Glycemia in Spontaneous Intracerebral Hemorrhage: Clinical Implications

Abstract Spontaneous cerebral hemorrhage or intracranial hemorrhage accounts for 10-15% of all strokes. Intracranial hemorrhage is much less common than ischemic stroke, but has higher mortality and morbidity, one of the leading causes of severe disability. Various alterations, among these the endocrine were identified when an intracerebral hemorrhage, these stress-mediated mechanisms exacerbate secondary injury. Deep knowledge of the injuries which are directly involved alterations of glucose, offers insight as cytotoxicity, neuronal death and metabolic dysregulations alter the prognosis of patients with spontaneous intracerebral hemorrhage.

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Clinical Outcomes and Prognostic Factors for Spontaneous Intracerebral Hemorrhage in Pediatric ICU: A 12-Year Experience

Journal of Intensive Care Medicine ◽

10.1177/0885066617726049 ◽

2017 ◽

Vol 34 (11-12) ◽

pp. 1003-1009

Author(s):

Marco Piastra ◽

Daniele De Luca ◽

Orazio Genovese ◽

Federica Tosi ◽

Francesca Caliandro ◽

...

Keyword(s):

Ischemic Stroke ◽

Prognostic Factors ◽

Intracerebral Hemorrhage ◽

Clinical Outcomes ◽

Pediatric Population ◽

Vegetative State ◽

Adult Population ◽

Spontaneous Intracerebral Hemorrhage ◽

Midline Shift ◽

Mortality And Morbidity

Background: In the pediatric population, spontaneous intracerebral hemorrhage (sICH) is as common as ischemic stroke and accounts for significant mortality and morbidity. Differently from the ischemic stroke, there are few guidelines for directing management of sICH. This article aims to analyze both clinical outcomes and prognostic factors in order to produce tools for the design of prospective randomized studies addressed to implement treatment of pediatric sICH. Methods: Twelve-year retrospective review of a single-center consecutivesICH pediatric cases admitted to the pediatric intensive care unit (PICU). Selected end points were survival, PICU stay, and dichotomized Glasgow Outcome Score (GOS), with recovery and moderate disability (GOS 4-5) classified as favorable outcome and vegetative state or severe disability (GOS 2-3) classified as unfavorable. Results: Data of 107 children younger than 14 years admitted to our PICU due to sICH were analyzed. Overall PICU mortality was 24.2%. On multivariate analysis, the single factor markedly influencing survival was the presence of midline shift ( P = .002). In PICU survivors, there were 42 GOS 2-3 and 39 GOS 4-5. A low Glasgow Coma Scale (GCS) on PICU admission was predictive of severe neurological impairment in survivors ( P = .003). Intraventricular hemorrhage and infratentorial origin did not influence outcome in this series. Conclusion: The severity of presentation of sICH expressed by the midline shift and the GCS at PICU admission are significant prognostic factors for survival and neurological outcome. Some prognostic factors of the adult population have not been confirmed.

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How do anticoagulated atrial fibrillation patients who suffer ischemic stroke or spontaneous intracerebral hemorrhage differ?

Clinical Cardiology ◽

10.1002/clc.22935 ◽

2018 ◽

Vol 41 (5) ◽

pp. 608-614

Author(s):

Heidi Lehtola ◽

Juha Hartikainen ◽

Päivi Hartikainen ◽

Tuomas Kiviniemi ◽

Ilpo Nuotio ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Spontaneous Intracerebral Hemorrhage

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Abstract TP331: Plasma IL-6 Levels are Independently Associated With Functional Outcome and Markers of Secondary Injury in Spontaneous Intracerebral Hemorrhage

Stroke ◽

10.1161/str.49.suppl_1.tp331 ◽

2018 ◽

Vol 49 (Suppl_1) ◽

Author(s):

Audrey C Leasure ◽

Arthur F Steinschneider ◽

Guido J Falcone ◽

Emily J Gilmore ◽

Lauren H Sansing ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Functional Outcome ◽

