Does the Volume and Localization of Intracerebral Hematoma Affect Short-Term Prognosis of Patients with Intracerebral Hemorrhage?

The aim of this study was to determine whether volume and localization of intracerebral hematoma affects the six-month prognosis of patients with intracerebral hemorrhage (ICH). Patients and Methods. The study included 75 patients with ICH of both sex and all age groups. ICH, based on CT scan findings, was divided in the following groups: lobar, subcortical, infratentorial, intraventricular haemorrhage and multiple hematomas. Volume of intracerebral hematoma was calculated according to formula . Intracerebral hematomas, according to the volume, are divided in three groups (0–29 mL, 30–60 mL, and >60 mL). Results. The highest mortality rate was recorded in the group with multiple hematomas (41%), while the lowest in infratentorial (12.8%). The best six-month survival was in patients with a volume up to 29 mL, 30 of them (64%) survived. The highest mortality rate was recorded in patients with the hematoma volume >60 mL (85%). Kaplan-Meier’s analysis showed that there was statistical significance between the size of the hematoma and the six-month survival (). More than half of patients (61.1%) who survived 6 months after ICH were functionally independent (Rankin scale ≤2). Conclusion The volume of hematoma significantly affects six-month prognosis in patients with intracerebral hemorrhage, while localization does not.

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Intracerebral Hematoma, Perihemorrhagic Edema and Urinary Excreted Cysteinyl Leukotrienes Correlation Study

Macedonian Medical Review ◽

10.2478/mmr-2014-0017 ◽

2014 ◽

Vol 68 (2) ◽

pp. 85-88

Author(s):

Natalija Dolnenec-Baneva ◽

Dijana Nikodijevic ◽

Gordana Kiteva-Trenchevska ◽

Igor Petrov ◽

Dragana Petrovska-Cvetkovska ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Brain Edema ◽

Correlation Study ◽

Intracerebral Hematoma ◽

Moderate Correlation ◽

Hematoma Volume ◽

Cysteinyl Leukotrienes ◽

Edema Volume ◽

Perihemorrhagic Edema

AbstractIntroduction.Several mechanisms in formation of perihemorrhagic edema are activated after contact of brain tissue-extravasated blood in intracerebral hemorrhage. Cysteinyl leukotrienes (cysLT) (C4, D4, E4) are included in this process as significant edema factors and they determine the neurological deficit and outcome. The study aim was a 5-day follow-up (admission/3 day/5 day) of urinary cysLT, hematoma volume, edema volume values and their correlation in patients after spontaneous, primary supratentorial intracerebral hemorrhage.Methods.An enzyme immunoassay was used for urinary cysLT measured in 62 patients and 80 healthy controls. Hematoma and edema volumes were visualized and measured by computed tomography and mathematically calculated with a special spheroid shape formula (V=AxBxC/2).Results.CysLT of hemorrhagic patients (1842.20±1413.2, 1181.54±906.2, 982.30±774.2pg/ml/mg creatinine) were significantly excreted (p<0.01). Brain edema (12.86±13.5, 22.38±21.1, 28.45±29.4cm3) was significantly increased (p<0.01). Hematoma volume values (13.05±14.5, 13.13±14.7, 12.99±14.7cm3) were not significant (p>0.05). A high correlation (multiple regression) between cysLT, hematoma and edema was found on the 3rdday (R=0.6) and a moderate correlation at admission (R=0.3) and on the 5thday (R=0.3).Conclusion.In our 5-day follow-up study a significant cysLT brain synthesis and significant brain edema progression versus constant hematoma volume values in hemorrhagic patients was found. A high correlation between cysLT, hematoma and edema volume was found on the 3rdday, a moderate correlation on admission and on the 5thday, which means that high cysLT and hematoma values were associated with high/moderate edema values.

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CT Scan Hematoma Volume: A Surrogate Endpoint for the Effect of Treatment in Intracerebral Hemorrhage

NeuroRx ◽

10.1016/j.nurx.2006.05.029 ◽

2006 ◽

Vol 3 (3) ◽

pp. 413-413

Author(s):

B SKOLNICK ◽

S DAVIS ◽

N BRUN ◽

S MATHEW ◽

S MAYER

Keyword(s):

Intracerebral Hemorrhage ◽

Ct Scan ◽

Surrogate Endpoint ◽

Hematoma Volume ◽

Effect Of Treatment

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The Effect of Age on Characteristics and Mortality of Intracerebral Hemorrhage in the Oldest-Old

Cerebrovascular Diseases ◽

10.1159/000448813 ◽

2016 ◽

Vol 42 (5-6) ◽

pp. 485-492 ◽

Cited By ~ 8

Author(s):

Paola Forti ◽

Fabiola Maioli ◽

Michele Domenico Spampinato ◽

Carlotta Barbara ◽

Valeria Nativio ◽

...

