scholarly journals Association of Molecular Markers With Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage

Stroke ◽  
2013 ◽  
Vol 44 (3) ◽  
pp. 658-663 ◽  
Author(s):  
Na Li ◽  
Yan Fang Liu ◽  
Li Ma ◽  
Hans Worthmann ◽  
Yi Long Wang ◽  
...  
Keyword(s):  
Molecular Markers ◽  
Clinical Outcome ◽  
Intracerebral Hemorrhage ◽  
Perihematomal Edema

Abstract WP309: Association of Molecular Markers with Perihematomal Edema and Clinical Outcome in Intracerebral Hemorrhage

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Na Li ◽  
Yan Fang Liu ◽  
Li Ma ◽  
Hans Worthmann ◽  
Peter Raab ◽  
...  
Keyword(s):  
Molecular Markers ◽  
Brain Injury ◽  
Clinical Outcome ◽  
Intracerebral Hemorrhage ◽  
Neuronal Cell Death ◽  
Neuronal Cell ◽  
Stroke Severity ◽  
Secondary Brain Injury ◽  
Hematoma Volume ◽  
Perihematomal Edema

Background and Purpose: Perihematomal edema (PHE) contributes to secondary brain injury in intracerebral hemorrhage (ICH). Increase of matrix metalloproteinases (MMPs) and growth factors (GFs) is considerably involved in blood-brain barrier disruption and neuronal cell death in ICH models. We therefore hypothesized that increased levels of these molecular markers are associated with PHE and clinical outcome in ICH patients. Methods: Fifty-nine patients with spontaneous ICH admitted within 24 hours of symptom onset were prospectively investigated. Noncontrast CT was performed on admission for diagnosis of ICH and quantification of initial hematoma volume. MRI was performed on day 3 in order to evaluate PHE. Concentrations of MMP-3, MMP-9, as well as vascular endothelial growth factor (VEGF) and Angiopoietin-1(Ang-1) on admission were determined by enzyme-linked immunosorbent assays. Clinical outcome was assessed by modified Rankin Scale (mRS) at 90days. Results: Increased MMP-3 levels were independently associated with PHE volume (P<0.05). Cytotoxic edema (CE) surrounding the hematoma was seen in 36 (61%) cases on 3-day MRI. CE did not correlate with the level of any of the biomarkers studied. Levels of MMP-3 ≥12.4 ng/ml and MMP-9 ≥192.4 ng/ml but not VEGF and Ang-1 predicted poor clinical outcome at 90 days (mRS>3) independent of stroke severity and hematoma volume at baseline (OR 25.3, P=0.035; OR 68.9, P=0.023; respectively). Conclusion: Metalloproteinases 3 and 9 seem to be significantly involved in secondary brain injury and outcome after primary ICH in humans and thus should be further evaluated as targets for therapeutic strategies in this devastating disorder.

scholarly journals Perihematomal Diffusion Restriction in Intracerebral Hemorrhage Depends on Hematoma Volume, But Does Not Predict Outcome

2016 ◽  
Vol 42 (3-4) ◽  
pp. 280-287 ◽  
Author(s):  
Sebastian Stösser ◽  
Hermann Neugebauer ◽  
Katharina Althaus ◽  
Albert C. Ludolph ◽  
Jan Kassubek ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Intracerebral Hemorrhage ◽  
Symptom Onset ◽  
Independent Predictor ◽  
Severe Disability ◽  
Clinical Predictors ◽  
Hematoma Volume ◽  
Diffusion Restriction ◽  
Apparent Diffusion ◽  
Perihematomal Edema

