Trigger Factors for Spontaneous Intracerebral Hemorrhage: A Case-Crossover Study

Background and Purpose: Whether certain activities can trigger spontaneous intracerebral hemorrhage (ICH) remains unknown. Insights into factors that trigger vessel rupture resulting in ICH improves knowledge on the pathophysiology of ICH. We assessed potential trigger factors and their risk for ICH onset. Methods: We included consecutive patients diagnosed with ICH between July 1, 2013, and December 31, 2019. We interviewed patients on their exposure to 12 potential trigger factors (eg, Valsalva maneuvers) in the (hazard) period soon before onset of ICH and their normal exposure to these trigger factors in the year before the ICH. We used the case-crossover design to calculate relative risks (RR) for potential trigger factors. Results: We interviewed 149 patients (mean age 64, 66% male) with ICH. Sixty-seven (45%) had a lobar hemorrhage, 60 (40%) had a deep hemorrhage, 19 (13%) had a cerebellar hemorrhage, and 3 (2%) had an intraventricular hemorrhage. For ICH in general, there was an increased risk within an hour after caffeine consumption (RR=2.5 [95% CI=1.8–3.6]), within an hour after coffee consumption alone (RR=4.8 [95% CI=3.3–6.9]), within an hour after lifting >25 kg (RR=6.6 [95% CI=2.2–19.9]), within an hour after minor head trauma (RR=10.1 [95% CI=1.7–60.2]), within an hour after sexual activity (RR=30.4 [95% CI=16.8–55.0]), within an hour after straining for defecation (RR=37.6 [95% CI=22.4–63.4]), and within an hour after vigorous exercise (RR=21.8 [95% CI=12.6–37.8]). Within 24 hours after flu-like disease or fever, the risk for ICH was also increased (RR=50.7 [95% CI=27.1–95.1]). Within an hour after Valsalva maneuvers, the RR for deep ICH was 3.5 (95% CI=1.7–6.9) and for lobar ICH the RR was 2.0 (95% CI=0.9–4.2). Conclusions: We identified one infection and several blood pressure related trigger factors for ICH onset, providing new insights into the pathophysiology of vessel rupture resulting in ICH.

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Abstract TP326: Lymphopenia, Infectious Complications and Outcome in Spontaneous Intracerebral Hemorrhage

Stroke ◽

10.1161/str.48.suppl_1.tp326 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Andrea Morotti ◽

Sandro Marini ◽

Michael J Jessel ◽

Kristin Schwab ◽

Alison M Ayres ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Lymphocyte Count ◽

Cox Regression ◽

Case Fatality ◽

Retrospective Chart Review ◽

Infectious Complications ◽

Multiple Infections ◽

Spontaneous Intracerebral Hemorrhage ◽

Poor Outcome ◽

Increased Risk

Background and Purpose: lymphopenia is increasingly recognized as a consequence of acute illness and may predispose to infections. We investigated whether admission lymphopenia (AL) is associated with increased risk of infectious complications and poor outcome in patients with spontaneous intracerebral hemorrhage (ICH). Methods: we analyzed a prospectively collected cohort of ICH patients ascertained between 1994 and 2015. Subjects were included if they had a lymphocyte count obtained within 24 h from onset and AL was defined as lymphocyte count<1000/uL. Infectious complications were assessed through retrospective chart review and the association between AL, infectious complications and mortality was investigated with a multivariable Cox regression and logistic regression respectively. Results: 2014 patients met the inclusion criteria (median age 75, males 54.0%) of whom 548 (27.2%) had AL and 605 (30.0%) experienced an infectious complication. Overall case fatality at 90 days was 36.9%. Patients with AL were more severely affected, as highlighted by larger hematoma volume, higher frequency of intraventricular hemorrhage and lower Glasgow Coma Scale score (all p<0.001). AL was independently associated with increased risk of pneumonia (Hazard Ratio [HR] 1.65, 95% confidence interval [CI] 1.32-2.05, p<0.001) and multiple infections (HR 1.75, 95% CI 1.22-2.51, p=0.002). The association with urinary tract infection, sepsis or other infections was not significant. AL was also an independent predictor of 90-day mortality (odds ratio 1.55, 95% CI 1.18-2.04, p=0.002) after adjusting for confounders. Conclusions: AL is common in ICH and associated with increased risk of infectious complications and poor outcome. Further studies will be needed to determine whether prophylactic antibiotics in ICH patients with AL can improve outcome.

