Abstract TP373: Tracts Enfolded by Small Hematomas Remain Intact in Acute Intracerebral Hemorrhage

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Rebecca McCourt ◽  
Taurian Guinand ◽  
Laura Gioia ◽  
Mahesh Kate ◽  
Sarah Treit ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Intracerebral Hemorrhage ◽  
Diffusion Tensor ◽  
Three Dimensional ◽  
Motor Impairment ◽  
Spatial Relationship ◽  
Three Dimensions ◽  
Motor Score ◽  
Hematoma Volume ◽  
Acute Intracerebral Hemorrhage

Background: Mortality can be predicted by intracerebral hemorrhage (ICH) volume, but motor recovery in survivors is variable. Motor impairment is likely related to the spatial relationship between the hematoma and corticospinal tract (CST). Diffusion Tensor Imaging (DTI) tractography can be used to visualize white matter tracts in three dimensions. We hypothesized that the interaction between the hematoma and CST would predict motor impairment in ICH patients. Methods: ICH patients with small-moderate hematomas were prospectively imaged with CT and DTI within 14 days of onset. Hematoma volume was assessed on CT using planimetric techniques. Three-dimensional recreations of the ipsilateral CST and the hematoma were made for each patient. The CST was categorized by interaction with the ICH as CST: Unaffected, Displaced, Partially Severed, Completely Severed, and Splitting the ICH. Motor function was classified as 'good' (NIHSS motor subscale 0-2) or 'poor' (3-8). Results: Thirty patients (mean age 68±13) underwent CT at a median (IQR) of 2.3 (3.5)h and DTI at 2.0 (3.6, range 0.6-13) days. Median hematoma volume was 8.2 (23) ml. Lesion distribution was: lobar 11 (37%), basal ganglia 18 (60%), brainstem 1 (3%). CSTs were primarily Displaced (n=9) or Unaffected (8), with the remainder being Partially Severed (4), Completely Severed (5), and Splitting the ICH (4). The latter 4 (13%) patients had small (<6ml, median 2.5 [3.0] ml) basal ganglia bleeds which enfolded the intact CST. Motor score at Day 7 was good in 50% of patients. Good outcome was seen in 8 (100%) Unaffected, 4 (44%) Displaced, 1 (25%) Partially Severed, 0 (0%) Severed and 2 (50%) Splitting the ICH patients. Logistic regression indicated that good motor score was predicted by CST category (r=2.3, p=0.016). Conclusion: CST integrity can be maintained when enfolded by small basal ganglia bleeds. Diffusion tractography patterns may be useful for predicting motor scores in small to moderate-sized hematomas.

scholarly journals Reliability of Hematoma Volume Measurement at Local Sites in a Multicenter Acute Intracerebral Hemorrhage Clinical Trial

Stroke ◽  
2013 ◽  
Vol 44 (1) ◽  
pp. 237-239 ◽  
Author(s):  
Haitham M. Hussein ◽  
Nauman A. Tariq ◽  
Yuko Y. Palesch ◽  
Adnan I. Qureshi ◽  
Keyword(s):  
Clinical Trial ◽  
Intracerebral Hemorrhage ◽  
Volume Measurement ◽  
Hematoma Volume ◽  
Acute Intracerebral Hemorrhage

scholarly journals Diagnosis of Dizziness Due to a Core Vestibular Projection Injury in a Patient with Intracerebral Hemorrhage

Diagnostics ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 220 ◽  
Author(s):  
Hyeok Gyu Kwon ◽  
Chul Hoon Chang ◽  
Sung Ho Jang
Keyword(s):  
Basal Ganglia ◽  
Intracerebral Hemorrhage ◽  
Physical Examination ◽  
Left Hemisphere ◽  
Diffusion Tensor ◽  
Insular Cortex ◽  
University Hospital ◽  
The Core ◽  
The University ◽  
Over Time

Herein, we present a patient diagnosed with dizziness due to a core vestibular projection injury following intracerebral hemorrhage (ICH). A 51-year-old female patient underwent conservative management for a spontaneous ICH in the left hemisphere (mainly affecting the basal ganglia and insular cortex). When she visited the rehabilitation department of the university hospital at two years after the ICH onset, she advised of the presence of moderate dizziness (mainly, light-headedness) that started after ICH onset. She mentioned that her dizziness had decreased slightly over time. No abnormality was observed in the vestibular system of either ear on physical examination by an otorhinolaryngologist. However, diffusion tensor tractography results showed that the core vestibular projection in the left hemisphere was discontinued at the basal ganglia level compared with the patient’s right core vestibular projection and that of a normal subject. Therefore, it appears that the dizziness in this patient can be ascribed to a left core vestibular projection injury.