Background: Perihematomal diffusion restriction (PDR) is a frequent finding in primary intracerebral hemorrhage (ICH) on diffusion-weighted MRI. Its frequency, associated clinical and imaging findings and impact on clinical outcome are not well understood. Methods: This is a retrospective single-center analysis of 172 patients with primary ICH who received MRI within 24 h from symptom onset. PDR was defined as a reduction of apparent diffusion coefficient below 550 × 10-6 mm2/s. Multivariate regression analyses were used to assess independent imaging and clinical predictors of PDR. Clinical outcome was assessed using the modified Rankin scale (mRS) at discharge. Results: PDR was present in 88 patients (51.2%). Median PDR volume was 1.1 ml (interquartile range 0.2-4.2). Multivariate analyses identified hematoma volume as the key independent predictor of PDR. The volume of perihematomal edema, lobar hematoma location and low diastolic blood pressure at admission were further predictors. Although the occurrence of PDR correlated with in-hospital mortality (75.0 vs. 43.4%, p < 0.001) and moderately severe to severe disability or death at discharge (mRS ≥4; 56.4 vs. 27.8%, p = 0.002), PDR was not an independent predictor of clinical outcome. In contrast, hematoma volume, ventricular extension of hemorrhage and higher age independently predicted an adverse clinical outcome. Conclusions: PDR is common after primary ICH within 24 h of symptom onset. Hematoma volume was identified as the key predictor of PDR. Although PDR was associated with mortality and severe disability, this effect was confounded by established risk factors. These results do not support a role of early PDR as prognostic factor after ICH independent of hematoma volume.

Association of Microglia/macrophage Polarization With Perihematomal Edema and Clinical Outcome in Patients With Acute Intracerebral Hemorrhage

2021 ◽  
Author(s):  
Xue-Ming Shen ◽  
Xiu-Peng Han ◽  
Hong-Qi Xu ◽  
Yan-Jun Tang ◽  
Song Han ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Intracerebral Hemorrhage ◽  
Clinical Outcomes ◽  
Macrophage Activation ◽  
Macrophage Polarization ◽  
Treatment Decision ◽  
Wilcoxon Test ◽  
M1 Phenotype ◽  
Perihematomal Edema ◽  
M2 Phenotype

Abstract Background: Perihematomal edema (PHE) is a marker of secondary injury in intracerebral hemorrhage (ICH) and is associated with poor clinical outcomes. Microglial and macrophage activation, or their polarization could lead to a pro-inflammatory or anti-inflammatory response in stroke. However, little is known about the association between inflammatory cells and ICH. Thus, we characterized the inflammatory cell response, and assessed its association with parameters such as hematoma, PHE volume, and clinical outcome in patients with acute ICH.Methods: Fifty-two patients with acute ICH were retrospectively enrolled in our study. All patients underwent surgery, and brain tissue from the PHE was acquired. Immunofluorescence staining was performed to evaluate microglia (CD11b+/TMEM119+), macrophages (CD11b+/TMEM119-), and the M1 (MHC+/CD11b+) and M2 (CD206+/CD11b+) phenotypes. The relative PHE (r-PHE) was the main marker for assessing PHE volume. The Wilcoxon test and Spearman correlation analysis were the main statistical analysis methods used.Results: Microglia/macrophages, and their phenotypes were detected within 6 hours after stroke. Microglia and the M2 phenotype were negatively correlated with r-PHE, while macrophages and the M1 phenotype were positively correlated with r-PHE; however, these parameters were not associated with age, sex, or location. There was a positive correlation between the microglia and M2-phenotype levels (r = 0.443, p = 0.001) and between the macrophage and M1-phenotype levels (r = 0.458, p <0.001). Microglia (r = -0.295, p = 0.033) and M2-phenotype (r = -0.384, p = 0.005) levels were negatively correlated with the National Institutes of Health stroke scale (NIHSS) after treatment.Finally, using lasso Poisson regression models, we developed a score for predicting the NIHSS score after treatment. Decision curve analysis showed notable net benefits of this score.Conclusion: Microglial and macrophage activation, and their polarization were significantly associated with r-PHE and clinical outcomes in ICH, and could provide therapeutic insights for PHE management after hemorrhagic stroke.

Serum Procalcitonin Levels are Associated with Clinical Outcome in Intracerebral Hemorrhage

2017 ◽  
Vol 38 (3) ◽  
pp. 727-733 ◽  
Author(s):  
Dingxiu He ◽  
Yun Zhang ◽  
Biao Zhang ◽  
Wei Jian ◽  
Xiaojian Deng ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Intracerebral Hemorrhage

scholarly journals Fully Automated Segmentation Algorithm for Perihematomal Edema Volumetry After Spontaneous Intracerebral Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (3) ◽  
pp. 815-823 ◽  
Author(s):  
Natasha Ironside ◽  
Ching-Jen Chen ◽  
Simukayi Mutasa ◽  
Justin L. Sim ◽  
Dale Ding ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Segmentation Algorithm ◽  
Automated Segmentation ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Perihematomal Edema

scholarly journals Brain Microbleeds: Distribution and Influence on Hematoma and Perihematomal Edema in Patients with Primary Intracerebral Hemorrhage

