Supratentorial intracerebral hemorrhage volume and other CT variables predict the 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.

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Abstract WP333: Intracerebral Hemorrhage Volume and Location in Two Population-Based Studies: 1988 and 2008-2012

Stroke ◽

10.1161/str.49.suppl_1.wp333 ◽

2018 ◽

Vol 49 (Suppl_1) ◽

Author(s):

Kyle B Walsh ◽

Charles Moomaw ◽

Padmini Sekar ◽

Jane Khoury ◽

Daniel Woo

Keyword(s):

Intracerebral Hemorrhage ◽

Population Based ◽

Hemorrhage Volume

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Translational Insights into Traumatic Brain Injury Occurring during Dabigatran or Warfarin Anticoagulation

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.2014.31 ◽

2014 ◽

Vol 34 (5) ◽

pp. 870-875 ◽

Cited By ~ 12

Author(s):

Jan Hendrik Schaefer ◽

Wendy Leung ◽

Limin Wu ◽

Elizabeth M Van Cott ◽

Josephine Lok ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracerebral Hemorrhage ◽

Oral Anticoagulants ◽

International Normalized Ratio ◽

Thrombin Time ◽

Limited Data ◽

Hemorrhage Volume ◽

Post Hoc ◽

Safety Advantage

To date, only limited data are available on the effects of pretreatment with novel oral anticoagulants in the event of traumatic brain injury (TBI). We determined intracerebral hemorrhage volume and functional outcome in a standardized TBI model in mice treated with warfarin or dabigatran. Additionally, we investigated whether excess concentrations of dabigatran could increase bleeding and whether this was preventable by using prothrombin complex concentrate (PCC). C57 mice were treated orally with warfarin or dabigatran; sham-treated mice served as controls. Effective anticoagulation was verified by measurement of international normalized ratio and diluted thrombin time, and TBI was induced by controlled cortical impact (CCI). Twenty-four hours after CCI, intracerebral hemorrhage volume was larger in warfarin-pretreated mice than in controls (10.1 ± 4.9 vs 4.1 ± 1.7 μL; analysis of variance post hoc P = 0.001), but no difference was found between controls and dabigatran-pretreated mice (5.3 ± 1.5 μL). PCC applied 30 minutes after CCI did not reliably reduce intracerebral hemorrhage induced by excess dabigatran concentration compared with saline (10.4 ± 11.2 vs 8.7 ± 7.1 μL). Our data suggest pathophysiological differences in TBI occurring during warfarin and dabigatran anticoagulation. The reduced hemorrhage formation under dabigatran therapy could present a safety advantage compared with warfarin. An excess dabigatran concentration, however, can increase hemorrhage.

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Blood Pressure Lowering Decreases Intracerebral Hemorrhage Volume and Improves Behavioral Outcomes in Experimental Animals

Journal of Stroke ◽

10.5853/jos.2020.02390 ◽

2020 ◽

Vol 22 (3) ◽

pp. 416-418

Author(s):

Ferdinand O. Bohmann ◽

Alexander Seiler ◽

Sarah Gelhard ◽

Leonie Stolz ◽

Boris Brill ◽

...

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Behavioral Outcomes ◽

Blood Pressure Lowering ◽

Experimental Animals ◽

Pressure Lowering ◽

Hemorrhage Volume

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Diagnostic and prognostic value of serum hepcidin concentration in patients with acute spontaneous supratentorial intracerebral hemorrhage

Zaporozhye Medical Journal ◽

10.14739/2310-1210.2021.2.228593 ◽

2021 ◽

Vol 23 (2) ◽

pp. 168-174

Author(s):