Secondary Injury ◽

Spontaneous Intracerebral Hemorrhage

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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 during Acute and Chronic Hypertension in Mice

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.2009.183 ◽

2009 ◽

Vol 30 (1) ◽

pp. 56-69 ◽

Cited By ~ 71

Author(s):

Yoshinobu Wakisaka ◽

Yi Chu ◽

Jordan D Miller ◽

Gary A Rosenberg ◽

Donald D Heistad

Keyword(s):

Oxidative Stress ◽

Nitric Oxide ◽

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Hemorrhagic Transformation ◽

Chronic Hypertension ◽

Spontaneous Intracerebral Hemorrhage ◽

Acute Hypertension ◽

Oxide Synthase ◽

The Brain

Oxidative stress and matrix metalloproteinases (MMPs) contribute to hemorrhagic transformation after ischemic stroke and brain injury after intracerebral hemorrhage (ICH). The goal of this study was to develop a new model of spontaneous ICH, based on the hypothesis that acute, superimposed on chronic, hypertension produces ICH. We hypothesized that increases in angiotensin II (AngII)-mediated oxidative stress and activation of MMPs are associated with, and may precede, spontaneous ICH during hypertension. In C57BL/6 mice, chronic hypertension was produced with AngII infusion and an inhibitor of nitric oxide synthase. During chronic hypertension, mice with acute hypertension from injections of AngII developed ICH. Oxidative stress and MMP levels increased in the brain even before developing ICH. Active MMPs colocalized with a marker of oxidative stress, especially on cerebral vessels that appeared to lead toward regions with ICH. Incidence of ICH and levels of oxidative stress and MMP-9 were greater in mice with acute hypertension produced by AngII than by norepinephrine. In summary, we have developed an experimental model of ICH during hypertension that may facilitate studies in genetically altered mice. We speculate that acute hypertension, especially when induced by AngII, may be critical in spontaneous ICH during chronic hypertension, possibly through oxidative stress and MMP-9.

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Surgical treatment of spontaneous intracerebral hemorrhage

Journal of Neurosurgery ◽

10.3171/jns.1973.39.2.0145 ◽

1973 ◽

Vol 39 (2) ◽

pp. 145-151 ◽

Cited By ~ 58

Author(s):

Jean E. Paillas ◽

Bernard Alliez

Keyword(s):

Surgical Treatment ◽

Intracerebral Hemorrhage ◽

Cerebral Hemorrhage ◽

Preoperative Diagnosis ◽

Spontaneous Intracerebral Hemorrhage ◽

Content Type ◽

Selection Of Patients ◽

Selection Of ◽

Fine Print

✓ The results of the surgical treatment of cerebral hemorrhage in 250 cases are reported. Preoperative diagnosis, the selection of patients, and the favorable moment to operate are discussed.

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Nonhematologic and Hematologic Factors in Spontaneous Intracerebral Hemorrhage

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0041-1735897 ◽

2021 ◽

Author(s):

Hau C. Kwaan

Keyword(s):

Risk Factors ◽

Intracerebral Hemorrhage ◽

Vascular Malformations ◽

Imaging Techniques ◽

Diagnostic Methods ◽

Hematoma Expansion ◽

Imaging Features ◽

Spontaneous Intracerebral Hemorrhage ◽

Mortality And Morbidity ◽

Asian Ethnicity

AbstractSpontaneous intracerebral hemorrhage is defined as nontraumatic bleeding into the brain without vascular malformations or presence of tumor. It occurs in about a third of all strokes and has a high mortality and morbidity. Risk factors that determine the outcome are incompletely understood. Known factors include older age, male gender, Asian ethnicity, hypertension, and comorbidity such as inherited or acquired bleeding diathesis and use of antithrombotic drugs. Likewise, the clinical characteristics of the hematoma such as location and volume of the hematoma and other imaging features are also important. Hematoma extension or expansion is a complication with an unfavorable outcome. Recognition of risk factors for hematoma expansion and measures to prevent it, such as blood pressure lowering, will improve the outcome. Enhanced diagnostic methods, especially in imaging techniques developed over the past decade, have not only led to a better understanding of the pathophysiology of spontaneous intracerebral hemorrhage but also of the factors that influence hematoma expansion. An improved knowledge is essential to better management, minimizing hematoma expansion and leading to a healthier outcome.