Keyword(s):

Elderly Patients ◽

Intracerebral Hemorrhage ◽

Ct Scan ◽

Symptom Onset ◽

Oldest Old ◽

Hematoma Expansion ◽

Elderly Subjects ◽

Supporting Evidence ◽

Hematoma Volume ◽

Young Old

Background: Incidence of acute intracerebral hemorrhage (ICH) increases with age, but there is a lack of information about ICH characteristics in the oldest-old (age ≥85 years). In particular, there is a need for information about hematoma volume, which is included in most clinical scales for prediction of mortality in ICH patients. Many of these scales also assume that, independent of ICH characteristics, the oldest-old have a higher mortality than younger elderly patients (age 65-74 years). However, supporting evidence from cohort studies is limited. We investigated ICH characteristics of oldest-old subjects compared to young (<65 years), young-old (65-74 years) and old-old (75-84 years) subjects. We also investigated whether age is an independent mortality predictor in elderly (age ≥65 years) subjects with acute ICH. Methods: We retrospectively collected clinical and neuroimaging data of 383 subjects (age 34-104 years) with acute supratentorial primary ICH who were admitted to an Italian Stroke Unit (SU) between October 2007 and December 2014. Measured ICH characteristics included hematoma location, volume and intraventricular extension of hemorrhage on admission CT scan; admission Glasgow Coma Scale ≤8 and hematoma expansion (HE) measured on follow-up CT-scans obtained after 24 h. General linear models and logistic models were used to investigate the association of age with ICH characteristics. These models were adjusted for pre-admission characteristics, hematoma location and time from symptom onset to admission CT scan. Limited to elderly subjects, Cox models were used to investigate the association of age with in-SU and 1-year mortality: the model for in-SU mortality adjusted for pre-admission and ICH admission characteristics and the model for 1-year mortality additionally adjusted for functional status and disposition at SU discharge. Results: Independent of pre-admission characteristics, hematoma location and time from symptom onset to admission CT-scan, oldest-old subjects had the highest admission hematoma volume (p < 0.01). Age was unrelated to all other ICH characteristics including HE. In elderly patients, multivariable adjusted risk of in-SU and 1-year mortality did not vary across age categories. Conclusions: Oldest-old subjects with acute supratentorial ICH have higher admission hematoma volume than young and young-old subjects but do not differ for other ICH characteristics. When taking into account confounding from ICH characteristics, risk of in-SU and 1-year mortality in elderly subjects with acute supratentorial ICH does not differ across age categories. Our findings question use of age as an independent criterion for stratification of mortality risk in elderly subjects with acute ICH.

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Evaluation of Volumetric Change of Intracerebral Hemorrhage in Patients Treated with Thrombolysis for Intraventricular Hemorrhage

Neurocritical Care ◽

10.1007/s12028-020-01054-7 ◽

2020 ◽

Author(s):

Franziska Staub-Bartelt ◽

Jasper Hans van Lieshout ◽

Thomas Beez ◽

Rainer Kram ◽

Daniel Hänggi ◽

...

Keyword(s):