O. А. Koziolkin ◽

A. A. Kuznietsov

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Intracerebral Hemorrhage ◽

Logistic Regression Analysis ◽

Prognostic Value ◽

Cerebral Lesions ◽

Acute Period ◽

Serum Hepcidin ◽

Hemorrhage Volume ◽

Diagnostic And Prognostic Value

The aim of the study was to evaluate the diagnostic and prognostic value of serum hepcidin concentration in patients with acute spontaneous supratentorial intracerebral hemorrhage (SSICH). Materials and methods. Prospective cohort study of 88 patients with acute SSICH receiving the conservative therapy was conducted. Level of neurological deficit was evaluated using the Full Outline of UnResponsiveness Scale, the Glasgow Coma Scale and the National Institute of Health Stroke Scale. Computed tomography was performed to detect an intracerebral hemorrhage volume (ICHV), secondary intraventricular hemorrhage volume (SIVHV) and total volume of intracranial hemorrhage (TVICH). Laboratory blood samples were taken within 24 hours of hospitalization. Hepcidin levels, serum iron concentrations and total iron-binding capacity were determined, followed by calculations of transferrin saturation coefficient. Early neurological deterioration (END) and unfavorable variants of the acute period of SSICH (lethal outcome, modified Rankin score 4-5 on the 21st day of the disease) were considered as endpoints. Statistical processing of the obtained results included a correlation analysis, logistic regression analysis and ROC-analysis. Results. It was identified, that serum hepcidin level in the patients with SSICH was correlated with ICHV (R = 0.44, P ˂ 0.01), SIVHV (R = 0.45, P ˂ 0.01) and TVICH (R = 0.57, P ˂ 0.01). Hepcidin serum concentrations in the patients with ICHV >30 ml exceeded the value of those in cases of ICHV ≤30 ml by 69.0 % (P ˂ 0.0001). Serum levels of hepcidin were significantly higher in the patients with an unfavorable course and outcome of the disease in the acute period on the 1st day of admission (P ˂ 0.0001). Informative multipredictor models were developed via multiple logistic regression analysis, which include hepcidin values coupled with clinical and neurovisualization findings and are predictive of lethal and unfavorable acute period functional outcomes (AUC = 0,93, P ˂ 0.0001). Conclusions. The level of serum hepcidin in patients with acute SSICH is associated with the severity of cerebral lesions. The integration of serum hepcidin concentration with clinical and neuroimaging findings in the structure of multipredictor logistic regression models allows to determine the vital and functional prognosis of the acute period of SSICH with an accuracy of >85 %

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Commentary on Associations of Radiographic Small Vessel Disease with Acute Intracerebral Hemorrhage Volume, Hematoma Expansion, and Intraventricular Hemorrhage

Neurocritical Care ◽

10.1007/s12028-019-00884-4 ◽

2019 ◽

Vol 32 (2) ◽

pp. 361-362

Author(s):

Sarah E. Nelson

Keyword(s):

Intracerebral Hemorrhage ◽

Intraventricular Hemorrhage ◽

Small Vessel Disease ◽

Small Vessel ◽

Hematoma Expansion ◽

Vessel Disease ◽

Acute Intracerebral Hemorrhage ◽

Hemorrhage Volume

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Tranexamic acid for acute intracerebral hemorrhage growth predicted by spot sign trial: Rationale and design

International Journal of Stroke ◽

10.1177/1747493017694394 ◽

2017 ◽

Vol 12 (3) ◽

pp. 326-331 ◽

Cited By ~ 10

Author(s):

Liping Liu ◽

Yilong Wang ◽

Xia Meng ◽

Na Li ◽

Ying Tan ◽

...

Keyword(s):

High Risk ◽

Intracerebral Hemorrhage ◽

Tranexamic Acid ◽

Primary Outcome Measure ◽

Hematoma Expansion ◽

Spot Sign ◽

Double Blind ◽

Risk Patients ◽

Acute Intracerebral Hemorrhage ◽

Hemorrhage Volume

Rationale Acute intracerebral hemorrhage inflicts a high-economic and -health burden. Computed tomography angiography spot sign is a predictor of hematoma expansion, is associated with poor clinical outcome and is an important stratifying variable for patients treated with haemostatic therapy. Aims We aim to compare the effect of treatment with tranexamic acid to placebo for the prevention of hemorrhage growth in patients with high-risk acute intracerebral hemorrhage with a positive spot sign. Design The tranexamic acid for acute intracerebral hemorrhage growth predicted by spot sign (TRAIGE) is a prospective, multicenter, placebo-controlled, double-blind, investigator-led, randomized clinical trial that will include an estimated 240 participants. Patients with intracerebral hemorrhage demonstrating symptom onset within 8 h and with the spot sign as a biomarker for ongoing hemorrhage, and no contraindications for antifibrinolytic therapy, will be enrolled to receive either tranexamic acid or placebo. The primary outcome measure is the presence of hemorrhage growth defined as an increase in intracerebral hemorrhage volume >33% or >6 ml from baseline to 24 ± 2 h. The secondary outcomes include safety and clinical outcomes. Conclusion The TRAIGE trial evaluates the efficacy of haemostatic therapy with tranexamic acid in the prevention of hemorrhage growth among high-risk patients with acute intracerebral hemorrhage.

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Abilities of a Densitometric Analysis of Computed Tomography Images and Hemorrhagic Parameters to Predict Outcome Favorability in Patients With Intracerebral Hemorrhage

Neurosurgery ◽

10.1093/neuros/nyx379 ◽

2017 ◽

Vol 83 (2) ◽

pp. 226-236 ◽

Cited By ~ 4

Author(s):

Hakseung Kim ◽

Xiaoke Yang ◽

Young Hun Choi ◽

Byung C Yoon ◽

Keewon Kim ◽

...

