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

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.

Download Full-text

Perihemorrhagic edema

Neurology ◽

10.1212/wnl.0000000000008129 ◽

2019 ◽

Vol 93 (12) ◽

pp. e1159-e1170 ◽

Cited By ~ 1

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.

Download Full-text

First 5-days follow-up and correlation study between urinary cysteinyl leukotrienes and edema values in primary spontaneous supratentorial intracerebral hemorrhage

SANAMED ◽

10.5937/sanamed1402123d ◽

2014 ◽

Vol 9 (2) ◽

pp. 123-129

Author(s):

Natalija Dolnenec-Baneva ◽

Dijana Nikodijevik ◽

Dragana Petrovska-Cvetkovska ◽

Anastasika Poposka

Keyword(s):

Intracerebral Hemorrhage ◽

Correlation Study ◽

Cysteinyl Leukotrienes

Download Full-text

Prestroke Metformin Use on the 1-Year Prognosis of Intracerebral Hemorrhage Patients with Type 2 Diabetes

Oxidative Medicine and Cellular Longevity ◽

10.1155/2021/2027359 ◽

2021 ◽

Vol 2021 ◽

pp. 1-9

Author(s):

Wen-Jun Tu ◽

Qingjia Zeng ◽

Kai Wang ◽

Yu Wang ◽

Bao-Liang Sun ◽

...

Keyword(s):

Type 2 Diabetes ◽

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Absolute Difference ◽

Inhospital Mortality ◽

Hematoma Volume ◽

Recurrence Rates ◽

Discharged Patients

Background. Although recent studies have focused on the use of metformin in treating ischemic stroke, there is little literature to support whether it can treat intracerebral hemorrhage (ICH). Therefore, this study is aimed at evaluating the possible effects of prestroke metformin (MET) on ICH patients with type 2 diabetes. Methods. From January 2010 to December 2019, all first-ever ICH patients with type 2 diabetes from our hospitals were included. All discharged patients would receive a one-time follow-up at 1 year after admission. Death, disability, and recurrence events were recorded. Results. We included 730 patients for analysis (the median age: 65 [IQR, 56-72] years and 57.7% was men). Of those patients, 281 (38.5%) had received MET before ICH (MET+), whereas 449 (61.5%) had not (MET−). MET (+) patients had a lower median baseline hematoma volume than did MET (-) patients (9.6 ml [IQR, 5.3-22.4 ml] vs. 14.7 ml [IQR, 7.9-28.6 ml]; P < 0.001 ). The inhospital mortality events were not significantly reduced in the MET (+) group compared with the MET (-) group (6.4% vs 8.9%, respectively; absolute difference, −2.5% [95% CI, −3.9% to −0.7%]; OR, 0.70 [95% CI, 0.39 to 1.27]; P = 0.22 ). The 1-year mortality events were not significantly reduced in the MET (+) group compared with the MET (-) group (14.1% vs 17.4%, respectively; absolute difference, −3.3% [95% CI, −5.1% to −1.8%]; OR, 0.73 [95% CI, 0.47 to 1.14]; P = 0.16 ). The 1-year disability events were not significantly reduced in the MET (+) group compared with the MET (-) group (28.4% vs 34.1%, respectively; absolute difference, −5.7% [95% CI, −8.2% to −3.3%]; OR, 0.77 [95% CI, 0.52 to 1.13]; P = 0.18 ). Finally, the recurrence rates in those two groups were not significantly different (MET [+] vs. MET [-]: 6.4% vs. 5.9%; absolute difference, 0.5% [95% CI, 0.2% to 1.3%]; OR, 1.08 [95% CI, 0.51 to 2.28]; P = 0.84 ). Conclusions. Pre-ICH metformin use was not associated with inhospital mortality and 1-year prognosis in diabetic ICH patients.

Download Full-text

Technical Notes and Result of Stereotactic Evacuation of Hematoma in Spontaneous Supratentorial Intracerebral Hematoma

Nepal Journal of Neuroscience ◽

10.3126/njn.v15i3.23278 ◽

2018 ◽

Vol 15 (3) ◽

pp. 27-31

Author(s):

Resha Shrestha ◽

Pranaya Shrestha ◽

Pravesh Rajbhandari ◽

Samir Acharya ◽

Sudan Dhakal ◽

...