Basal Ganglia ◽

Intracerebral Hemorrhage ◽

Ct Scan ◽

Intraventricular Hemorrhage ◽

Volume Reduction ◽

Percentage Reduction ◽

Hematoma Volume ◽

Group A ◽

Group B ◽

Lysis Therapy

Abstract Background Intraventricular hemorrhage (IVH) is often caused by irruption of intracerebral hemorrhage (ICH) of basal ganglia or thalamus into the ventricular system. Instillation of recombinant tissue plasminogen activator (rtPA) via an external ventricular drainage (EVD) has been shown to effectively decrease IVH volumes while the impact of rtPA instillation on ICH volumes remains unclear. In this series, we analyzed volumetric changes of ICH in patients with and without intrathecal lysis therapy. Methods Between 01/2013 and 01/2019, 36 patients with IVH caused by hemorrhage of basal ganglia, thalamus or brain stem were treated with rtPA via an EVD (Group A). Initial volumes were determined in the first available computed tomography (CT) scan, final volumes in the last CT scan before discharge. During the same period, 41 patients with ICH without relevant IVH were treated without intrathecal lysis therapy at our neurocritical care unit (Group B). Serial CT scans were evaluated separately for changes in ICH volumes for both cohorts using OsiriX DICOM viewer. The Wilcoxon signed-rank test was performed for statistical analysis in not normally distributed variables. Results Median initial volume of ICH for treatment Group A was 6.5 ml and was reduced to 5.0 ml after first instillation of rtPA (p < 0.01). Twenty-six patients received a second treatment with rtPA (ICH volume reduction 4.5 to 3.3 ml, p < 0.01) and of this cohort further 16 patients underwent a third treatment (ICH volume reduction 3.0 ml to 1.5 ml, p < 0.01). Comparison of first and last CT scan in Group A confirmed an overall median percentage reduction of 91.7% (n = 36, p < 0.01) of ICH volumes and hematoma resolution in Group A was significantly more effective compared to non-rtPA group, Group B (percentage reduction = 68%) independent of initial hematoma volume in the regression analysis (p = 0.07, mean 11.1, 95%CI 7.7–14.5). There were no adverse events in Group A related to rtPA instillation. Conclusion Intrathecal lysis therapy leads to a significant reduction in the intraparenchymal hematoma volume with faster clot resolution compared to the spontaneous hematoma resorption. Furthermore, intrathecal rtPA application had no adverse effect on ICH volume.

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Intracerebral Hemorrhage-Score Allows a Reliable Prediction of Mortality in Patients with Spontaneous Intracerebral Hemorrhage Managed by Fibrinolytic Therapy

Cerebrovascular Diseases ◽

10.1159/000504246 ◽

2019 ◽

Vol 48 (3-6) ◽

pp. 165-170

Author(s):

Vesna Malinova ◽

Bogdan Iliev ◽

Dorothee Mielke ◽

Veit Rohde

Keyword(s):

Mortality Rate ◽

Intracerebral Hemorrhage ◽

Fibrinolytic Therapy ◽

Clot Lysis ◽

High Morbidity ◽

Hematoma Volume ◽

Chi Square ◽

Prediction Of Mortality ◽

Chi Square Test ◽

Ich Score

Objective: Intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. Prognosis estimation would be helpful for the treatment decision making in ICH patients. The ICH-score was published in 2001 to estimate the 30-day mortality in conservatively treated patients with ICH. We evaluated the reproducibility of the ICH-score in ICH patients undergoing fibrinolytic therapy. Methods: We performed a retrospective analysis of patients with supratentorial ICH managed by fibrinolytic therapy and evaluated the 30-day mortality. The ICH-score was then applied to match the mortality in our patients with the mortality predicted by the ICH-score. The ICH-score is based on parameters available at admission: age, hematoma volume, intraventricular expansion, and clinical status according to the Glasgow Coma Scale. Results: A total of 233 patients were analyzed. The 30-day mortality rate was 30% (70/233). An age of ≥80 years was associated with a significantly higher mortality rate (OR 2.26, chi-square test p = 0.01). A hematoma volume of ≥30 mL led significantly more often to 30-day mortality (OR 3.72, chi-square test p = 0.01). The mortality was significantly higher in the patients with intraventricular hemorrhage (2.97, chi-square test p = 0.003). The ICH-score showed a significant correlation with mortality (chi-square test, p < 0.0001). The following mortality rates were estimated using the ICH-score in our cohort: 1 = 0% (0/13), 2 = 0% (0/51), 3 = 1.3% (1/82), 4 = 43% (13/31), 5 = 100% (56/56). Conclusion: The ICH-score not only allows a reliable estimation of the 30-day mortality in patients with ICH treated conservatively but also treated by clot lysis. Compared to conservative treatment, the fibrinolytic therapy reduced the 30-day mortality in the patients with ICH-scores 1–4. Patients with ICH-score 5 do not have a benefit of fibrinolytic therapy and should no longer be considered to be candidates for fibrinolytic therapy.