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Cilostazol versus aspirin in ischemic stroke with cerebral microbleeds versus prior intracerebral hemorrhage

International Journal of Stroke ◽

10.1177/1747493020941273 ◽

2020 ◽

pp. 174749302094127

Author(s):

Hong-Kyun Park ◽

Ji Sung Lee ◽

Bum Joon Kim ◽

Jong-Ho Park ◽

Yong-Jae Kim ◽

...

Keyword(s):

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Cerebral Hemorrhage ◽

Cerebral Haemorrhage ◽

Cerebral Microbleeds ◽

Vascular Events ◽

Clinical Trial Registration ◽

Significant Treatment ◽

End Point ◽

First Occurrence

Background In PreventIon of CArdiovascular Events in Ischaemic Stroke Patients with High Risk of Cerebral HaemOrrhage (PICASSO), cilostazol versus aspirin was comparable for the end points of cerebral hemorrhage and major vascular events. However, underlying hemorrhage-prone lesions could modify the treatment effect. Aims We explored whether the safety and efficacy of cilostazol versus aspirin would differ between hemorrhage-prone lesions (multiple cerebral microbleeds vs. prior intracerebral hemorrhage). Methods In this post hoc analysis of PICASSO, we divided patients into the cerebral microbleeds and prior intracerebral hemorrhage subgroups. The primary safety end point was the first occurrence of cerebral hemorrhage. The primary efficacy end point was the composite of stroke, myocardial infarction, or vascular death. Results Of 1512 patients, 903 (59.7%) had multiple cerebral microbleeds and 609 (40.3%) had prior intracerebral hemorrhage. The cerebral hemorrhage risk was lower with cilostazol versus aspirin (0.12%/year vs. 1.49%/year; hazard ratio, 0.08 [95% confidence interval 0.01–0.60]; p = 0.015) in the cerebral microbleeds subgroup, but was not different (1.26%/year vs. 0.79%/year; hazards ratio 1.60 [0.52–4.90]; p = 0.408) in the prior intracerebral hemorrhage subgroup. The interaction of treatment-by-subgroup was significant ( pinteraction = 0.011). For the composite of major vascular events, there was a trend toward a lower risk with cilostazol versus aspirin (3.56%/year vs. 5.53%/year; hazards ratio 0.64 [0.41–1.01]; p = 0.056) in the cerebral microbleeds subgroup, but was comparable (5.21%/year vs. 5.05%/year; hazards ratio 1.03 [0.63–1.67]; p = 0.913) in the prior intracerebral hemorrhage subgroup without a significant treatment-by-subgroup interaction ( pinteraction = 0.165). Conclusions Cilostazol versus aspirin might be a better option in ischemic stroke with multiple cerebral microbleeds, but confirmatory trials are needed. Clinical Trial Registration URL: http://www.clinicaltrials.gov . NCT01013532.

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Antagonizing dabigatran by idarucizumab in cases of ischemic stroke or intracranial hemorrhage in Germany—Updated series of 120 cases

International Journal of Stroke ◽

10.1177/1747493019895654 ◽

2020 ◽

Vol 15 (6) ◽

pp. 609-618 ◽

Cited By ~ 2

Author(s):

Pawel Kermer ◽

Christoph C Eschenfelder ◽

Hans-Christoph Diener ◽

Martin Grond ◽

Yasser Abdalla ◽

...

