorrhage.

scholarly journals Impact of Early C-Reactive Protein/Albumin Ratio on Intra-Hospital Mortality Among Patients with Spontaneous Intracerebral Hemorrhage

2020 ◽  
Vol 9 (4) ◽  
pp. 1236 ◽  
Author(s):  
Michael Bender ◽  
Kristin Haferkorn ◽  
Michaela Friedrich ◽  
Eberhard Uhl ◽  
Marco Stein
Keyword(s):  
Regression Analysis ◽  
Intracerebral Hemorrhage ◽  
Hospital Mortality ◽  
Cox Regression ◽  
Spontaneous Intracerebral Hemorrhage ◽  
C Reactive Protein ◽  
Albumin Ratio ◽  
Cox Regression Analysis ◽  
Reactive Protein ◽  
The Impact

Objective: The impact of increased C-reactive protein (CRP)/albumin ratio on intra-hospital mortality has been investigated among patients admitted to general intensive care units (ICU). However, it was not investigated among patients with spontaneous intracerebral hemorrhage (ICH). This study aimed to investigate the impact of CRP/albumin ratio on intra-hospital mortality in patients with ICH. Patients and Methods: This retrospective study was conducted on 379 ICH patients admitted between 02/2008 and 12/2017. Blood samples were drawn upon admission and the patients’ demographic, medical, and radiological data were collected. The identification of the independent prognostic factors for intra-hospital mortality was calculated using binary logistic regression and COX regression analysis. Results: Multivariate regression analysis shows that higher CRP/albumin ratio (odds ratio (OR) = 1.66, 95% confidence interval (CI) = 1.193–2.317, p = 0.003) upon admission is an independent predictor of intra-hospital mortality. Multivariate Cox regression analysis indicated that an increase of 1 in the CRP/albumin ratio was associated with a 15.3% increase in the risk of intra-hospital mortality (hazard ratio = 1.153, 95% CI = 1.005–1.322, p = 0.42). Furthermore, a CRP/albumin ratio cut-off value greater than 1.22 was associated with increased intra-hospital mortality (Youden’s Index = 0.19, sensitivity = 28.8, specificity = 89.9, p = 0.007). Conclusions: A CRP/albumin ratio greater than 1.22 upon admission was significantly associated with intra-hospital mortality in the ICH patients.

scholarly journals The Influence of Oxidative Stress on Neurological Outcomes in Spontaneous Intracerebral Hemorrhage

Biomolecules ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1615
Author(s):  
Julia Masomi-Bornwasser ◽  
Elena Kurz ◽  
Christina Frenz ◽  
Jan Schmitt ◽  
Dominik M. A. Wesp ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Brain Injury ◽  
Intracerebral Hemorrhage ◽  
Total Antioxidant Status ◽  
Secondary Brain Injury ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Neurological Outcomes ◽  
Total Antioxidant ◽  
Patient’S Outcome ◽  
The Impact

Spontaneous intracerebral hemorrhage (ICH) causes, besides the primary brain injury, a secondary brain injury (SBI), which is induced, amongst other things, by oxidative stress (OS) and inflammation, determining the patient’s outcome. This study aims to assess the impact of OS in plasma and cerebrospinal fluid (CSF) on clinical outcomes in patients with ICH. A total of 19 ICH (volume > 30 cc) patients and 29 control patients were included. From day one until seven, blood and CSF samples were obtained, and ICH volume was calculated. OS markers, like malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), glutathione-sulfhydryl (GSH), and the total antioxidant status (TAS) were measured. Clinical data on treatment and outcome were determined. Patients with mRS ≤ 4 showed significantly elevated SOD and GSH-Px levels in plasma compared to patients with poor CO (p = 0.004; p = 0.002). Initial increased TAS in plasma and increased MDA in CSF were linked to an unfavorable outcome after six months (p = 0.06, r = 0.45; p = 0.05, r = 0.44). A higher ICH volume was associated with a worse outcome at week six (p = 0.04, r = 0.47). OS plays a significant role in SBI. Larger ICHs, elevated MDA in CSF, and TAS in plasma were associated with a detrimental outcome, whereas higher plasma-SOD and -GSH-Px were associated with a favorable outcome.

scholarly journals Stroke subtypes in southern Iran

2015 ◽  
Vol 4 (1) ◽  
pp. 47-49
Author(s):  
Rasool Safari ◽  
Afshin Borhanihaghighi ◽  
Seyed Taghi Heydari ◽  
Anahid Safari ◽  
Salvador Cruz-Flores
Keyword(s):  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Intracerebral Hemorrhage ◽  
Single Center ◽  
Stroke Patients ◽  
Stroke Subtype ◽  
Younger Patients ◽  
Single Center Study ◽  
Length Of Hospitalization ◽  
Center Study