2013 ◽  
Vol 26 (2) ◽  
pp. 184-190 ◽  
Author(s):  
Wei-Ming Lin ◽  
Tse-Yen Yang ◽  
Hsu-Huei Weng ◽  
Chih-Feng Chen ◽  
Ming-Hsueh Lee ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Perihematomal Edema

Abstract WMP106: Soluble CD163 as a Prognostic Marker for Perihematomal Edema Formation and Functional Outcomes in Intracerebral Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Meaghan Roy-O’Reilly ◽  
Davis So ◽  
Glenda Torres ◽  
Liang Zhu ◽  
Jaroslaw Aronowski ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcomes ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Tissue Injury ◽  
Enzyme Linked Immunosorbent Assay ◽  
Healthy Controls ◽  
Edema Formation ◽  
Soluble Cd163 ◽  
Perihematomal Edema

Introduction: Macrophages are the predominant cell capable of removing toxic hemoglobin at sites of tissue injury, and CD163 has been recognized as the hemoglobin scavenger receptor present on the macrophage cell surface. In this study, we explored the levels of soluble CD163 (sCD163) in patients with intracerebral hemorrhage (ICH) to ascertain whether sCD163 was associated with clinicoradiologic features and long-term functional outcomes. Methods: Our ICH cohort was comprised of 50 patients with moderate-sized basal ganglia hematomas. We collected serial serum and cerebrospinal fluid (CSF) at pre-specified timepoints (24 hours, 48 hours, 3-5 days, 6-8 days, and greater than 10 days post-ictus). We also obtained samples from 10 healthy controls. Levels of sCD163 were measured by enzyme-linked immunosorbent assay. A linear mixed model was used to compare sCD163 values among various groups, using a Bonferroni correction for multiple test adjustment. The method of generalized estimating equations was used to determine associations with dichotomized outcomes (modified Rankin Scale score 0-3 versus 4-6). Results: Compared to healthy controls, serum sCD163 was higher in the ICH patients (40.6 versus 128.4 ng/mL). Within the ICH cohort, early values (24 hours to 5 days post-ictus) of serum sCD163 were significantly higher in patients who elaborated minimal perihematomal edema (PHE) (200.3 in patients with less than 10 mL PHE versus 71.8; p = 0.046). 6 to greater than 10 days post-ictus, sCD163 levels tailed off for patients with less PHE whereas levels rose in patients with greater PHE. Continued subacute elevation of sCD163, particularly in the CSF, was highly associated with poorer outcomes, both at discharge and at 90 days (p < 0.001). These associations were independent of age, gender, peak hematoma volume, and ICH score; there was a statistically significant association of CSF sCD163 values with degree of intraventricular hemorrhage (p = 0.04). Conclusions: sCD163 may be a dynamic marker in ICH, with acute levels distinguishing edema patterns and subacute levels predicting functional outcome. Further studies are needed to confirm these findings and explore the pathophysiology behind these observations.

Abstract P423: Race and Ethnicity Influence Perihematomal Edema Volume in Supratentorial Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Julian N Acosta ◽  
Yasheng Chen ◽  
Cameron Both ◽  
Audrey C Leasure ◽  
Fernando Testai ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Race And Ethnicity ◽  
Learning Algorithm ◽  
Multivariable Analysis ◽  
Secondary Brain Injury ◽  
Racial Groups ◽  
Deep Learning Algorithm ◽  
Perihematomal Edema ◽  
Study Participants ◽  
Racial Ethnic