Abstract TP351: Microembolic Signals Monitoring in Acute Intracerebral Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Eva Rocha Ramos ◽  
Izadora Deliberalli ◽  
Joao Brainer ◽  
Aneesh B Singhal ◽  
Gisele S Silva
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Intracranial Hypertension ◽  
Transcranial Doppler ◽  
Large Artery ◽  
Hematoma Volume ◽  
Ethanol Abuse ◽  
Acute Intracerebral Hemorrhage ◽  
The Mean

Background: The etiology of remote DWI lesions in acute intracerebral hemorrhage (ICH) is still unknown. Postulated mechanisms include intracranial or extracranial emboli, small vessel abnormalities and ischemia following acute intracranial hypertension. Our aim is to evaluate the presence of spontaneous microembolic signals (MES) using transcranial Doppler (TCD) in acute ICH patients. Methods: Twenty patients with acute ICH were prospectively enrolled and monitored with TCD for 1 hour on admission days 1, 3 and 7. TCD monitoring was performed using 2MHz probes. Results: Of the 20 patients evaluated, 40% were females and mean age was 55.6±14.1. Eight patients (40%) had dyslipidemia, 15 (75%) hypertension, 5 (20%) diabetes, 2 (10%) ethanol abuse, 6 (30%) smoking and 1 (10%) had prior ischemic stroke. Most frequent location was lobar (9 patients). The mean hematoma volume was 13,5±17,9 ml. Of six patients who underwent MRI, 2 (20%) had remote DWI lesions. Embolic sources were found in 3 patients (1 with atrial fibrillation and 2 with large artery atherosclerosis). Microembolic signals were detected in seven patients (35%). Conclusion: The high occurrence of microemboli in patients admitted with acute ICH indicates a possible embolic mechanism for DWI lesions in these patients.

scholarly journals Low Serum Calcium Levels Contribute to Larger Hematoma Volume in Acute Intracerebral Hemorrhage

Stroke ◽  
2013 ◽  
Vol 44 (7) ◽  
pp. 2004-2006 ◽  
Author(s):  
Yasuteru Inoue ◽  
Fumio Miyashita ◽  
Kazunori Toyoda ◽  
Kazuo Minematsu
Keyword(s):  
Intracerebral Hemorrhage ◽  
Serum Calcium ◽  
Hematoma Volume ◽  
Acute Intracerebral Hemorrhage ◽  
Low Serum

scholarly journals Serum glucose and potassium ratio as a predictive factor for prognosis of acute intracerebral hemorrhage

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110096
Author(s):  
Xiao-Yu Wu ◽  
Yao-Kun Zhuang ◽  
Yong Cai ◽  
Xiao-Qiao Dong ◽  
Ke-Yi Wang ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Characteristic Curve ◽  
Serum Glucose ◽  
Clinical Variable ◽  
Hematoma Volume ◽  
Nihss Score ◽  
Patients At Risk ◽  
Acute Intracerebral Hemorrhage ◽  
Poor Outcomes ◽  
Gcs Score

Objective The serum glucose/potassium ratio (GPR) is a potential prognostic predictor for acute brain injury-related diseases. We calculated the serum GPR in patients with acute intracerebral hemorrhage (ICH) and explored its prognostic value for long-term prognoses and ICH severity. Methods This retrospective cohort study consecutively included 92 patients with ICH and 92 healthy controls. The National Institutes of Health Stroke Scale (NIHSS) score, Glasgow coma scale (GCS) score, and hematoma volume were used to assess severity. A modified Rankin Scale score > 2 at 90 days post-stroke was defined as a poor outcome. Results The serum GPR was significantly higher in patients than controls. The serum GPR was weakly correlated with the NIHSS score, GCS score, and hematoma volume. The serum GPR, GCS score, and hematoma volume were independently associated with poor outcomes. In the receiver operating characteristic curve analysis, the serum GPR remarkably discriminated patients at risk of poor outcomes at 90 days. The serum GPR significantly improved the prognostic predictive capability of hematoma volume and tended to increase that of the GCS score. Conclusion Serum GPR is an easily obtained clinical variable for predicting clinical outcomes after ICH.

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

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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