Keyword(s):

Retrospective Study ◽

Surgical Treatment ◽

Minimal Invasive ◽

Technical Note ◽

Stereotactic Surgery ◽

Intracerebral Hematoma ◽

Modified Rankin Scale ◽

Hematoma Volume ◽

Baseline Characteristics

Primary intracerebral hematoma constitutes about 10-15% of all strokes and is associated with high mortality and severe disability. Surgical treatment of intracerebral hemorrhage is quite controversial. It is believed that minimal invasive stereotactic surgery may reduce hematoma volume and decrease secondary neurotoxicity. The technical note of stereotactic surgery has been illustrated. A retrospective study from March 2016 to March 2018 has been conducted and all patients who underwent stereotactic evacuation of hematoma were included in this study. Baseline characteristics of patients and outcome in terms of Glasgow Coma Scale (GCS) and Modified Rankin Scale (mRS) have been shown. We have found significant improvement in GCS postoperatively, however mRS did not improve immediately but was significantly better in three months follow up period.

Download Full-text

Mast Cell Blocking Reduces Brain Edema and Hematoma Volume and Improves Outcome after Experimental Intracerebral Hemorrhage

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/sj.jcbfm.9600387 ◽

2006 ◽

Vol 27 (4) ◽

pp. 795-802 ◽

Cited By ~ 46

Author(s):

Daniel Strbian ◽

Turgut Tatlisumak ◽

Usama Abo Ramadan ◽

Perttu J Lindsberg

Keyword(s):

Mast Cell ◽

Intracerebral Hemorrhage ◽

Brain Edema ◽

Hematoma Volume

Download Full-text

Volumetric accuracy of different imaging modalities in acute intracerebral hemorrhage

BMC Medical Imaging ◽

10.1186/s12880-022-00735-3 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Frieder Schlunk ◽

Johannes Kuthe ◽

Peter Harmel ◽

Heinrich Audebert ◽

Uta Hanning ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Ct Angiography ◽

Imaging Modalities ◽

Spontaneous Intracerebral Hemorrhage ◽

Hematoma Volume ◽

Noncontrast Ct ◽

Mri Sequences ◽

Volumetric Accuracy ◽

Volumetric Measurements

Abstract Background Follow-up imaging in intracerebral hemorrhage is not standardized and radiologists rely on different imaging modalities to determine hematoma growth. This study assesses the volumetric accuracy of different imaging modalities (MRI, CT angiography, postcontrast CT) to measure hematoma size. Methods 28 patients with acute spontaneous intracerebral hemorrhage referred to a tertiary stroke center were retrospectively included between 2018 and 2019. Inclusion criteria were (1) spontaneous intracerebral hemorrhage (supra- or infratentorial), (2) noncontrast CT imaging performed on admission, (3) follow-up imaging (CT angiography, postcontrast CT, MRI), and (4) absence of hematoma expansion confirmed by a third cranial image within 6 days. Two independent raters manually measured hematoma volume by drawing a region of interest on axial slices of admission noncontrast CT scans as well as on follow-up imaging (CT angiography, postcontrast CT, MRI) using a semi-automated segmentation tool (Visage image viewer; version 7.1.10). Results were compared using Bland–Altman plots. Results Mean admission hematoma volume was 18.79 ± 19.86 cc. All interrater and intrarater intraclass correlation coefficients were excellent (1; IQR 0.98–1.00). In comparison to hematoma volume on admission noncontrast CT volumetric measurements were most accurate in patients who received postcontrast CT (bias of − 2.47%, SD 4.67: n = 10), while CT angiography often underestimated hemorrhage volumes (bias of 31.91%, SD 45.54; n = 20). In MRI sequences intracerebral hemorrhage volumes were overestimated in T2* (bias of − 64.37%, SD 21.65; n = 10). FLAIR (bias of 6.05%, SD 35.45; n = 13) and DWI (bias of-14.6%, SD 31.93; n = 12) over- and underestimated hemorrhagic volumes. Conclusions Volumetric measurements were most accurate in postcontrast CT while CT angiography and MRI sequences often substantially over- or underestimated hemorrhage volumes.