Introduction: Perihematomal Edema (PHE) is a neuroimaging biomarker of secondary brain injury in patients with spontaneous, non-traumatic intracerebral hemorrhage (ICH). There are limited data on racial/ethnic differences in the development of PHE. This dearth of data is partially driven by the time-consuming process of manually segmenting PHE. Leveraging a validated automated pipeline for PHE segmentation, we evaluated whether race and ethnicity influence baseline PHE volume in patients with ICH. Methods: The Ethnic/Racial Variations in Intracerebral Hemorrhage (ERICH) study is a prospective, multicenter study of ICH that recruited 1,000 adult participants from each of three racial/ethnic groups (non-Hispanic White, non-Hispanic Black, and Hispanic). We applied a previously validated deep learning algorithm to automatically determine PHE volumes on baseline CTs in these study participants. Quality control procedures were used to include only sufficiently accurate PHE measurements. Linear regression was used to identify factors associated with log-transformed PHE volume and to identify differences across Ethnic/Racial groups. Results: Our imaging pipeline provided good quality baseline PHE measurements on 2,008 out of 3,000 ERICH study participants. After excluding infratentorial hemorrhages (273) and those with missing or null baseline ICH volume (49), 1,686 remained for analysis (median age 59 [IQR 51-71], 687 [41%] female sex). Median PHE volume was 12.0 (IQR 4.8-27.1) for whites, 11.9 (IQR 4.5-26.1) for Hispanics and 8.3 (IQR 3.0-19.2) for blacks. Compared to Blacks, Hispanics (beta 0.22; 95%CI 0.11-0.32; p<0.001) and Whites (beta 0.20; 95%CI 0.07-0.33; p=0.003) had higher baseline PHE volumes, in multivariable analysis adjusting for age, sex, ICH location, log-baseline ICH volume, log-baseline intraventricular volume, and systolic blood pressure on admission. Conclusion: Race and ethnicity influence the volume of baseline PHE. Further studies are needed to validate our results and investigate the biological underpinnings of this difference.

Association between Apolipoprotein E Polymorphism and Clinical Outcome after Ischemic Stroke, Intracerebral Hemorrhage, and Subarachnoid Hemorrhage

2021 ◽  
pp. 1-10
Author(s):  
Wen Pan ◽  
Min Zhang ◽  
Zhenping Guo ◽  
Wenfeng Xiao ◽  
Chao You ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Intracerebral Hemorrhage ◽  
Apolipoprotein E ◽  
Functional Outcomes ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Fixed Effects Models ◽  
Increased Risk

<b><i>Backgrounds:</i></b> Previous studies reported inconsistent results regarding associations between apolipoprotein E (<i>APOE</i>) polymorphism and clinical outcomes after ischemic stroke (IS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH). Thus, the study was designed to make a systematic review and meta-analysis regarding the association between <i>APOE</i> polymorphism and clinical outcome after IS, ICH, and SAH. <b><i>Methods:</i></b> To identify studies eligible for this meta-analysis, we searched for articles published before August 2021 in the databases (PubMed, Web of Science, and Google Scholar). We used STATA 12.0 software to compute hazard ratios (HRs) and their 95% confidence intervals (CIs) regarding <i>APOE</i> polymorphism and clinical outcome after IS, ICH, and SAH. <b><i>Results:</i></b> Meta-analysis showed no significant association between <i>APOE</i> polymorphism and functional outcome after IS with fixed effects models (ε4 carrier vs. non-ε4 carrier: HR, 1.00; 95% CI: 0.83–1.21, <i>I</i><sup>2</sup> = 29.4%, <i>p</i> = 0.183; ε2 carrier vs. non-ε2 carrier: HR, 0.92; 95% CI: 0.72–1.16, <i>I</i><sup>2</sup> = 15.6%, <i>p</i> = 0.307). Meta-analysis showed that ICH patients carrying ε4 allele have increased risk of poor outcome in Caucasian population with fixed effects models (ε4 carrier vs. non-ε4 carrier: HR, 1.75; 95% CI: 1.19–2.57, <i>I</i><sup>2</sup> = 0.0%, <i>p</i> = 0.543). Meta-analysis showed no significant association between <i>APOE</i> polymorphism and functional outcomes after SAH with random effects models (ε4 carrier vs. non-ε4 carrier: HR, 1.51; 95% CI: 0.80–2.84, <i>I</i><sup>2</sup> = 57.1%, <i>p</i> = 0.022). <b><i>Conclusions:</i></b> In conclusion, the present study demonstrated <i>APOE</i> ε4 carriers show worse functional outcomes after ICH, but not after IS or SAH. More large-scale studies were critical to explore the association between <i>APOE</i> polymorphism and clinical outcome after IS, ICH, and SAH.

Sign in / Sign up

Export Citation Format

Share Document