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Epidemiologic Characteristics of Suicide in Panama, 2007–2016

Medicina ◽

10.3390/medicina56090442 ◽

2020 ◽

Vol 56 (9) ◽

pp. 442

Author(s):

Virginia Núñez-Samudio ◽

Aris Jiménez-Domínguez ◽

Humberto López Castillo ◽

Iván Landires

Keyword(s):

Mortality Rate ◽

Statistical Significance ◽

Age Groups ◽

Multidimensional Poverty ◽

Suicide Mortality ◽

Female Ratio ◽

Multidimensional Poverty Index ◽

Suicide Rates ◽

Male To Female ◽

Related Mortality

Background and objectives: We aim to describe the demographic characteristics associated with suicide in Panama, to estimate the suicide mortality rate and years of potential life lost (YPLL) to suicide, and to explore the correlation of suicide rates with the Multidimensional Poverty Index (MPI). We present a descriptive retrospective epidemiological report of suicide-related mortality (Panama, 2007–2016). Materials and Methods: Data were matched-merged to calculate unadjusted suicide mortality rates (overall, and by sex, age groups, and administrative region), YPLL, and coefficients (r) for the correlation of MPI and suicide rates. Results: There were 1475 deaths by suicide (86% among men, 47% between 20 and 39 years). The average mortality rate was estimated at 3.91 per 100,000 population with an average YPLL rate of 3.79 per 1000 population. There was a statistically significant trend to reduce YPLL over time (r = −0.93; p< 0.001). Exploratory analyses did not show a significant correlation between the MPI and suicide rates. Our study showed a 6:1 male-to-female ratio of suicide, mostly affecting the age groups of 20–29 and over 80 years. Conclusions: Exploratory analyses on the correlation of the MPI and the suicide rates did not achieve statistical significance, and alternative explanations, such as access to pesticides and alcohol, were further explored to inform potential interventions.

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Epidemiology of Intra-Cerebral Hemorrhage in Young Adult Patients

JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga ◽

10.20473/juxta.v11i22020.65-68 ◽

2020 ◽

Vol 11 (2) ◽

pp. 65

Author(s):

Melisa Melisa ◽

Asra Al Fauzi ◽

Anggraini Dwi Sensusiati

Keyword(s):

Young Adults ◽

Young Adult ◽

Basal Ganglia ◽

Intracerebral Hemorrhage ◽

Ct Scan ◽

General Hospital ◽

Medical Records ◽

Descriptive Study ◽

Hematoma Volume ◽

Observational Descriptive Study

Introduction: This study aimed to define the CT scan imaging of young adult intracerebral hemorrhage (ICH) patients in Dr. Soetomo General Hospital, Surabaya.Methods: This was an observational descriptive study. The data were collected retrospectively with medical records of 18 to 45 years old ICH patients who were treated in Dr. Soetomo General Hospital, Surabaya between 2014 and 2017. The collected data were then presented into tables.Results: 207 patients were identified in this study. The locations of the ICH were basal ganglia (45.89%), lobar (41.55%), thalamus (10.63%), brainstem (8.7%), cerebellum (4.83%), and others (3.86%). The volume of ICH varied from less than 30 cc (66.67%), 30 to 59 cc (27.54%), and more than 60 cc (5.8%). Conclusion: The CT scan imaging of young adults ICH mainly had hematoma volume less than 30 cc and was mostly located in basal ganglia area then followed by lobar area.

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Short-term outcomes of endoscopic evacuation of supratentorial spontaneous intracerebral hematoma: Early experience from developing country

Surgical Neurology International ◽

10.25259/sni_118_2021 ◽

2021 ◽

Vol 12 ◽

pp. 309

Author(s):

Mohammad Elbaroody ◽

Mohamed Adel Ghoneim ◽

Ahmed El Fiki ◽

Hesham Hozayen ◽

Wael El-Mahdy

Keyword(s):

Minimally Invasive ◽

Minimally Invasive Technique ◽

Intracerebral Hematoma ◽

Invasive Technique ◽

Hematoma Volume ◽

Short Term ◽

Hematoma Evacuation ◽

Postoperative Hematoma ◽

Common Location ◽

Ich Score

Background: Minimally invasive endoscopic hematoma evacuation is a promising treatment option for intracerebral hemorrhage (ICH). However, the technique still needs improvement. Methods: We report our early clinical experience of using this technique to evacuate supratentorial spontaneous intracerebral hematomas and evaluate its short-term outcomes. Results: The study included 15 patients, basal ganglia hematoma was the most common location 62.5%, mean preoperative hematoma volume was 61.07 cc, mean ICH score was 3, and mean rate of hematoma evacuation was 89.27%. Factors that could be related to mortality were Glasgow Coma Score (GCS) on admission (P = 0.001), ICH score (P = 0.004); postoperative GCS (P < 0.001), postoperative hematoma volume (P = 0.006); intraventricular extension (P = 0.001), and rate of evacuation (P = 0.001). Conclusion: Endoscopic technique is a safe surgical option for evacuation of spontaneous supratentorial ICH. This minimally invasive technique could be helpful to provide better short-term outcomes for selected patients. However, in our experience, this minimally invasive technique did not change the outcome for cases presented with poor GCS on admission 4/15. Our results warrant a future prospective, randomized, controlled efficacy trial.

