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.

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.

scholarly journals Surgery for Coagulopathy-Related Intracerebral Hemorrhage: Craniotomy vs. Minimally Invasive Neurosurgery

Life ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 564
Author(s):  
Yen-Bo Liu ◽  
Lu-Ting Kuo ◽  
Chih-Hao Chen ◽  
Woon-Man Kung ◽  
Hsin-Hsi Tsai ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Intracerebral Hemorrhage ◽  
Functional Outcomes ◽  
Large Scale ◽  
Promising Result ◽  
Multivariable Logistic Regression Analysis ◽  
Published Data ◽  
Complication Rates ◽  
Minimally Invasive Neurosurgery ◽  
Reduction Of Mortality

Coagulopathy-related intracerebral hemorrhage (ICH) is life-threatening. Recent studies have shown promising results with minimally invasive neurosurgery (MIN) in the reduction of mortality and improvement of functional outcomes, but no published data have recorded the safety and efficacy of MIN for coagulopathy-related ICH. Seventy-five coagulopathy-related ICH patients were retrospectively reviewed to compare the surgical outcomes between craniotomy (n = 52) and MIN (n = 23). Postoperative rebleeding rates, morbidity rates, and mortality at 1 month were analyzed. Postoperative Glasgow Outcome Scale Extended (GOSE) and modified Rankin Scale (mRS) scores at 1 year were assessed for functional outcomes. Morbidity, mortality, and rebleeding rates were all lower in the MIN group than the craniotomy group (8.70% vs. 30.77%, 8.70% vs. 19.23%, and 4.35% vs. 23.08%, respectively). The 1-year GOSE score was significantly higher in the MIN group than the craniotomy group (3.96 ± 1.55 vs. 3.10 ± 1.59, p = 0.027). Multivariable logistic regression analysis also revealed that MIN contributed to improved GOSE (estimate: 0.99650, p = 0.0148) and mRS scores (estimate: −0.72849, p = 0.0427) at 1 year. MIN, with low complication rates and improved long-term functional outcome, is feasible and favorable for coagulopathy-related ICH. This promising result should be validated in a large-scale prospective study.

scholarly journals Antiplatelet Therapy After Spontaneous Intracerebral Hemorrhage and Functional Outcomes

Stroke ◽  
2019 ◽  
Vol 50 (11) ◽  
pp. 3057-3063
Author(s):  
Santosh B. Murthy ◽  
Alessandro Biffi ◽  
Guido J. Falcone ◽  
Lauren H. Sansing ◽  
Victor Torres Lopez ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Antiplatelet Therapy ◽  
Functional Outcomes ◽  
Randomized Clinical Trials ◽  
Massachusetts General Hospital ◽  
Meta Analysis ◽  
Hazard Ratio ◽  
Stroke Registry ◽  
All Cause Mortality

Background and Purpose— Observational data suggest that antiplatelet therapy after intracerebral hemorrhage (ICH) alleviates thromboembolic risk without increasing the risk of recurrent ICH. Given the paucity of data on the relationship between antiplatelet therapy after ICH and functional outcomes, we aimed to study this association in a multicenter cohort. Methods— We meta-analyzed data from (1) the Massachusetts General Hospital ICH registry (n=1854), (2) the Virtual International Stroke Trials Archive database (n=762), and (3) the Yale stroke registry (n=185). Our exposure was antiplatelet therapy after ICH, which was modeled as a time-varying covariate. Our primary outcomes were all-cause mortality and a composite of major disability or death (modified Rankin Scale score 4–6). We used Cox proportional regression analyses to estimate the hazard ratio of death or poor functional outcome as a function of antiplatelet therapy and random-effects meta-analysis to pool the estimated HRs across studies. Additional analyses stratified by hematoma location (lobar and deep ICH) were performed. Results— We included a total of 2801 ICH patients, of whom 288 (10.3%) were started on antiplatelet medications after ICH. Median times to antiplatelet therapy ranged from 7 to 39 days. Antiplatelet therapy after ICH was not associated with mortality (hazard ratio, 0.85; 95% CI, 0.66–1.09), or death or major disability (hazard ratio, 0.83; 95% CI, 0.59–1.16) compared with patients not started on antiplatelet therapy. Similar results were obtained in additional analyses stratified by hematoma location. Conclusions— Antiplatelet therapy after ICH appeared safe and was not associated with all-cause mortality or functional outcome, regardless of hematoma location. Randomized clinical trials are needed to determine the effects and harms of antiplatelet therapy after ICH.

scholarly journals Does Prior Surgery Affect Total Ankle Complication and Failure Rates?