Keyword(s):

Computed Tomography ◽

Intracerebral Hemorrhage ◽

Rapid Assessment ◽

Ct Images ◽

Interquartile Range ◽

Densitometric Analysis ◽

Computed Tomography Images ◽

Outcome Favorability ◽

Actual Volume ◽

Hemorrhage Volume

Abstract BACKGROUND Intracerebral hemorrhage (ICH) is one of the most devastating subtypes of stroke. A rapid assessment of ICH severity involves the use of computed tomography (CT) and derivation of the hemorrhage volume, which is often estimated using the ABC/2 method. However, these estimates are highly inaccurate and may not be feasible for anticipating outcome favorability. OBJECTIVE To predict patient outcomes via a quantitative, densitometric analysis of CT images, and to compare the predictive power of these densitometric parameters with the conventional ABC/2 volumetric parameter and segmented hemorrhage volumes. METHODS Noncontrast CT images of 87 adult patients with ICH (favorable outcomes = 69, unfavorable outcomes = 12, and deceased = 6) were analyzed. In-house software was used to calculate the segmented hemorrhage volumes, ABC/2 and densitometric parameters, including the skewness and kurtosis of the density distribution, interquartile ranges, and proportions of specific pixels in sets of CT images. Nonparametric statistical analyses were conducted. RESULTS The densitometric parameter interquartile range exhibited greatest accuracy (82.7%) in predicting favorable outcomes. The combination of skewness and the interquartile range effectively predicted mortality (accuracy = 83.3%). The actual volume of the ICH exhibited good coherence with ABC/2 (R = 0.79). Both parameters predicted mortality with moderate accuracy (<78%) but were less effective in predicting unfavorable outcomes. CONCLUSION Hemorrhage volume was rapidly estimated and effectively predicted mortality in patients with ICH; however, this value may not be useful for predicting favorable outcomes. The densitometric analysis exhibited significantly higher power in predicting mortality and favorable outcomes in patients with ICH.

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Impact of Increased Hemoglobin on Spontaneous Intracerebral Hemorrhage

Neurocritical Care ◽

10.1007/s12028-021-01305-1 ◽

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.

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Prognostic value of serum S100B concentration in patients with acute spontaneous supratentorial intracerebral hemorrhage

Pathologia ◽

10.14739/2310-1237.2021.1.228850 ◽

2021 ◽

Vol 18 (1) ◽

pp. 19-25

Author(s):

О. A. Koziolkin ◽

A. A. Kuznietsov

Keyword(s):

Logistic Regression ◽

Intracerebral Hemorrhage ◽

Prognostic Value ◽

Conservative Therapy ◽

S100b Protein ◽

Short Term ◽

Serum S100b ◽

Acute Period ◽

Protein Levels ◽

Hemorrhage Volume

Aim of the work – to evaluate the informativeness of serum protein S100B levels in detection of short-term prognosis in patients with acute period of spontaneous supratentorial intracerebral hemorrhage (SSICH) on the background of concervative therapy. Materials and methods. Prospective cohort study of 90 patients with acute SSICH on the background of conservative therapy was done. Level of neurological deficit was evaluated using Full Outline of Unresponsiveness Scale, Glasgow Coma Scale and National Institute of Health Stroke Scale. Computed tomography was done to detect the intracerebral hemorrhage volume (ICHV), secondary intraventricular hemorrhage volume (SIVHV) and total volume of intracranial hemorrhage (TVICH). Laboratory blood samples were taken within 24 hours of hospitalization. Levels of S100B protein in serum were measured using immunoassay analysis. Unfavorable variants of course (early neurological deterioration (END) during 48 hours from hospitalization) and disease acute period outcome of ICH (modified Rankin score 4–6 on the 21st day of the disease) were considered as endpoints. Statistical processing of the obtained results included correlation analysis, logistic regression analysis and ROC-analysis. Results. Neurological deterioration during 48 hours after hospitalization was detected in 18 (20.0 %) patients, unfavorable SSICH acute period outcome was revealed in 49 (54.4 %) patients. It was detected that serum S100B protein correlates with ICHV (R = 0.34, P ˂ 0.01), SIVHV (R = 0.39, P ˂ 0.01) and TVICH (R = 0.45, P ˂ 0.01). Thus, the patients with unfavorable SSICH acute period course and outcome are characterized with the higher S100B protein levels (P ˂ 0.0001). High sensitive multipredicive logistic regression model that integrates prognostic value of serum of S100B protein concentration with informativeness of clinical, neurological parameters (National Institute of Health Stroke Scale score, SIVHV) was elaborated. It helps to detect the individual risk of unfavorable acute SSICH period outcome on the ground of conservative therapy with the accuracy 90.0 % (AUC ± SE (95 % CІ) = 0.95 ± 0.02 (0.89–0.99), P ˂ 0.0001). Conclusions. Serum S100B protein levels in patients with SSICH on the 1st day after hospitalization is the informative additional parameter in verification of short-term prognosis on the background of conservative therapy.

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