Objective: To investigate about frequency of different subtypes of stroke in south of IranMethods: This  is a retrospective, single-center study  conducted at Namazi Hospital, Shiraz, south of Iran. Age, sex, length of hospitalization and  mortality  of  stroke patients were recorded by reviewing hospital medical records.Results: 16 351 patients (53.6% male, 46.4%female) were recruited.  Ischemic stroke (10750 patients, 65.7%), intracerebral hemorrhage(3282 patients,20.1%) and subarachnoid hemorrhage(1057 patients,6.5%)  were the most common subtypes of stroke, respectively. In 1262 patients (7.7%) the stroke subtype could not been specified. Ischemic stroke and intracerebral hemorrhage were more common in men but subarachnoid hemorrhage was more common in women. Subarachnoid hemorrhage occurred significantly in younger patients. Mortality was significantly higher in intracerebral hemorrhage. Hospital stay was significantly longer in subarachnoid hemorrhage group.Conclusion: the distribution of the different  subtypes of stroke in Iran is similar to Caucasians.

Frontal bur hole through an eyebrow incision for image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage

2012 ◽  
Vol 117 (4) ◽  
pp. 767-773 ◽  
Author(s):  
Justin A. Dye ◽  
Joshua R. Dusick ◽  
Darrin J. Lee ◽  
Nestor R. Gonzalez ◽  
Neil A. Martin
Keyword(s):  
Glasgow Coma Scale ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Invasive Technique ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Midline Shift ◽  
Hematoma Volume ◽  
Coma Scale ◽  
Endoscopic Evacuation ◽  
The Mean

Object Surgical evacuation of spontaneous intracerebral hemorrhage (sICH) remains a subject of controversy. Minimally invasive techniques for hematoma evacuation have shown a trend toward improved outcomes. The aim of the present study is to describe a minimally invasive alternative for the evacuation of sICH and evaluate its feasibility. Methods The authors reviewed records of all patients who underwent endoscopic evacuation of an sICH at the UCLA Medical Center between March 2002 and March 2011. All patients in whom the described technique was used for evacuation of an sICH were included in this series. In this approach an incision is made at the superior margin of the eyebrow, and a bur hole is made in the supraorbital bone lateral to the frontal sinus. Using stereotactic guidance, the surgeon advanced the endoscopic sheath along the long axis of the hematoma and fixed it in place at two specific depths where suction was then applied until 75%–85% of the preoperatively determined hematoma volume was removed. An endoscope's camera, then introduced through the sheath, was used to assist in hemostasis. Preoperative and postoperative hematoma volumes and reduction in midline shift were calculated and recorded. Admission Glasgow Coma Scale and modified Rankin Scale (mRS) scores were compared with postoperative scores. Results Six patients underwent evacuation of an sICH using the eyebrow/bur hole technique. The mean preoperative hematoma volume was 68.9 ml (range 30.2–153.9 ml), whereas the mean postoperative residual hematoma volume was 11.9 ml (range 5.1–24.1 ml) (p = 0.02). The mean percentage of hematoma evacuated was 79.2% (range 49%–92.7%). The mean reduction in midline shift was 57.8% (p < 0.01). The Glasgow Coma Scale score improved in each patient between admission and discharge examination. In 5 of the 6 patients the mRS score improved from admission exam to last follow-up. None of the patients experienced rebleeding. Conclusions This minimally invasive technique is a feasible alternative to other means of evacuating sICHs. It is intended for anterior basal ganglia hematomas, which usually have an elongated, ovoid shape. The approach allows for an optimal trajectory to the long axis of the hematoma, making it possible to evacuate the vast majority of the clot with only one pass of the endoscopic sheath, theoretically minimizing the amount of damage to normal brain.

Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage

1993 ◽  
Vol 78 (2) ◽  
pp. 188-191 ◽  
Author(s):  
Joseph P. Broderick ◽  
Thomas Brott ◽  
Thomas Tomsick ◽  
Rosemary Miller ◽  
Gertrude Huster
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Confidence Interval ◽  
Intracerebral Hemorrhage ◽  
Annual Incidence ◽  
Laboratory Research ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Content Type ◽  
Fine Print

✓ The authors report a study of all instances of spontaneous intracerebral hemorrhage (ICH) (188 cases) and subarachnoid hemorrhage (SAH) (80 cases) that occurred in the Greater Cincinnati area during 1988. Adjusted for age, sex, and race, the annual incidence of ICH was 15 per 100,000 population (95% confidence interval 13 to 17) versus six per 100,000 for SAH (95% confidence interval 5 to 8). The incidence of ICH was at least double that of SAH for women, men, and whites and approximately 1½ times that for blacks. The 30-day mortality rate of 44% for ICH was not significantly different from the 46% mortality rate for SAH. Despite the evidence that ICH is more than twice as common and the disorder just as deadly as SAH, clinical and laboratory research continues to focus primarily on SAH.