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0034
Author(s):  
Luigi Manzi ◽  
Federico Giuseppe Usuelli ◽  
Alexander Caughman ◽  
Christopher E. Gross
Keyword(s):  
Functional Outcome ◽  
Repeated Measures ◽  
Functional Outcomes ◽  
Time Course ◽  
Temporal Evolution ◽  
Consecutive Series ◽  
Exact Test ◽  
Time Points ◽  
Significant Difference ◽  
Pain Outcomes

Category: Ankle Arthritis; Ankle Introduction/Purpose: Given that most ankle replacements are post-traumatic in origin, it is important to investigate if prior interventions can affect a patient’s functional outcome or the possibility of having a complication. Prior surgeries create scar, incisions, and possible affect bone health that could interfere with healing. The purpose of the study is to assess the pain and functional temporal outcomes of patients with and without prior surgeries in the ipsilateral ankle. We hypothesize that those with a previous ipsilateral ankle procedure will not have an increased complication rate or worse functional outcomes. Methods: We retrospectively identified a consecutive series of 100 primary TARs with a prior procedure who were followed for a minimum of 3 years. The follow-up time points considered were 0, 6, 12, and 36 months. Outcomes were measured using AOFAS, VAS, SF12, and range of motion scores. The mean patient age was 56.5 +- 13.4 years. Sixty-four patients had previous interventions which included osteosynthesis (49), arthroscopy (11), hardware removal (25), arthrodesis (3), prosthesis (1), open fracture (9), and other open surgery (12). Within-group comparisons were performed using one-way repeated-measures ANOVA (1-w rANOVA), analyzing temporal course of clinical data (comparisons between different time points) between the groups. To compare the time course of clinical measures between the two groups, 2-w rANOVAs were performed. Data and statistical analysis were conducted using Matlab (MathWorks, Natick, MA). Results: For each type of intervention, every outcome was compared to test whether presurgery interventions have an influence on the temporal evolution of the outcomes. The two groups did not show any difference on the temporal evolution of the outcomes. The type of intervention did have a weak effect on outcomes. Treatment of previous open fractures was the only pre- surgical intervention that showed a statistically significant difference in temporal evolution of functional and pain outcomes between intervention and non-intervention groups. No significant correlations were found between all outcomes and the time between the last intervention and prosthesis. Using Fisher’s-exact test, there was not a significant association between the those who had previous surgery and those who did not and the rate of complication and revision (p =0.10). Conclusion: A pre-operative discussion should center on potential complications and predicted functional outcomes. The presence, type, and timing of an intervention prior to an ankle replacement does not strongly affect the temporal outcomes of pain and functional outcome scores. Furthermore, the complication or revision rate is not affected by prior surgeries.

scholarly journals Association of Serum IL-6 (Interleukin 6) With Functional Outcome After Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Author(s):  
Audrey C. Leasure ◽  
Lindsey R. Kuohn ◽  
Kevin N. Vanent ◽  
Matthew B. Bevers ◽  
W. Taylor Kimberly ◽  
...  
Keyword(s):  
Treatment Group ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Interleukin 6 ◽  
Factor Vii ◽  
Modified Rankin Scale ◽  
Predictors Of Outcome ◽  
Edema Volume ◽  
Secondary Analyses ◽  
Perihematomal Edema

Background and Objectives: IL-6 (interleukin 6) is a proinflammatory cytokine and an established biomarker in acute brain injury. We sought to determine whether admission IL-6 levels are associated with severity and functional outcome after spontaneous intracerebral hemorrhage (ICH). Methods: We performed an exploratory analysis of the recombinant activated FAST trial (Factor VII for Acute ICH). Patients with admission serum IL-6 levels were included. Regression analyses were used to assess the associations between IL-6 and 90-day modified Rankin Scale. In secondary analyses, we used linear regression to evaluate the association between IL-6 and baseline ICH and perihematomal edema volumes. Results: Of 841 enrolled patients, we included 552 (66%) with available admission IL-6 levels (mean age 64 [SD 13], female sex 203 [37%]). IL-6 was associated with poor outcome (modified Rankin Scale, 4–6; per additional 1 ng/L, odds ratio, 1.30 [95% CI, 1.04–1.63]; P =0.02) after adjustment for known predictors of outcome after ICH and treatment group. IL-6 was associated with ICH volume after adjustment for age, sex, and ICH location, and this association was modified by location (multivariable interaction, P =0.002), with a stronger association seen in lobar (β, 12.51 [95% CI, 6.47–18.55], P <0.001) versus nonlobar (β 5.32 [95% CI, 3.36–7.28], P <0.001) location. IL-6 was associated with perihematomal edema volume after adjustment for age, sex, ICH volume, and ICH location (β 1.22 [95% CI, 0.15–2.29], P =0.03). Treatment group was not associated with IL-6 levels or outcome. Conclusions: In the FAST trial population, higher admission IL-6 levels were associated with worse 90-day functional outcome and larger ICH and perihematomal edema volumes.

