Location-specific differences in hematoma volume predict outcomes in patients with spontaneous intracerebral hemorrhage

2019 ◽  
Vol 15 (1) ◽  
pp. 90-102 ◽  
Author(s):  
Natasha Ironside ◽  
Ching-Jen Chen ◽  
Victoria Dreyer ◽  
Brandon Christophe ◽  
Thomas J Buell ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Dependence ◽  
Characteristic Curve ◽  
Receiver Operator Characteristic Curve ◽  
Independent Effect ◽  
Study Cohort ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hematoma Volume ◽  
Multivariable Regression ◽  
Ich Score

Background and objective Functional outcome after spontaneous intracerebral hemorrhage (ICH) may vary depending on hematoma volume and location. We assessed the interaction between hematoma volume and location, and modified the original ICH score to include such an interaction. Methods Consecutive ICH patients were enrolled in the Intracerebral Hemorrhage Outcomes Project from 2009 to 2017. Inclusion criteria were age≥18 years, baseline modified Rankin Scale (mRS) score 0–2, neuroimaging, and follow-up. Functional dependence and mortality were defined as 90-day mRS>2 and death, respectively. A location ICH score was developed using multivariable regression and area under the receiver operator characteristic curve (AUROC) analyses. Results The study cohort comprised 311 patients, and the derivation and validation cohorts comprised 209 and 102 patients, respectively. Interactions between hematoma volume and location predicted functional dependence ( p = 0.008) and mortality ( p = 0.025). The location ICH score comprised age≥80 years (1 point), Glasgow Coma Scale score (3–9 = 2 points; 10–13 = 1 point), volume–location (lobar:≥24 mL=2 points, 21–24 mL=1 point; deep:≥8 mL=2 points, 7–8 mL=1 point; brainstem:≥6 mL=2 points, 3–6 mL=1 point; cerebellum:≥24 mL=2 points, 12–24 mL=1 point), and intraventricular hemorrhage (1 point). AUROC of the location ICH score was higher in functional dependence (0.883 vs. 0.770, p = 0.002) but not mortality (0.838 vs. 0.841, p = 0.918) discrimination compared to the original ICH score. Conclusions The interaction between hematoma volume and location exerted an independent effect on outcomes. Excellent discrimination of functional dependence and mortality was observed with incorporation of location-specific volume thresholds into a prediction model. Therefore, the volume–location relationship plays an important role in ICH outcome prediction.

scholarly journals Comparison of Black Hole Sign, Satellite Sign, and Iodine Sign to Predict Hematoma Expansion in Patients with Spontaneous Intracerebral Hemorrhage

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Milind Ratna Shakya ◽  
Fan Fu ◽  
Miao Zhang ◽  
Yi Shan ◽  
Fan Yu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Black Hole ◽  
Intracerebral Hemorrhage ◽  
Odds Ratio ◽  
Predictive Accuracy ◽  
Characteristic Curve ◽  
Receiver Operator Characteristic Curve ◽  
Hematoma Expansion ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Significant Difference

Purpose. To discretely and collectively compare black hole sign (BHS) and satellite sign (SS) with recently introduced gemstone spectral imaging-based iodine sign (IS) for predicting hematoma expansion (HE) in spontaneous intracerebral hemorrhage (SICH). Methods. This retrospective study includes 90 patients from 2017 to 2019 who underwent both spectral computed tomography angiography (CTA) as well as noncontrast computed tomography (NCCT) within 6 hours of SICH onset along with subsequent follow-up NCCT scanned within 24 hours. We named the presence of any of BHS or SS as any NCCT sign. Two independent reviewers analyzed all the HE predicting signs. Receiver-operator characteristic curve analysis and logistic regression were performed to compare the predictive performance of HE. Results. A total of 61 patients had HE, out of which IS was seen in 78.7% (48/61) while BHS and SS were seen in 47.5% (29/61) and 41% (25/61), respectively. The area under the curve for BHS, SS, and IS was 63.4%, 67%, and 82.4%, respectively, while for any NCCT sign was 71.5%. There was no significant difference between IS and any NCCT sign ( P = 0.108 ). Multivariate analysis showed IS (odds ratio 68.24; 95% CI 11.76-396.00; P < 0.001 ) and any NCCT sign (odds ratio 19.49; 95% CI 3.99-95.25; P < 0.001 ) were independent predictors of HE whereas BHS (odds ratio 0.34; 95% CI 0.01-38.50; P = 0.534 ) and SS (odds ratio 4.54; 95% CI 0.54-38.50; P = 0.165 ) had no significance. Conclusion. The predictive accuracy of any NCCT sign was better than that of sole BHS and SS. Both any NCCT sign and IS were independent predictors of HE. Although IS had higher predictive accuracy, any NCCT sign may still be regarded as a fair predictor of HE when CTA is not available.