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Frequent Emergency Department Visits After Spontaneous Intracerebral Hemorrhage: Who Is at Risk?

The Neurohospitalist ◽

10.1177/1941874418755951 ◽

2018 ◽

Vol 8 (4) ◽

pp. 166-170

Author(s):

Jerina Nogueira ◽

Pedro Abreu ◽

Patrícia Guilherme ◽

Ana Catarina Félix ◽

Fátima Ferreira ◽

...

Keyword(s):

At Risk ◽

Emergency Department ◽

Intracerebral Hemorrhage ◽

Hospital Discharge ◽

Transitional Care ◽

Neurological Impairment ◽

Emergency Department Visits ◽

Spontaneous Intracerebral Hemorrhage ◽

Increased Risk ◽

Ed Visits

Background: The long-term prognosis of spontaneous intracerebral hemorrhage (SICH) is poor. Frequent emergency department (ED) visits can signal increased risk of hospitalization and death. There are no studies describing the risk of frequent ED visits after SICH. Methods: Retrospective cohort study of a community representative consecutive SICH survivors (2009-2015) from southern Portugal. Logistic regression analysis was performed to identify sociodemographic and clinical factors associated with frequent ED visits (≥4 visits) within the first year after hospital discharge. Results: A total of 360 SICH survivors were identified, 358 (98.6%) of whom were followed. The median age was 72; 64% were males. The majority of survivors (n = 194, 54.2%) had at least 1 ED visit. Reasons for ED visits included infections, falls with trauma, and isolated neurological symptoms. Forty-four (12.3%) SICH survivors became frequent ED visitors. Frequent ED visitors were older and had more hospitalizations ( P < .001) and ED visits ( P < .001) prior to the SICH, unhealthy alcohol use ( P = .049), longer period of index SICH hospitalization ( P = .032), pneumonia during hospitalization ( P = .001), and severe neurological impairment at discharge ( P = .001). Pneumonia during index hospitalization (odds ratio [OR]: 3.08; confidence interval [CI]: 1.39-6.76; P = .005) and history of ED visits prior to SICH (OR: 1.64; CI: 1.19-2.26, P = .003) increased the likelihood of becoming a frequent ED visitor. Conclusions: Predictors of frequent ED visits are identifiable at hospital discharge and during any ED visit. Improvement of transitional care and identification of at-risk patients may help reduce multiple ED visits.

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Association Between Alkaline Phosphatase and Clinical Outcomes in Patients With Spontaneous Intracerebral Hemorrhage

Frontiers in Neurology ◽

10.3389/fneur.2021.677696 ◽

2021 ◽

Vol 12 ◽

Author(s):

Sijia Li ◽

Wenjuan Wang ◽

Qian Zhang ◽

Yu Wang ◽

Anxin Wang ◽

...

Keyword(s):