TIMP-2 Polymorphisms Define Subtypes of Hypertensive Intracerebral Hemorrhage with Distinct Perihematomal Edema Development Patterns

2020 ◽  
Vol 17 (1) ◽  
pp. 44-49
Author(s):  
Ru Chen ◽  
Zhi Song ◽  
Mingzhu Deng ◽  
Wen Zheng ◽  
Jia Liu ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Cerebral Edema ◽  
Cerebral Hemorrhage ◽  
Functional Outcomes ◽  
Hematoma Volume ◽  
Development Patterns ◽  
Genotype Group ◽  
Major Threat ◽  
Hypertensive Intracerebral Hemorrhage ◽  
Perihematomal Edema

Background: Perihematomal edema (PHE) is a major threat leading to poor functional outcomes after intracerebral hemorrhage (ICH). TIMP-2 is considered to participate in the formation of PHE after ICH by antagonizing the damaging effects of MMP-2. In the early study, the polymorphisms of TIMP-2 rs8179090 have shown to influence the expression of TIMP-2. Objective: To prove that the severity of PHE was different in ICH patients with different TIMP-2 rs8179090 genotypes. Methods: In this prospective study, 130 hypertensive ICH patients were enrolled. The poly phisms of rs8179090 in TIMP-2 were determined. The hematoma volume and PHE volume were measured by computed tomography (CT) scan immediately after the onset of ICH, and were measured again one week and two weeks after the onset. Then, the comparison of TIMP-2 rs8179090 genotypes was made. Result: TIMP-2-418 position (rs8179090) had two genotypes in the studied population, GC and GG. Patients with the GC genotype developed more severe PHE, with a higher incidence of delayed cerebral edema in cerebral hemorrhage than those with the GG genotype. Conclusion: We have found that the GC genotype group may develop more severe PHE, with an increased incidence of delayed cerebral edema in cerebral hemorrhage.

Abstract T MP65: Rate of Peri-Hematomal Edema Expansion Predicts Outcome After Intracerebral Hemorrhage

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Sebastian Urday ◽  
Lauren A Beslow ◽  
David Goldstein ◽  
Feng Dai ◽  
Fan Zhang ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Symptom Onset ◽  
Intraventricular Hemorrhage ◽  
Strong Association ◽  
Expansion Rate ◽  
Multivariable Model ◽  
Hematoma Volume ◽  
Poor Functional Outcome ◽  
The Relationship

Background and Purpose: There have been conflicting reports regarding the association between peri-hematomal edema (PHE) in spontaneous intracerebral hemorrhage (ICH) and outcome. We hypothesized that PHE expansion rate from baseline to 24 hours predicts mortality and poor functional outcome after ICH. Methods: ICH, PHE and intraventricular hemorrhage volumes were measured for 139 subjects who presented with primary ICH and received head computed tomography scans at baseline and 24-hours post-ICH. Subjects were retrospectively identified from a prospective cohort study of ICH. Inclusion criteria were age over 18 years with primary spontaneous supratentorial ICH. Exclusion criteria were infratentorial hemorrhage, primary intraventricular hemorrhage, or any suspected cause of secondary ICH. Logistic regression was performed to evaluate the relationship between PHE expansion rate and 90-day mortality and functional outcome. Poor functional outcome was defined as a modified Rankin Scale (mRS) score > 2. Results: There was a strong association between PHE expansion rate and mortality (OR 1.42, p = 0.0025) and a trend in the correlation between PHE expansion rate and poor outcome (OR 1.50, p = 0.07). In a multivariable model accounting for hematoma volume and time from symptom onset to 24 hour scan, PHE expansion rate was a significant predictor of mortality (OR 1.07, p = 0.032). In a multivariable model accounting for hematoma volume, age, Glasgow Coma Scale score, presence of intraventricular hemorrhage and time from symptom onset to 24 hour scan, PHE expansion rate predicted poor functional outcome (OR 2.58, p = 0.05). Conclusions: PHE expansion rate predicts outcome in ICH and may represent a novel therapeutic target.

Irregular Shape as An Independent Predictor of Prognosis in Patients with Primary Intracerebral Hemorrhage

2021 ◽  
Author(s):  
Chunyang Liu ◽  
Haopeng Zhang ◽  
Lixiang Wang ◽  
Qiuyi Jiang ◽  
Enzhou Lu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Logistic Regression ◽  
Intracerebral Hemorrhage ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Irregular Shape ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Poor Outcome ◽  
Irregular Shapes ◽  
D Dimer

Abstract BACKGROUND AND PURPOSE The utility of non-contrast computed tomography (NCCT) markers in the prognosis of spontaneous intracerebral hemorrhage (ICH) has been concerned. This study aimed to investigate the predictive value of the computed tomography irregularity shape for poor functional outcomes in patients with spontaneous intracerebral hemorrhage. PATIENTS AND Methods: We retrospectively reviewed all 782 patients with intracranial hemorrhage in our stroke emergency center from January 2018 to September 2019. Laboratory examination and CT examination were measured within 24 hours of admission. After three months, the patient's functional outcome was assessed using the modified Rankin Scale (mRS). Multinomial logistic regression analyses were applied to identify independent predictors of functional outcome in patients with intracerebral hemorrhage. RESULTS Out of the 627 patients included in this study, those with irregular shapes on CT imaging had a higher proportion of poor outcome and mortality 90 days after discharge (P<0.001). Irregular shapes were found to be significant independent predictors of poor outcome and mortality on multiple logistic regression analysis. Besides, the increase of plasma D-dimer was associated with the occurrence of irregular shape (P=0.0387). CONCLUSIONS Patients with irregular shape showed worse functional outcomes after intracerebral hemorrhage. The elevated expression level of plasma D-dimer may be directly related to the formation of irregular shapes.

Sign in / Sign up

Export Citation Format

Share Document