Author response: Peak perihemorrhagic edema correlates with functional outcome in intracerebral hemorrhage

Neurology ◽  
2018 ◽  
Vol 91 (14) ◽  
pp. 674.1-674
Author(s):  
Bastian Volbers ◽  
Hagen B. Huttner
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Author Response ◽  
Response Peak ◽  
Perihemorrhagic Edema

Perihemorrhagic edema

Neurology ◽  
2019 ◽  
Vol 93 (12) ◽  
pp. e1159-e1170 ◽  
Author(s):  
Maximilian I. Sprügel ◽  
Joji B. Kuramatsu ◽  
Bastian Volbers ◽  
Stefan T. Gerner ◽  
Jochen A. Sembill ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Time Course ◽  
Multivariable Logistic Regression Analysis ◽  
Lesion Volume ◽  
Hematoma Volume ◽  
Edema Volume ◽  
Major Parameter ◽  
Perihemorrhagic Edema

ObjectiveTo determine the influence of intracerebral hemorrhage (ICH) location and volume and hematoma surface on perihemorrhagic edema evolution.MethodsPatients with ICH of the prospective Universitätsklinikum Erlangen Cohort of Patients With Spontaneous Intracerebral Hemorrhage (UKER-ICH) cohort study (NCT03183167) between 2010 and 2013 were analyzed. Hematoma and edema volume during hospital stay were volumetrically assessed, and time course of edema evolution and peak edema correlated to hematoma volume, location, and surface to verify the strength of the parameters on edema evolution.ResultsOverall, 300 patients with supratentorial ICH were analyzed. Peak edema showed a high correlation with hematoma surface (R2 = 0.864, p < 0.001) rather than with hematoma volumes, regardless of hematoma location. Smaller hematomas with a higher ratio of hematoma surface to volume showed exponentially higher relative edema (R2 = 0.755, p < 0.001). Multivariable logistic regression analysis revealed a cutoff ICH volume of 30 mL, beyond which an increase of total mass lesion volume (combined volume of hematoma and edema) was not associated with worse functional outcome. Specifically, peak edema was associated with worse functional outcome in ICH <30 mL (odds ratio [OR] 2.63, 95% confidence interval [CI] 1.68–4.12, p < 0.001), contrary to ICH ≥30 mL (OR 1.20, 95% CI 0.88–1.63, p = 0.247). There were no significant differences between patients with lobar and those with deep ICH after adjustment for hematoma volumes.ConclusionsPeak perihemorrhagic edema, although influencing mortality, is not associated with worse functional outcomes in ICH volumes >30 mL. Although hematoma volume correlates with peak edema extent, hematoma surface is the major parameter for edema evolution. The effect of edema on functional outcome is therefore more pronounced in smaller and irregularly shaped hematomas, and these patients may particularly benefit from edema-modifying therapies.

Abstract 2653: Hypothermia For Intracerebral Hemorrhage: Mortality And Long-term Functional Outcome

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Dimitre Staykov ◽  
Ingrid Wagner ◽  
Arnd Doerfler ◽  
Stefan Schwab ◽  
Rainer Kollmar
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Symptom Onset ◽  
Bleeding Event ◽  
Volumetric Analysis ◽  
Outcome Data ◽  
One Year ◽  
The Cost ◽  
Perihemorrhagic Edema

Background Mild prolonged hypothermia reduces perihemorrhagic edema (PHE) growth and may improve survival after large intracerebral hemorrhage (ICH). However, functional outcome data are scarce and lower mortality after large ICH may be achieved at the cost of higher disability. We investigated the course of edema evolution and long term functional outcome in 22 consecutive patients with large ICH (>25ml) who were treated with hypothermia. Methods Mild endovascular hypothermia (35°C) was applied within 12h after symptom onset for a period of 10 days. PHE was measured on computed tomography scans using a semi-automatic threshold based algorithm. Outcome was assessed 90 days and one year after symptom onset. Results Twenty-two patients aged 62±9 years with spontaneous supratentorial ICH (58±25ml) received hypothermia. Volumetric analysis showed significantly less PHE in those patients during and after hypothermia, as compared to historical controls who did not receive hypothermia. Twenty patients (91%) survived until day 90 after symptom onset. One year after the bleeding event, eight patients had a modified Rankin scale (mRS) score of 3, eight patients had a mRS of 4, two patients a mRS of 5 and totally four patients had died. Conclusions Despite of large initial ICH size, patients treated with hypothermia showed a low mortality rate and eight patients (36%) were able to walk without assistance one year after ICH. Hypothermia may be a promising treatment approach in large ICH. An ongoing multicenter randomized clinical trial (CINCH) is investigating this treatment option.

scholarly journals Peak perihemorrhagic edema correlates with functional outcome in intracerebral hemorrhage

Neurology ◽  
2018 ◽  
Vol 90 (12) ◽  
pp. e1005-e1012 ◽  
Author(s):  
Bastian Volbers ◽  
Antje Giede-Jeppe ◽  
Stefan T. Gerner ◽  
Jochen A. Sembill ◽  
Joji B. Kuramatsu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Retrospective Cohort ◽  
Independent Predictor ◽  
Hematoma Expansion ◽  
Factors Influencing ◽  
Multivariable Logistic Regression ◽  
Inflammatory Processes ◽  
Perihemorrhagic Edema

ObjectiveTo evaluate the association of perihemorrhagic edema (PHE) evolution and peak edema extent with day 90 functional outcome in patients with intracerebral hemorrhage (ICH) and identify pathophysiologic factors influencing edema evolution.MethodsThis retrospective cohort study included patients with spontaneous supratentorial ICH between January 2006 and January 2014. ICH and PHE volumes were studied using a validated semiautomatic volumetric algorithm. Multivariable logistic regression and propensity score matching (PSM) accounting for age, ICH volume, and location were used for assessing measures associated with functional outcome and PHE evolution. Clinical outcome on day 90 was assessed using the modified Rankin Scale (0–3 = favorable, 4–6 = poor).ResultsA total of 292 patients were included. Median age was 70 years (interquartile range [IQR] 62–78), median ICH volume on admission 17.7 mL (IQR 7.9–40.2). Besides established factors for functional outcome, i.e., ICH volume and location, age, intraventricular hemorrhage, and NIH Stroke Scale score on admission, multivariable logistic regression revealed peak PHE volume (odds ratio [OR] 0.984 [95% confidence interval (CI) 0.973–0.994]) as an independent predictor of day 90 outcome. Peak PHE volume was independently associated with initial PHE increase up to day 3 (OR 1.060 [95% CI 1.018–1.103]) and neutrophil to lymphocyte ratio on day 6 (OR 1.236 [95% CI 1.034–1.477; PSM cohort, n = 124]). Initial PHE increase (PSM cohort, n = 224) was independently related to hematoma expansion (OR 3.647 [95% CI 1.533–8.679]) and fever burden on days 2–3 (OR 1.456 [95% CI 1.103–1.920]).ConclusionOur findings suggest that peak PHE volume represents an independent predictor of functional outcome after ICH. Inflammatory processes and hematoma expansion seem to be involved in PHE evolution and may represent important treatment targets.

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

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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