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Samarasekera N, Rodrigues MA, Toh PS, Salman RAS. Imaging features of intracerebral hemorrhage with cerebral amyloid angiopathy: Systematic review and meta-analysis. PLoS One 2017; 12:e0180923. [PMID: 28700676 PMCID: PMC5507310 DOI: 10.1371/journal.pone.0180923] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 06/23/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We sought to summarize Computed Tomography (CT)/Magnetic Resonance Imaging (MRI) features of intracerebral hemorrhage (ICH) associated with cerebral amyloid angiopathy (CAA) in published observational radio-pathological studies. METHODS In November 2016, two authors searched OVID Medline (1946-), Embase (1974-) and relevant bibliographies for studies of imaging features of lobar or cerebellar ICH with pathologically proven CAA ("CAA-associated ICH"). Two authors assessed studies' diagnostic test accuracy methodology and independently extracted data. RESULTS We identified 22 studies (21 cases series and one cross-sectional study with controls) of CT features in 297 adults, two cross-sectional studies of MRI features in 81 adults and one study which reported both CT and MRI features in 22 adults. Methods of CAA assessment varied, and rating of imaging features was not masked to pathology. The most frequently reported CT features of CAA-associated ICH in 21 case series were: subarachnoid extension (pooled proportion 82%, 95% CI 69-93%, I2 = 51%, 12 studies) and an irregular ICH border (64%, 95% CI 32-91%, I2 = 85%, five studies). CAA-associated ICH was more likely to be multiple on CT than non-CAA ICH in one cross-sectional study (CAA-associated ICH 7/41 vs. non-CAA ICH 0/42; χ2 = 7.8, p = 0.005). Superficial siderosis on MRI was present in 52% of CAA-associated ICH (95% CI 39-65%, I2 = 35%, 3 studies). CONCLUSIONS Subarachnoid extension and an irregular ICH border are common imaging features of CAA-associated ICH, but methodologically rigorous diagnostic test accuracy studies are required to determine the sensitivity and specificity of these features.
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Affiliation(s)
- Neshika Samarasekera
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Pheng Shiew Toh
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
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Wu TY, Yassi N, Shah DG, Ma M, Sharma G, Putaala J, Strbian D, Campbell BCV, Yan B, Tatlisumak T, Desmond PM, Davis SM, Meretoja A. Simultaneous Multiple Intracerebral Hemorrhages (SMICH). Stroke 2017; 48:581-586. [PMID: 28232593 DOI: 10.1161/strokeaha.116.015186] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/12/2016] [Accepted: 11/28/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Simultaneous multiple intracerebral hemorrhages (SMICHs) are uncommon. Few single-center studies have analyzed characteristics and outcome of SMICH. We analyzed clinical characteristics and outcome of SMICH patients from 2 comprehensive stroke centers. METHODS Baseline imaging from consecutive intracerebral hemorrhage (ICH) patients (n=1552) from Helsinki ICH study and Royal Melbourne Hospital ICH study was screened for SMICH. ICH pathogenesis was classified according to the structural lesion, medication, amyloid angiopathy, systemic/other disease, hypertension, undetermined classification system (SMASH-U). ICH caused by trauma, tumor, and aneurysmal rupture was excluded. Baseline clinical and radiological characteristics and 90-day mortality were compared between SMICH and single ICH patients. Association of SMICH with 90-day mortality was assessed in multivariable logistic regression models adjusted for predictors of ICH outcome. RESULTS Of 1452 patients, 85 (5.9%) were classified as SMICH. SMICH were more often female (58% versus 42%; P=0.004), had lower baseline Glasgow Coma Scale (12 versus 14; P=0.008), and more frequent lobar location (59% versus 34%; P<0.001) compared with single ICH. The SMASH-U pathogenesis of SMICH patients was less often hypertensive (20% versus 37%; P=0.001), more often systemic coagulopathy (12% versus 3%; P<0.001), and trended toward more cerebral amyloid angiopathy (32% versus 23%; P=0.071). SMICH was not associated with 90-day mortality on univariate (37% versus 35%; P=0.610), multivariable (odds ratio, 0.783; 95% confidence interval, 0.401-1.529; P=0.473), or propensity score-matched analyses (odds ratio, 0.760; 95% confidence interval, 0.352-1.638; P=0.484). CONCLUSIONS SMICH occurs in ≈1 in 20 ICH, more commonly with lobar located hematomas and systemic coagulopathy with less hypertensive angiopathy. The associated mortality is similar to single ICH. Given varied etiologies, SMICH management should target the underlying pathology.