Abstract 3022: Image-Guided Endoscopic Evacuation of Spontaneous Intracerebral Hemorrhage

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Joshua R Dusick ◽  
Justin Dye ◽  
Nestor Gonzalez ◽  
Jennifer Varma ◽  
John Frazee ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
High Morbidity ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hematoma Volume ◽  
Invasive Approach ◽  
Image Guided ◽  
Aspiration Technique ◽  
Endoscopic Evacuation ◽  
Ich Score ◽  
The Impact

Introduction: Spontaneous intracerebral hemorrhage (ICH) is associated with a high morbidity and mortality rate despite current medical management. The benefits of open surgical evacuation for ICH remain controversial. Here we present initial results of the effectiveness of stereotactic image-guided endoscopic evacuation of ICH. Methods: Over 9-years, 41 patients with ICH (age 65+−14 years, 66% male, average admission GCS 10 & ICH Score 2, 46% with concurrent intraventricular hemorrhage) were treated. The current technique, which evolved from using direct endoscopic visualization, uses frameless stereotactic guidance alone to aspirate at two specified locations within the hematoma. An endoscope sheath is introduced through a bur hole into the hematoma along its long axis. Suction is applied to the sheath, without endoscopic viewing, at two locations, 1/3 and 2/3 of the way through the long-axis of the ICH. Endoscopic visualization of the cavity is then performed to ensure hemostasis. ICH volume was calculated using pre- and postoperative CT measurements ((length x width x height)/2). Results: Pre- and postoperative ICH volumes averaged 56.5 and 15.9cc, respectively, a reduction of 67.6+−41.9% (p<0.0001) with greater than 50% reduction in 78% of patients. Within 30 days, two patients (5%) developed rebleeding, one with acutely increased hematoma volume on postop CT. Average preop modified Rankin Score (mRS) decreased from 4.4 to 4.1 at follow-up (p=0.17). Seven-day and 30-day mortality occurred in 5 (12%) and 1 (2.4%) patients, respectively. This 30-day mortality compares favorably with the predicted rate of 26% based on average ICH score of 2 for the series. There were 2 surgical complications including ipsilateral ischemic stroke and subdural hematoma. Comparing the current aspiration technique to the previous technique, there were trends towards greater average reduction in hematoma volume (81.7% versus 58.5%, respectively, p=0.08) and greater improvement in clinical outcome (average mRS improvement 0.75 points versus 0 points, respectively, p=0.08). Conclusions: Image-guided endoscopic evacuation is a minimally-invasive approach to reduce ICH volume. Greater than 50% reduction in hematoma volume was achieved in the large majority of patients. Further study is required to evaluate the impact of endoscopic ICH evacuation on clinical outcomes compared to other treatments.

scholarly journals Anti-inflammatory genes in PBMCs post-spontaneous intracerebral hemorrhage

2021 ◽  
Vol 12 (1) ◽  
pp. 58-66
Author(s):  
Doan Nguyen ◽  
Vi Tran ◽  
Alireza Shirazian ◽  
Cruz Velasco-Gonzalez ◽  
Ifeanyi Iwuchukwu
Keyword(s):  
Intracerebral Hemorrhage ◽  
Negative Correlation ◽  
Mononuclear Cells ◽  
Inflammatory Cells ◽  
Favorable Outcome ◽  
Hospital Length Of Stay ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hematoma Volume ◽  
Peripheral Blood Mononuclear ◽  
Anti Inflammatory

Abstract Background Neuroinflammation is important in the pathophysiology of spontaneous intracerebral hemorrhage (ICH) and peripheral inflammatory cells play a role in the clinical evolution and outcome. Methodology Blood samples from ICH patients (n = 20) were collected at admission for 5 consecutive days for peripheral blood mononuclear cells (PBMCs). Frozen PBMCs were used for real-time PCR using Taqman probes (NFKB1, SOD1, PPARG, IL10, NFE2L2, and REL) and normalized to GAPDH. Data on hospital length of stay and modified Rankin score (MRS) were collected with 90-day MRS ≤ 3 as favorable outcome. Statistical analysis of clinical characteristics to temporal gene expression from early to delayed timepoints was compared for MRS groups (favorable vs unfavorable) and hematoma volume. Principle findings and results IL10, SOD1, and REL expression were significantly higher at delayed timepoints in PBMCs of ICH patients with favorable outcome. PPARG and REL increased between timepoints in patients with favorable outcome. NFKB1 expression was not sustained, but significantly decreased from higher levels at early onset in patients with unfavorable outcome. IL10 expression showed a negative correlation in patients with high hematoma volume (>30 mL). Conclusions and significance Anti-inflammatory, pro-survival regulators were highly expressed at delayed time points in ICH patients with a favorable outcome, and IL10 expression showed a negative correlation to high hematoma volume.