Download Full-text

Unilateral Moyamoya Phenomenon Due to MCA Occlusion in a Child Presenting with Intracerebral Hemorrhage

Interventional Neuroradiology ◽

10.1177/159101990601200413 ◽

2006 ◽

Vol 12 (4) ◽

pp. 369-373 ◽

Cited By ~ 2

Author(s):

S.G. Srikanth ◽

K. Nagarajan ◽

H.S. Chandrashekar ◽

M.K. Vasudev ◽

Shibu V. Pillai

Keyword(s):

Intracerebral Hemorrhage ◽

Middle Cerebral Artery ◽

Moyamoya Disease ◽

Cerebral Artery ◽

Initial Evaluation ◽

Intracerebral Hematoma ◽

Mca Occlusion ◽

Moyamoya Phenomenon

Spontaneous middle cerebral artery (MCA) occlusion leading to moyamoya phenomenon is different from classical moyamoya disease. Previous studies have reported such phenomena in adults with ischemic lesions, except for a solitary case in a child. We report a case of a ten-year old girl who presented with a deep intracerebral hematoma and a normal ipsilateral middle cerebral artery on initial evaluation by CT. Subsequently, on follow-up angiography, the ipsilateral MCA was occluded with evidence of unilateral basal lenticulostriate and transdural collateral supply causing a ‘moyamoya’ phenomenon. This report discusses a rare and interesting disease from the perspective of ‘moyamoya’ phenomenon and angiogenesis.

Download Full-text

Jugular Venous Reflux Is Associated with Perihematomal Edema after Intracerebral Hemorrhage

BioMed Research International ◽

10.1155/2017/7514639 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7

Author(s):

Hao Feng ◽

Hongxia Zhang ◽

Wen He ◽

Jian Zhou ◽

Xingquan Zhao

Keyword(s):

Computed Tomography ◽

Intracerebral Hemorrhage ◽

Color Doppler ◽

Color Doppler Ultrasound ◽

Venous Reflux ◽

Hematoma Volume ◽

Brain Computed Tomography ◽

Perihematomal Edema ◽

Jugular Venous Reflux

The purpose of this study was to determine whether jugular venous reflux (JVR) is associated with perihematomal edema (PHE) in individuals with intracerebral hemorrhage (ICH). Patients with spontaneous supratentorial ICH within 72 h of symptom onset were enrolled. Baseline brain computed tomography (CT) scan was performed, with a follow-up CT examination at 12 ± 3 days after onset. Jugular venous color Doppler ultrasound was performed at 12 ± 3 days after onset to examine the JVR status. A total of 65 patients with ICH were enrolled. In logistic regression analysis, absolute PHE volume was significantly associated with JVR (OR, 5.46; 95% CI, 1.04–28.63; p=0.044) and baseline hematoma volume (OR, 1.14; 95% CI, 1.03–1.26; p=0.009) within 72 h of onset. It was also correlated with JVR (OR, 15.32; 95% CI, 2.52–92.99; p=0.003) and baseline hematoma volume (OR, 1.14; 95% CI, 1.04–1.24; p=0.006) at 12 ± 3 days after onset. In a similar manner, relative PHE volume was significantly associated with JVR (OR, 14.85; 95% CI, 3.28–67.17; p<0.001) within 72 h of onset and at 12 ± 3 days after onset (OR, 5.87; 95% CI, 1.94–17.77; p=0.002). JVR is associated with both absolute and relative PHE volumes after ICH.