Alkaline Phosphatase ◽

Logistic Regression ◽

Intracerebral Hemorrhage ◽

Clinical Outcomes ◽

Functional Outcomes ◽

Adverse Outcomes ◽

Spontaneous Intracerebral Hemorrhage ◽

Mortality And Morbidity ◽

The Third ◽

Increased Risk

Background: Spontaneous intracerebral hemorrhage (ICH) is associated with high rates of mortality and morbidity. Alkaline phosphatase (ALP) is related to increased risk of cardiovascular events and is also closely associated with adverse outcomes after ischemic or hemorrhagic stroke. However, there are limited data about the effect of ALP on clinical outcomes after ICH. Therefore, we aimed to investigate the relationship between serum ALP level and prognosis in ICH patients.Methods: From January 2014 to September 2016, 939 patients with spontaneous ICH were enrolled in our study from 13 hospitals in Beijing. Patients were categorized into four groups based on the ALP quartiles (Q1, Q2, Q3, Q4). The main outcomes were 30-day, 90-day, and 1-year poor functional outcomes (modified Rankin Scale score of 3–6). Multivariable logistic regression and interaction analyses were performed to evaluate the relationships between ALP and clinical outcomes after ICH.Results: In the logistic regression analysis, compared with the third quartile of ALP, the adjusted odds ratios of the Q1, Q2, and Q4 for 30-day poor functional outcome were 1.31 (0.80–2.15), 1.16 (0.71–1.89), and 2.16 (1.32–3.55). In terms of 90-day and 1-year poor functional outcomes, the risks were significantly higher in the highest quartile of ALP compared with the third quartile after adjusting the confounding factors [90-day: highest quartile OR = 1.86 (1.12–3.10); 1-year: highest quartile OR = 2.26 (1.34–3.80)]. Moreover, there was no significant interaction between ALP and variables like age or sex.Conclusions: High ALP level (>94.8 U/L) was independently associated with 30-day, 90-day, and 1-year poor functional outcomes in ICH patients. Serum ALP might serve as a predictor for poor functional outcomes after ICH onset.

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Spontaneous Intracerebral Hemorrhage: Patient’s Activities before the Onset of Stroke and Localization of Intracerebral Hemorrhage in Black Africans

Research in Health Science ◽

10.22158/rhs.v4n2p101 ◽

2019 ◽

Vol 4 (2) ◽

pp. p101

Author(s):

Serge Malenga Mpaka ◽

Blaise Ngizulu Mazuka ◽

Didier Ndabahweje Ndyanabo ◽

Benjamin Longo-Mbenza ◽

Michel Lelo Tshikwela

Keyword(s):

Physical Activity ◽

Intracerebral Hemorrhage ◽

Hemorrhagic Stroke ◽

P Value ◽

Spontaneous Intracerebral Hemorrhage ◽

Logistic Regression Models ◽

Emotional Factors ◽

Increased Risk ◽

Significant Difference ◽

Republic Of The Congo

Background: Some published studies on the patient’s activity before the stroke occurrence indicate that thereis an increased risk of the onset of acute stroke during these activities. In our community, these data are not yet assessed. The purpose of this pilot study was to examine whether intracerebral hemorrhage may be linked to patient’s physical activity before the onset and to carry out any relationship with location of the hemorrhage.Methods: The patient’s activity before the onset of stroke and location of hemorrhage in 58 patients (40 men and 18 women, aged 39 to 81years) admitted with spontaneous intracerebral hemorrhage seen by CT in Kinshasa, Democratic Republic of the Congo, from 2012 to 2015, were recorded and analyzed using logistic regression models. Results: In 31% of the case, the onset developed after emotional factors, in 24% in the lavatory, in 15% during housework and in 12% during sexual activity (X-squared = 8.319, p-value = 0.081). There was no significant difference between those activities and the site of intracerebral hemorrhage (p?0.05).Conclusion: Most patients in this series seemed to be stricken by the hemorrhagic stroke during some physical activity. It is less certain that location of intracerebral hemorrhage was linked with these activities.

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Factors predicting pneumonia in patients admitted with spontaneous supratentorial intracerebral hemorrhage in western region of Nepal

Journal of Brain and Spine Foundation Nepal ◽

10.3126/jbsfn.v2i1.39015 ◽

2021 ◽

Vol 2 (1) ◽

pp. 31-36

Author(s):

Subhash Yogi ◽

Joshan Neupane ◽

Aabishkar Bhattarai ◽

Bijaya Karki ◽

Benju Tilija Pun

Keyword(s):