scholarly journals Machine Learning-Based Approaches for Prediction of Patients’ Functional Outcome and Mortality after Spontaneous Intracerebral Hemorrhage

2022 ◽  
Vol 12 (1) ◽  
pp. 112
Author(s):  
Rui Guo ◽  
Renjie Zhang ◽  
Ran Liu ◽  
Yi Liu ◽  
Hao Li ◽  
...  
Keyword(s):  
Machine Learning ◽  
Logistic Regression ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Laboratory Data ◽  
Predictive Performance ◽  
High Morbidity ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Receiver Operating Characteristic Curves ◽  
Ich Score

Spontaneous intracerebral hemorrhage (SICH) has been common in China with high morbidity and mortality rates. This study aims to develop a machine learning (ML)-based predictive model for the 90-day evaluation after SICH. We retrospectively reviewed 751 patients with SICH diagnosis and analyzed clinical, radiographic, and laboratory data. A modified Rankin scale (mRS) of 0–2 was defined as a favorable functional outcome, while an mRS of 3–6 was defined as an unfavorable functional outcome. We evaluated 90-day functional outcome and mortality to develop six ML-based predictive models and compared their efficacy with a traditional risk stratification scale, the intracerebral hemorrhage (ICH) score. The predictive performance was evaluated by the areas under the receiver operating characteristic curves (AUC). A total of 553 patients (73.6%) reached the functional outcome at the 3rd month, with the 90-day mortality rate of 10.2%. Logistic regression (LR) and logistic regression CV (LRCV) showed the best predictive performance for functional outcome (AUC = 0.890 and 0.887, respectively), and category boosting presented the best predictive performance for the mortality (AUC = 0.841). Therefore, ML might be of potential assistance in the prediction of the prognosis of SICH.

scholarly journals 17p12 Influences Hematoma Volume and Outcome in Spontaneous Intracerebral Hemorrhage

Stroke ◽  
2018 ◽  
Vol 49 (7) ◽  
pp. 1618-1625 ◽  
Author(s):  
Sandro Marini ◽  
William J. Devan ◽  
Farid Radmanesh ◽  
Laura Miyares ◽  
Timothy Poterba ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hematoma Volume

scholarly journals HEMATOMA VOLUME AND OTHER PROGNOSTIC FACTORS WITH MORTALITY IN SPONTANEOUS INTRACEREBRAL HEMORRHAGE

2015 ◽  
Vol 3 (Suppl 1) ◽  
pp. A981
Author(s):  
HB Rotzel ◽  
A Serrano Lázaro ◽  
D Aguillón Prada ◽  
A Mesejo Arizmendi ◽  
C Sanchís Piqueras ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Intracerebral Hemorrhage ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hematoma Volume

Abstract TP346: Quantitative Analysis of Intracranial Blood Volumes and Relationship With Stress Induced Hyperglycemia and Outcomes in Intracerebral Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Claire Delpirou Nouh ◽  
Bappaditya Ray ◽  
Chao Xu ◽  
Evgeny Sidorov
Keyword(s):  
Intracerebral Hemorrhage ◽  
Quantitative Estimation ◽  
Adverse Outcomes ◽  
P Value ◽  
Study Cohort ◽  
Intracranial Volume ◽  
Linear Regression Models ◽  
Positive Correlation ◽  
Point Increase ◽  
Ich Score

Introduction: Stress-induced hyperglycemia (SIH) is independently associated with poor clinical outcome in intracerebral hemorrhage (ICH). It is unknown if quantitative radiological parameters determine SIH in ICH population. Hypothesis: Investigate whether SIH is associated with change in intracranial volume due to ICH using unbiased quantitative estimation, intraventricular hemorrhage (IVH) and ICH location. Methods: Retrospective cohort of 328 patients with spontaneous ICH over 5-year. Glycemic Gap (GG) is used to define SIH. Receiver Operator Curve (ROC) determined threshold for adverse outcomes (hospice or death). Blood volume was estimated in each intracranial compartment on admission head Computed Tomography (CT) using image segmentation software. Linear regression models and Pearson’s correlation analysis were used to study inter-relationship between SIH, ICH and IVH volume. Results: A GG of 29.5 mg/dL and higher defined SIH in this study cohort. Patients with SIH had significantly larger hemorrhage (30.5 mL vs 17.6 mL, p<0.005). ICH, IVH volumes and SIH showed positive correlation (r=0.185, p<0.005; r=0.233, p<0.005 respectively). Subcortically located ICH patients were more likely to have SIH as compared to other locations (ANOVA F-test p-value 0.011). ICH score also showed positive correlation with SIH (r =0.333, p<0.005). For each point increase in ICH score, GG increased by 10.6 mg/dL. Conclusion: Our single center retrospective study reports dose dependent SIH with ICH/IVH volumes and subcortical hemorrhage location. Such observation likely alludes to involvement of hypothalamo-pituitary endocrine axis in pathogenesis of SIH after ICH.

scholarly journals Determining ICH Score: can we go beyond?