Download Full-text

Stereotactic Catheter Drainage Versus Conventional Craniotomy for Severe Spontaneous Intracerebral Hemorrhage in the Basal Ganglia

Cell Transplantation ◽

10.1177/0963689719852302 ◽

2019 ◽

Vol 28 (8) ◽

pp. 1025-1032 ◽

Cited By ~ 2

Author(s):

Jia Shi ◽

Zhonghai Cai ◽

Wei Han ◽

Bo Dong ◽

Yumin Mao ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Clinical Outcomes ◽

Operating Time ◽

Predisposing Factors ◽

Spontaneous Intracerebral Hemorrhage ◽

Hematoma Volume ◽

Good Clinical Outcome ◽

Catheter Drainage ◽

Gcs Score

Intracerebral hemorrhage (ICH) is one of the most devastating forms of cerebrovascular pathology. However, its treatment remains a matter of debate among neurosurgeons and neurologists. The study was to explore the efficacy of minimally invasive surgery (stereotactic catheter drainage, SCD) for patients with severe intracerebral hemorrhage (Glasgow Coma Scale, GCS) score ≤ 8 and hematoma volume ≥ 30 cm3) and to determine predisposing factors for good clinical outcome. A total of 75 patients with severe ICH were included in this retrospective study. Patients were assigned to the SCD group (n=38) or the conventional craniotomy group (n=37). Patients were followed up for 12 months postoperatively, and their clinical parameters were compared. During the operation, the SCD group exhibited a lower bleeding volume ( p<0.001) and shorter operating time ( p<0.001) than the conventional craniotomy group. For postoperative efficacy, the rates of pneumonia and tracheotomy were lower ( p=0.002 and p=0.027, respectively), and the duration of hospital and neurosurgery intensive care unit (NSICU) in days were significantly shorter in the SCD group ( p=0.046 and p=0.047, respectively). Furthermore, patients in the SCD group showed improved modified Rankin Scale (mRS) scores at discharge ( p<0.018) and at 12-month follow up ( p<0.001). Predisposing factors for good clinical outcomes were hematoma volume (<50 cm3, 95% confidence interval (CI): 1.043–1.956, p<0.046), initial GCS score (>6, 95% CI: 3.248–187.466, p<0.001), hypertension (none, 95% CI: 1.440–2.922, p<0.001), and treatment modality (SCD, 95% CI: 1.422–3.226, p<0.001). Taken together, SCD surgery is safe and effective in patients with severe ICH and has fewer complications and better clinical outcomes than conventional craniotomy.

Download Full-text

Association of Brain Iron Overload With Brain Edema and Brain Atrophy After Intracerebral Hemorrhage

Frontiers in Neurology ◽

10.3389/fneur.2020.602413 ◽

2020 ◽

Vol 11 ◽

Author(s):

Ran Liu ◽

Haoran Zhang ◽

Shuangjuan Cheng ◽

Yuyao Sun ◽

Haijiao Li ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Iron Overload ◽

Brain Edema ◽

Brain Atrophy ◽

Contralateral Side ◽

Iron Deposition ◽

Ipsilateral Side ◽

Observational Cohort ◽

3.0 T

Objective: This study evaluated iron overload after intracerebral hemorrhage (ICH) using ESWAN sequences.Methods: This single-center prospective observational cohort study enrolled supratentorial ICH patients. MRI was obtained with a 3.0-T scanner at day 1, day 14, day 30, and follow-up (300 days or later). R2* mapping was generated based on the ESWAN. R2* value of the ipsilateral side represented iron deposition, and the R2* value of the contralateral side served as control. R2* value was adjusted by volume and used to assess total iron overload. Brain edema was measured on T2 FLAIR-weighted images. Brain atrophy was calculated as the contralateral hemisphere volume minus the injured hemisphere volume.Results: Twnety-seven patients with a spontaneous supratentorial ICH were included in this analysis. The ipsilateral R2* value was 40.27 ± 11.62, 41.92 ± 13.56, and 60.89 ± 14.09 at days 1, 14, and 30, respectively. The R2* value was significantly higher in the ICH side than the contralateral side (p < 0.01). Increased R2* value was seen on day 30 compared to day 14 (p < 0.01). The R2* value showed logistic decay with the distance to the hematoma margin (p < 0.01). Brain edema at day 14 and brain atrophy at follow-up correlated with R2* value adjusted by volume at day 14 (p < 0.01).Conclusions: After ICH, the iron deposition in the perihematomal region was progressively increased during the first month. R2* value adjusted by volume predicted acute brain edema and chronic brain atrophy.

Download Full-text