Abstract TP451: Intracerebral Hemorrhage Volume Predicts Neurological Pupil Index

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Venkatesh Aiyagari ◽  
Khadijah Mazhar ◽  
Daiwai Olson ◽  
Sonja Stutzman ◽  
James Moreno ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Neurocritical Care ◽  
Mass Effect ◽  
Hematoma Expansion ◽  
Midline Shift ◽  
Hematoma Volume ◽  
Hemorrhage Volume ◽  
The Mean ◽  
Neurological Pupil Index

Introduction: Hand-held automated pupillometry reliably evaluates the pupillary light reflex (PLR) at the bedside and there is growing interest in studying its ability to detect midline shift and mass effect. We hypothesized that intracerebral hemorrhage (ICH) volume would correlate with objective measures of PLR, specifically the Neurological Pupil index (NPi). Methods: This was a retrospective study of ICH patients with serial pupillometer readings admitted to the Neurocritical Care Unit and enrolled in the END-PANIC registry. CT images were examined to measure hematoma volume using the simplified ABC/2 method, midline shift, hydrocephalus score, and Graeb score to measure interventricular hemorrhage. Demographics were examined with standard measures of central tendency, hypotheses with logistic regression, categorical data with Fisher’s Exact X 2 , and multivariate modeling with constructed MAX-R models. Results: Of 44 subjects, 50% were male and the mean age was 65.4 years. ICH location was deep in 56.8% and lobar in 43.2%. There was a significant correlation between ICH volume and NPi of the pupil ipsilateral (r 2 =0.48, p<0.0001) and contralateral (r 2 =0.39, p<0.0001) to the hematoma. Shift of the septum pellucidum also correlated with NPi (ipsilateral[r 2 =0.25, p=0.0006], contralateral[r 2 =0.15, p=0.0106]), as did shift of the pineal gland (ipsilateral[r 2 =0.21, p=0.0017], contralateral[r 2 =0.11, p=0.0328]). No statistically significant correlation was found between hydrocephalus score or Graeb score and NPi. ICH volume was the most predictive of abnormal NPi (Figure 1). Conclusions: The NPi correlates with ICH volume and shift of midline structures. Abnormalities in NPi can be predicted by hematoma volume. Future studies should explore the role of NPi in detecting hematoma expansion and worsening midline shift.

Predictors and outcome of seizures after spontaneous intracerebral hemorrhage

2009 ◽  
Vol 111 (1) ◽  
pp. 87-93 ◽  
Author(s):  
Tzu-Ming Yang ◽  
Wei-Che Lin ◽  
Wen-Neng Chang ◽  
Jih-Tsun Ho ◽  
Hung-Chen Wang ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Intracerebral Hemorrhage ◽  
Neurological Complication ◽  
Multiple Logistic Regression ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Seizure Rate ◽  
Symptomatic Seizures ◽  
The Mean ◽  
The Relationship

Object Seizures are an important neurological complication of spontaneous intracerebral hemorrhage (ICH). A better understanding of the risk factors of seizures following ICH is needed to predict which patients will require treatment. Methods Two hundred and forty-three adult patients were enrolled in this 1-year retrospective study. Multiple logistic regression was used to evaluate the relationship between baseline clinical factors and the presence or absence of seizure during the study period. Results Seizures occurred in 20 patients with ICH, including acute symptomatic seizures in 9 and unprovoked seizures in 11. None progressed to status epilepticus during hospitalization. After a minimum 3-year follow-up period, the mean Glasgow Outcome Scale score was 3.8 ± 1.1 for patients who had had seizures and 3.5 ± 1.3 for those who had not. The multiple logistic regression model demonstrated that the mean ICH volume was independently associated with seizures, and any increase of 1 mm3 in ICH volume increased the seizure rate by 2.7%. Conclusions Higher mean ICH volumes at presentation were predictive of seizure, and the presence of late seizures was predictive of developing epilepsy. Most seizures occurred within 2 years of spontaneous ICH over a minimum of 3 years of follow-up.

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