Diabetes Mellitus ◽

Intracerebral Hemorrhage ◽

Spontaneous Intracerebral Hemorrhage ◽

Chi Square ◽

Term Outcome ◽

Long Term Outcome ◽

Medical College ◽

Increased Risk ◽

Student’S T ◽

Ich Score

Introduction: Despite the well-documented association of stroke-associated complications and infections with increased mortality, morbidity and worse long-term outcome, there are only limited data available on independent predictors of pneumonia in patients with acute intracerebral hemorrhage. In this study, our objective was to evaluate risk factors and comorbid conditions associated with the diagnosis of hospital acquired pneumonia in the patients admitted with spontaneous intracerebral hemorrhage and to determine the independent predictors of pneumonia in these patients. Methods: A retrospective analysis was done in patients admitted in Intensive Care Unit of Nepalgunj Medical College with spontaneous intracerebral hemorrhage. Various clinic-demographic parameters were tested for association with pneumonia or no pneumonia group using chi square or student’s “t” test. Results: A total of 117 patients, 86 men (73.5%) and 31 women (26.5%) with spontaneous intracerebral hemorrhage were included in the study. There were 36 (30.77%) patients with pneumonia. The association Diabetes mellitus (p<0.01), COPD (p<0.01), smoking (p<0.01), mean GCS (p<0.01), ICH volume (p=0.01), ICH score (p<0.01), operated status (p<0.01), Ganglionic (<0.01), Brain stem (p=0.03) and Ventricular (p=0.01) location of hematoma was statistically significant with pneumonia. Outcome in terms of MRS at discharge was also poorer for patients with pneumonia (p=0.01). Conclusion: Diabetes mellitus, COPD, mean GCS, ICH volume, ICH score, operated status, higher MRS score were associated with increased risk of pneumonia in ICH. Similarly, ganglionic hematoma, brainstem hematoma and those having intraventricular hemorrhages are also associated with increased risk of pneumonia. Outcome in patients in terms of MRS were also poorer in those who had pneumonia.

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Early chemoprophylaxis for deep venous thrombosis does not increase the risk of hematoma expansion in patients presenting with spontaneous intracerebral hemorrhage

Surgical Neurology International ◽

10.25259/sni_100_2021 ◽

2021 ◽

Vol 12 ◽

pp. 277

Author(s):

Dimitri Laurent ◽

Olgert Bardhi ◽

Paul Kubilis ◽

Brian Corliss ◽

Stephanie Adamczak ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Hematoma Expansion ◽

Optimal Timing ◽

Thromboembolic Events ◽

Spontaneous Intracerebral Hemorrhage ◽

Increased Risk ◽

Venous Thromboembolic Events ◽

Venous Thromboembolic

Background: Spontaneous intracerebral hemorrhage (ICH) is a significant cause of morbidity and mortality worldwide. The development of venous thromboembolism (VTE), including deep venous thrombosis or pulmonary embolism, is correlated with negative outcomes following ICH. Due to the risk of hematoma expansion associated with the use of VTE chemoprophylaxis, there remains significant debate about the optimal timing for its initiation following ICH. We analyzed the risk of early chemoprophylaxis on hematoma expansion following ICH. Methods: We performed a retrospective analysis of patients presenting with spontaneous ICH at single institution between 2011 and 2018. The rate of hematoma expansion was compared between patients that received early chemoprophylaxis (on admission) and those that received conventional chemoprophylaxis (>24 h). Results: Data for 235 patients were available for analysis. Eleven patients (7.5%) in the early prophylaxis cohort and seven patients (8.0%) in the conventional prophylaxis cohort developed VTE (P = 0.9). Hematoma expansion also did not differ significantly (early 19%, conventional 23%, P = 0.5). Conclusion: The use of early chemoprophylaxis against venous thromboembolic events following ICH appears safe in our patient population without increasing the risk of hematoma expansion. Given the increased risk of poor outcome in the setting of VTE, early VTE chemoprophylaxis should be considered in patients who present with ICH. Larger, prospective, and randomized studies are necessary to better elucidate the risk of early chemoprophylaxis and potential reduction in venous thromboembolic events.

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Consumption of caffeinated beverages and kidney function decline in an elderly Mediterranean population with metabolic syndrome

Scientific Reports ◽

10.1038/s41598-021-88028-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Andrés Díaz-López ◽

Indira Paz-Graniel ◽

Verónica Ruiz ◽

Estefanía Toledo ◽

Nerea Becerra-Tomás ◽

...