Keyword(s):

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Acute Ischemic Stroke ◽

Intracranial Hemorrhage ◽

Intracranial Bleeding ◽

National Institutes Of Health ◽

Product Launch ◽

Tissue Type ◽

Bleeding Complications ◽

Hematoma Growth

Background Idarucizumab is a monoclonal antibody fragment with high affinity for dabigatran reversing its anticoagulant effects within minutes. Thereby, patients with acute ischemic stroke who are on dabigatran treatment may become eligible for thrombolysis with recombinant tissue-type plasminogen activator (rt-PA). In patients on dabigatran with intracerebral hemorrhage idarucizumab could prevent lesion growth. Aims To provide insights into the clinical use of idarucizumab in patients under effective dabigatran anticoagulation presenting with signs of acute ischemic stroke or intracranial hemorrhage. Methods Retrospective data collected from German neurological/neurosurgical departments administering idarucizumab following product launch from January 2016 to August 2018 were used. Results One-hundred and twenty stroke patients received idarucizumab in 61 stroke centers. Eighty patients treated with dabigatran presented with ischemic stroke and 40 patients suffered intracranial bleeding (intracerebral hemorrhage (ICH) in n = 27). In patients receiving intravenous thrombolysis with rt-PA following idarucizumab, 78% showed a median improvement of 7 points in National Institutes of Health Stroke Scale. No bleeding complications were reported. Hematoma growth was observed in 3 out of 27 patients with ICH. Outcome was favorable with a median National Institutes of Health Stroke Scale improvement of 4 points and modified Rankin score 0–3 in 61%. Six out of 40 individuals (15%) with intracranial bleeding died during hospital stay. Conclusion Administration of rt-PA after reversal of dabigatran activity with idarucizumab in case of acute ischemic stroke seems feasible, effective, and safe. In dabigatran-associated intracranial hemorrhage, idarucizumab appears to prevent hematoma growth and to improve outcome.

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Cause of death in spontaneous intracerebral hemorrhage survivors

Neurology ◽

10.1212/wnl.0000000000010736 ◽

2020 ◽

Vol 95 (20) ◽

pp. e2736-e2745

Author(s):

Lindsey R. Kuohn ◽

Audrey C. Leasure ◽

Julian N. Acosta ◽

Kevin Vanent ◽

Santosh B. Murthy ◽

...

Keyword(s):

Ischemic Stroke ◽

Intracerebral Hemorrhage ◽

Cause Of Death ◽

Intracranial Hemorrhage ◽

Causes Of Death ◽

Multinomial Logistic Regression ◽

Hospital Readmissions ◽

Cox Proportional Hazards ◽

Term Survival ◽

Increased Risk

ObjectiveTo determine the leading causes of death in intracerebral hemorrhage (ICH) survivors, we used administrative data from 3 large US states to identify adult survivors of a first-time spontaneous ICH and track all hospital readmissions resulting in death.MethodsWe performed a longitudinal analysis of prospectively collected claims data from hospitalizations in California (2005–2011), New York (2005–2014), and Florida (2005–2014). Adult residents admitted with a nontraumatic ICH who survived to discharge were included. Patients were followed for a primary outcome of any readmission resulting in death. The cause of death was defined as the primary diagnosis assigned at discharge. Multivariable Cox proportional hazards and multinomial logistic regression were used to determine factors associated with the risk for and cause of death.ResultsOf 72,432 ICH survivors (mean age 68 years [SD 16], 48% female), 12,753 (18%) died during a median follow-up period of 4.0 years (interquartile range 2.3–6.3). The leading causes of death were infection (34%), recurrent intracranial hemorrhage (14%), cardiac disease (8%), respiratory failure (8%), and ischemic stroke (5%). Death in patients with atrial fibrillation (AF) was more likely to be caused by ischemic stroke (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.9–2.9, p < 0.001) and less likely to be caused by recurrent intracranial hemorrhage (OR 0.7, 95% CI 0.6–0.8, p < 0.001) compared to patients without AF.ConclusionsInfection is the leading cause of death in all ICH survivors. Survivors with AF were at increased risk for death from ischemic stroke. These findings will help prioritize interventions aimed to improve long-term survival and recovery in ICH survivors.

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