Analysis of different hematoma expansion shapes caused by different risk factors in patients with hypertensive intracerebral hemorrhage

AbstractSpontaneous intracerebral hemorrhage is defined as nontraumatic bleeding into the brain without vascular malformations or presence of tumor. It occurs in about a third of all strokes and has a high mortality and morbidity. Risk factors that determine the outcome are incompletely understood. Known factors include older age, male gender, Asian ethnicity, hypertension, and comorbidity such as inherited or acquired bleeding diathesis and use of antithrombotic drugs. Likewise, the clinical characteristics of the hematoma such as location and volume of the hematoma and other imaging features are also important. Hematoma extension or expansion is a complication with an unfavorable outcome. Recognition of risk factors for hematoma expansion and measures to prevent it, such as blood pressure lowering, will improve the outcome. Enhanced diagnostic methods, especially in imaging techniques developed over the past decade, have not only led to a better understanding of the pathophysiology of spontaneous intracerebral hemorrhage but also of the factors that influence hematoma expansion. An improved knowledge is essential to better management, minimizing hematoma expansion and leading to a healthier outcome.

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Establishment of prediction score for hematoma expansion after intracerebral hemorrhage

10.21203/rs.2.306/v1 ◽

2019 ◽

Author(s):

Xiangyu Kong ◽

Wei Qian ◽

Jun Dong ◽

Zhiyuan Qian

Keyword(s):

Risk Factors ◽

High Risk ◽

Intracerebral Hemorrhage ◽

High Risk Group ◽

Prediction Score ◽

Hematoma Expansion ◽

Net Benefit ◽

Group Score ◽

Enhanced Ct ◽

Independent Risk Factors

Abstract Background: Identification of intracerebral hemorrhage (ICH) patients at risk of hematoma expansion(HE) could facilitate the selection of candidates likely to benefit from therapies aiming to minimize ICH growth. We, therefore, aimed to develop a prediction score for HE that can be quickly used during the critical phase. Methods: A retrospective analysis of clinical features of 317 ICH patients in the Second Affiliated Hospital of Soochow University from January, 2016 to May, 2018 was conducted. Independent risk factors of HE were obtained according to multiple logistic regression, and a prediction score was established and preliminarily evaluated. Results: History of anticoagulants, ultraearly hematoma growth≥2.7ml/h, GCS≤8, and non-enhanced CT signs (island sign, black hole sign, blend sign, niveau formation) exist one or more, were independent risk factors for HE (P <0.05).The C statistics of score was 0.854 (95%CI, 0.803~0.904); P < 0.001); calibration was outstanding (c2=3.323, P = 0.344); decision curve analysis showed the score was safe and reliable, with high net benefit. After dichotomized, the sensitivity, specificity and accuracy of the high-risk group (score≥4.5) were 0.77, 0.85 and 0.83, respectively. Conclusion The score can accurately identify high-risk individuals with HE, swift guide treatment decisions, and can also be used in clinical trials. Keywords: Intracerebral hemorrhage; Hematoma expansion; Non-enhanced CT; Prediction; Score.

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Location-specific risk factors for intracerebral hemorrhage

Neurology ◽

10.1212/wnl.0000000000010418 ◽

2020 ◽

Vol 95 (13) ◽

pp. e1807-e1818

Author(s):

Wilmar M.T. Jolink ◽

Kim Wiegertjes ◽

Gabriël J.E. Rinkel ◽

Ale Algra ◽

Frank-Erik de Leeuw ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Risk Factor ◽