2009 ◽  
Vol 67 (3a) ◽  
pp. 605-608 ◽  
Author(s):  
Gustavo Cartaxo Patriota ◽  
João Manoel da Silva-Júnior ◽  
Alécio Cristino Evangelista Santos Barcellos ◽  
Joaquim Barbosa de Sousa Silva Júnior ◽  
Diogo Oliveira Toledo ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Auxiliary Variable ◽  
Accurate Information ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Great Heterogeneity ◽  
One Year ◽  
The One ◽  
Ich Score ◽  
Reliable Scale

Spontaneous intracerebral hemorrhage (SICH) still presents a great heterogeneity in its clinical evaluation, demonstrating differences in the enrollment criteria used for the study of intracerebral hemorrhage (ICH) treatment. The aim of the current study was to assess the ICH Score, a simple and reliable scale, determining the 30-day mortality and the one-year functional outcome. Consecutive patients admitted with acute SICH were prospectively included in the study. ICH Scores ranged from 0 to 4, and each increase in the ICH Score was associated with an increase in the 30-day mortality and with a progressive decrease in good functional outcome rates. However, the occurrence of a pyramidal pathway injury was better related to worse functional outcome than the ICH Score. The ICH Score is a good predictor of 30-day mortality and functional outcome, confirming its validity in a different socioeconomic populations. The association of the pyramidal pathway injury as an auxiliary variable provides more accurate information about the prognostic evolution.

Frontal bur hole through an eyebrow incision for image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage

2012 ◽  
Vol 117 (4) ◽  
pp. 767-773 ◽  
Author(s):  
Justin A. Dye ◽  
Joshua R. Dusick ◽  
Darrin J. Lee ◽  
Nestor R. Gonzalez ◽  
Neil A. Martin
Keyword(s):  
Glasgow Coma Scale ◽  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Invasive Technique ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Midline Shift ◽  
Hematoma Volume ◽  
Coma Scale ◽  
Endoscopic Evacuation ◽  
The Mean

Object Surgical evacuation of spontaneous intracerebral hemorrhage (sICH) remains a subject of controversy. Minimally invasive techniques for hematoma evacuation have shown a trend toward improved outcomes. The aim of the present study is to describe a minimally invasive alternative for the evacuation of sICH and evaluate its feasibility. Methods The authors reviewed records of all patients who underwent endoscopic evacuation of an sICH at the UCLA Medical Center between March 2002 and March 2011. All patients in whom the described technique was used for evacuation of an sICH were included in this series. In this approach an incision is made at the superior margin of the eyebrow, and a bur hole is made in the supraorbital bone lateral to the frontal sinus. Using stereotactic guidance, the surgeon advanced the endoscopic sheath along the long axis of the hematoma and fixed it in place at two specific depths where suction was then applied until 75%–85% of the preoperatively determined hematoma volume was removed. An endoscope's camera, then introduced through the sheath, was used to assist in hemostasis. Preoperative and postoperative hematoma volumes and reduction in midline shift were calculated and recorded. Admission Glasgow Coma Scale and modified Rankin Scale (mRS) scores were compared with postoperative scores. Results Six patients underwent evacuation of an sICH using the eyebrow/bur hole technique. The mean preoperative hematoma volume was 68.9 ml (range 30.2–153.9 ml), whereas the mean postoperative residual hematoma volume was 11.9 ml (range 5.1–24.1 ml) (p = 0.02). The mean percentage of hematoma evacuated was 79.2% (range 49%–92.7%). The mean reduction in midline shift was 57.8% (p < 0.01). The Glasgow Coma Scale score improved in each patient between admission and discharge examination. In 5 of the 6 patients the mRS score improved from admission exam to last follow-up. None of the patients experienced rebleeding. Conclusions This minimally invasive technique is a feasible alternative to other means of evacuating sICHs. It is intended for anterior basal ganglia hematomas, which usually have an elongated, ovoid shape. The approach allows for an optimal trajectory to the long axis of the hematoma, making it possible to evacuate the vast majority of the clot with only one pass of the endoscopic sheath, theoretically minimizing the amount of damage to normal brain.

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