Keyword(s):

Metabolic Syndrome ◽

Coffee Consumption ◽

Caffeine Intake ◽

Mediterranean Population ◽

Caffeine Consumption ◽

Obese Adults ◽

Disease Epidemiology ◽

Increased Risk ◽

Caffeinated Coffee ◽

Egfr Decline

AbstractIt remains unclear whether caffeinated beverages could have deleterious renal effects in elderly population with underlying comorbid conditions. We investigated the associations between coffee, tea, or caffeine intake and 1-year changes in glomerular filtration rate (eGFR) in a large Spanish cohort of overweight/obese elderly with metabolic syndrome (MetS). This prospective analysis includes 5851 overweight/obese adults (55–75 years) with MetS from the PREDIMED-Plus study. We assessed coffee, tea, and caffeine consumption from a validated food-frequency questionnaire and creatinine-based eGFR using the Chronic Kidney Disease Epidemiology Collaboration equation. Multivariate-adjusted regression models were applied to test associations between baseline coffee, tea, or caffeine intake and 1-year eGFR changes. Caffeinated coffee (> 2 cups/day) and tea (at least 1 cup/day) drinkers had 0.88 and 0.93 mL/min/1.73 m2 greater eGFR decrease respectively, compared to those with less than 1 cup/day of coffee consumption or non-tea drinkers. Furthermore, caffeinated coffee consumption of > 2 cups/day was associated with 1.19-fold increased risk of rapid eGFR decline > 3 mL/min/1.73 m2 (95% CI 1.01–1.41). Similarly, individuals in the highest (median, 51.2 mg/day) tertile of caffeine intake had a 0.87 mL/min/1.73 m2 greater eGFR decrease. Decaffeinated coffee was not associated with eGFR changes. In conclusion, higher consumption of caffeinated coffee, tea, and caffeine was associated with a greater 1-year eGFR decline in overweight/obese adults with MetS.

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The association between caffeine and cognitive decline: examining alternative causal hypotheses

International Psychogeriatrics ◽

10.1017/s1041610213002469 ◽

2014 ◽

Vol 26 (4) ◽

pp. 581-590 ◽

Cited By ~ 9

Author(s):

K. Ritchie ◽

M.L. Ancelin ◽

H. Amieva ◽

O. Rouaud ◽

I. Carrière

Keyword(s):

Cognitive Decline ◽

Depressive Symptomatology ◽

Coffee Consumption ◽

Diabetes Type 2 ◽

Total Sample ◽

Elderly Persons ◽

Caffeine Consumption ◽

Alternative Pathways ◽

Increased Risk

ABSTRACTBackground:Numerous studies suggest that higher coffee consumption may reduce the rate of aging-related cognitive decline in women. It is thus potentially a cheap and widely available candidate for prevention programs provided its mechanism may be adequately understood. The assumed effect is that of reduced amyloid deposition, however, alternative pathways notably by reducing depression and diabetes type 2 risk have not been considered.Methods:A population study of 1,193 elderly persons examining depressive symptomatology, caffeine consumption, fasting glucose levels, type 2 diabetes onset, serum amyloid, and factors known to affect cognitive performance was used to explore alternative causal models.Results:Higher caffeine consumption was found to be associated with decreased risk of incident diabetes in men (HR = 0.64; 95% CI 0.42–0.97) and increased risk in women (HR = 1.51; 95% CI 1.08–2.11). No association was found with incident depression. While in the total sample lower ratio Aβ42/Aβ40 levels (OR = 1.36, 95% CI 1.05–1.77, p = 0.02) were found in high caffeine consumers, this failed to reach significance when the analyses were stratified by gender.Conclusions:We found no evidence that reduced risk of cognitive decline in women with high caffeine consumption is moderated or confounded by diabetes or depression. The evidence of an association with plasma beta amyloid could not be clearly demonstrated. Insufficient proof of causal mechanisms currently precludes the recommendation of coffee consumption as a public health measure. Further research should focus on the high estrogen content of coffee as a plausible alternative explanation.

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