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Renal function is associated with one-month and one-year mortality in patients with intracerebral hemorrhage

10.22541/au.162220834.48625049/v1 ◽

2021 ◽

Author(s):

I-Kuan Wang ◽

Tzung-Hai Yen ◽

Chon-Haw Tsai ◽

Yu Sun ◽

Wei-Lun Chang ◽

...

Keyword(s):

Mortality Rate ◽

Intracerebral Hemorrhage ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Mortality Rates ◽

Short Term ◽

Stroke Registry ◽

Mortality Risks ◽

One Year

Background: This study evaluated short-term (1-month) and long-term (1-year) mortality risks associated with kidney function measured by estimated glomerular filtration rate (eGFR) levels at admission for patients with intracerebral hemorrhage. Methods: From the Taiwan Stroke Registry data, we identified and stratified patients with intracerebral hemorrhage into 5 subgroups by the eGFR levels at admission: ≥ 90, 60-89, 30-59, 15-29, and < 15 mL/min/1.73m2 or on dialysis from April 2006 to December 2016. Risks of 1-month mortality and 1-year mortality rates after intracerebral hemorrhage were investigated by the eGFR levels. Results: Both the 1-month mortality and 1-year mortality rates increased as the eGFR level decreased. The 1-month mortality rate was over 5-fold greater in patients with eGFR < 15 mL/min/1.73m2 or on dialysis than in patients with eGFR levels ≥ 90 mL/min/1.73m2 (8.31 versus 1.50 per 1000 person-days), with an adjusted hazard ratio (HR) of 4.59 [95% confidence interval (CI) = 2.71-7.78]. Similarly, the 1-year mortality rate was 7.5-fold greater in patients with eGFR < 15 mL/min/1.73m2 or on dialysis than in patients with eGFR ≥ 90 mL/min/1.73m2, with an adjusted HR of 4.54 (95% CI 2.95-6.98). Conclusion: The eGFR level can be an indicator of prognosis for patients with intracerebral hemorrhage.

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Association of early glycemic change with short-term mortality in lobar and non-lobar intracerebral hemorrhage

Scientific Reports ◽

10.1038/s41598-021-95453-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Paola Forti ◽

Fabiola Maioli ◽

Marco Zoli

Keyword(s):

Intracerebral Hemorrhage ◽

Continuous Variable ◽

Serum Glucose ◽

Diabetic Patients ◽

Short Term ◽

Cox Models ◽

Short Term Mortality ◽

Glucose Test ◽

Acute Intracerebral Hemorrhage ◽

Persistent Hyperglycemia

AbstractThe association between early glycemic change and short-term mortality in non-diabetic patients with acute intracerebral hemorrhage (ICH) is unclear. We retrospectively investigated non-diabetic patients with lobar (n = 262) and non-lobar ICH (n = 370). Each patient had a random serum glucose test on hospital admission and a fasting serum glucose test within the following 48 h. Hyperglycemia was defined as serum glucose ≥ 7.8 mmol/l. Four patterns were determined: no hyperglycemia (reference category), persistent hyperglycemia, delayed hyperglycemia, and decreasing hyperglycemia. Associations with 30-day mortality were estimated using Cox models adjusted for major features of ICH severity. Persistent hyperglycemia was associated with 30-day mortality in both lobar (HR 3.00; 95% CI 1.28–7.02) and non-lobar ICH (HR 4.95; 95% CI 2.20–11.09). In lobar ICH, 30-day mortality was also associated with delayed (HR 4.10; 95% CI 1.77–9.49) and decreasing hyperglycemia (HR 2.01, 95% CI 1.09–3.70). These findings were confirmed in Cox models using glycemic change (fasting minus random serum glucose) as a continuous variable. Our study shows that, in non-diabetic patients with ICH, early persistent hyperglycemia is an independent predictor of short-term mortality regardless of hematoma location. Moreover, in non-diabetic patients with lobar ICH, both a positive and a negative glycemic change are associated with short-term mortality.

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