Intracerebral Hemorrhage ◽

Meta Analysis ◽

Spontaneous Intracerebral Hemorrhage ◽

Case Control Studies ◽

White Participant ◽

Male Sex ◽

Hypertensive Intracerebral Hemorrhage

ObjectiveTo conduct a systematic review and meta-analysis of studies reporting on risk factors according to location of the intracerebral hemorrhage.MethodsWe searched PubMed and Embase for cohort and case-control studies reporting ≥100 patients with spontaneous intracerebral hemorrhage that specified the location of the hematoma and reported associations with risk factors published until June 27, 2019. Two authors independently extracted data on risk factors. Estimates were pooled with the generic variance-based random-effects method.ResultsAfter screening 10,013 articles, we included 42 studies totaling 26,174 patients with intracerebral hemorrhage (9,141 lobar and 17,033 nonlobar). Risk factors for nonlobar intracerebral hemorrhage were hypertension (risk ratio [RR] 4.25, 95% confidence interval [CI] 3.05–5.91, I2 = 92%), diabetes mellitus (RR 1.35, 95% CI 1.11–1.64, I2 = 37%), male sex (RR 1.63, 95% CI 1.25–2.14, I2 = 61%), alcohol overuse (RR 1.48, 95% CI 1.21–1.81, I2 = 19%), underweight (RR 2.12, 95% CI 1.12–4.01, I2 = 31%), and being a Black (RR 2.83, 95% CI 1.02-7.84, I2 = 96%) or Hispanic (RR 2.95, 95% CI 1.69-5.14, I2 = 71%) participant compared with being a White participant. Hypertension, but not any of the other risk factors, was also a risk factor for lobar intracerebral hemorrhage (RR 1.83, 95% CI 1.39–2.42, I2 = 76%). Smoking, hypercholesterolemia, and obesity were associated with neither nonlobar nor lobar intracerebral hemorrhage.ConclusionsHypertension is a risk factor for both nonlobar and lobar intracerebral hemorrhage, although with double the effect for nonlobar intracerebral hemorrhage. Diabetes mellitus, male sex, alcohol overuse, underweight, and being a Black or Hispanic person are risk factors for nonlobar intracerebral hemorrhage only. Hence, the term hypertensive intracerebral hemorrhage for nonlobar intracerebral hemorrhage is not appropriate.

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Abstract WP409: Hematoma Expansion After Spontaneous Intracerebral Hemorrhage in Children

Stroke ◽

10.1161/str.44.suppl_1.awp409 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Lori C Jordan ◽

Lauren A Beslow ◽

Melissa C Gindville ◽

Jonathan T Kleinman ◽

Rachel A Bastian ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Volumetric Analysis ◽

Hematoma Expansion ◽

Spot Sign ◽

Research Areas ◽

Hematoma Growth ◽

Receive Treatment ◽

Hypertensive Intracerebral Hemorrhage ◽

To Receive

Objective: Hematoma expansion and its predictors like the “spot sign” are important research areas in adults with primary (hypertensive) intracerebral hemorrhage (ICH), but are rarely studied in secondary ICH. At one center, in adults with ICH due to brain arteriovenous malformation (AVM), aneurysm, or tumor, significant hematoma expansion (>33%) occurred in 6/30 (20%) within 24 hours. In children, the frequency of hematoma expansion and the appropriate timing of follow-up neuroimaging are unknown. We assessed the frequency and extent of hematoma expansion in children with non-traumatic ICH. Methods: From 2007 to 2012, 73 children with spontaneous ICH were enrolled in a three-center prospective study (≥37 weeks gestation-17 years). Inclusion for this sub-study: 2 head CTs obtained for clinical indications within 48 hours after presentation with ICH (28 children). Exclusion: Surgical evacuation of hematoma before 2 nd CT was obtained (2 children), IVH only (7 children), neonates <29 days old (20 children). Hematoma volume was assessed via manual volumetric analysis. Results: Of 73 children, 25 (34%) met all inclusion and exclusion criteria. Median age was 9.0 years, interquartile range (IQR) 2.1-14.1. Median time from symptom onset to first CT was 9.4 hours (IQR 4.5-20). ICH was due to coagulopathy or vascular cause in 22/25 children (88%). Median baseline ICH volume was 22.2mL (range 2-86mL). Hematoma expansion occurred in 7/25 (28%) with 2 head CTs. Median ICH volume expansion was 4mL (range 0.1-12mL), 32% (range 2-58%) of baseline ICH volume. Three had significant (>33%) expansion; all had coagulopathy or vascular etiologies of ICH. As expected, children with 2 head CTs had larger baseline ICH volumes (p=0.05) and were more likely to receive treatment for elevated intracranial pressure (ICP) (p=0.001) compared to children with ICH who had fewer than 2 head CTs within 48 hours. Conclusion: Hematoma expansion occurred in 28% of children with clinical concern for hematoma growth and was >33% in 12%. Repeat CT should be considered in those with large ICH and increased ICP. Head CTs were not obtained at prescribed time intervals; research CTs without clear benefit are not feasible in children.

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