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Affiliation(s)
- Teddy Y Wu
- From the Department of Medicine and Neurology, Melbourne Brain Centre (T.Y.W., N.Y., D.G.S., M.M., B.C.V.C., B.Y., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), the Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Helsinki University Hospital, Finland (J.P., D.S., T.T., A.M.); Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, People's Republic of China (M.M.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).,Guest Editor for this article was Giuseppe Lanzino, MD.,Presented in part at the International Stroke Conference of the American Heart Association, Houston, TX, February 22-24, 2017
| | - Nawaf Yassi
- From the Department of Medicine and Neurology, Melbourne Brain Centre (T.Y.W., N.Y., D.G.S., M.M., B.C.V.C., B.Y., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), the Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Helsinki University Hospital, Finland (J.P., D.S., T.T., A.M.); Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, People's Republic of China (M.M.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).,Guest Editor for this article was Giuseppe Lanzino, MD.,Presented in part at the International Stroke Conference of the American Heart Association, Houston, TX, February 22-24, 2017
| | - Darshan G Shah
- From the Department of Medicine and Neurology, Melbourne Brain Centre (T.Y.W., N.Y., D.G.S., M.M., B.C.V.C., B.Y., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), the Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Helsinki University Hospital, Finland (J.P., D.S., T.T., A.M.); Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, People's Republic of China (M.M.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).,Guest Editor for this article was Giuseppe Lanzino, MD.,Presented in part at the International Stroke Conference of the American Heart Association, Houston, TX, February 22-24, 2017
| | - Minmin Ma
- From the Department of Medicine and Neurology, Melbourne Brain Centre (T.Y.W., N.Y., D.G.S., M.M., B.C.V.C., B.Y., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), the Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Helsinki University Hospital, Finland (J.P., D.S., T.T., A.M.); Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, People's Republic of China (M.M.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).,Guest Editor for this article was Giuseppe Lanzino, MD.,Presented in part at the International Stroke Conference of the American Heart Association, Houston, TX, February 22-24, 2017
| | - Gagan Sharma
- From the Department of Medicine and Neurology, Melbourne Brain Centre (T.Y.W., N.Y., D.G.S., M.M., B.C.V.C., B.Y., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), the Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Helsinki University Hospital, Finland (J.P., D.S., T.T., A.M.); Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, People's Republic of China (M.M.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).,Guest Editor for this article was Giuseppe Lanzino, MD.,Presented in part at the International Stroke Conference of the American Heart Association, Houston, TX, February 22-24, 2017
| | - Jukka Putaala
- From the Department of Medicine and Neurology, Melbourne Brain Centre (T.Y.W., N.Y., D.G.S., M.M., B.C.V.C., B.Y., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), the Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Helsinki University Hospital, Finland (J.P., D.S., T.T., A.M.); Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, People's Republic of China (M.M.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).,Guest Editor for this article was Giuseppe Lanzino, MD.,Presented in part at the International Stroke Conference of the American Heart Association, Houston, TX, February 22-24, 2017
| | - Daniel Strbian
- From the Department of Medicine and Neurology, Melbourne Brain Centre (T.Y.W., N.Y., D.G.S., M.M., B.C.V.C., B.Y., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), the Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Helsinki University Hospital, Finland (J.P., D.S., T.T., A.M.); Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, People's Republic of China (M.M.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).,Guest Editor for this article was Giuseppe Lanzino, MD.,Presented in part at the International Stroke Conference of the American Heart Association, Houston, TX, February 22-24, 2017
| | - Bruce C V Campbell
- From the Department of Medicine and Neurology, Melbourne Brain Centre (T.Y.W., N.Y., D.G.S., M.M., B.C.V.C., B.Y., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), the Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Helsinki University Hospital, Finland (J.P., D.S., T.T., A.M.); Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, People's Republic of China (M.M.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).,Guest Editor for this article was Giuseppe Lanzino, MD.,Presented in part at the International Stroke Conference of the American Heart Association, Houston, TX, February 22-24, 2017
| | - Bernard Yan
- From the Department of Medicine and Neurology, Melbourne Brain Centre (T.Y.W., N.Y., D.G.S., M.M., B.C.V.C., B.Y., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), the Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Helsinki University Hospital, Finland (J.P., D.S., T.T., A.M.); Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, People's Republic of China (M.M.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).,Guest Editor for this article was Giuseppe Lanzino, MD.,Presented in part at the International Stroke Conference of the American Heart Association, Houston, TX, February 22-24, 2017
| | - Turgut Tatlisumak
- From the Department of Medicine and Neurology, Melbourne Brain Centre (T.Y.W., N.Y., D.G.S., M.M., B.C.V.C., B.Y., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), the Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Helsinki University Hospital, Finland (J.P., D.S., T.T., A.M.); Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, People's Republic of China (M.M.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).,Guest Editor for this article was Giuseppe Lanzino, MD.,Presented in part at the International Stroke Conference of the American Heart Association, Houston, TX, February 22-24, 2017
| | - Patricia M Desmond
- From the Department of Medicine and Neurology, Melbourne Brain Centre (T.Y.W., N.Y., D.G.S., M.M., B.C.V.C., B.Y., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), the Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Helsinki University Hospital, Finland (J.P., D.S., T.T., A.M.); Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, People's Republic of China (M.M.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).,Guest Editor for this article was Giuseppe Lanzino, MD.,Presented in part at the International Stroke Conference of the American Heart Association, Houston, TX, February 22-24, 2017
| | - Stephen M Davis
- From the Department of Medicine and Neurology, Melbourne Brain Centre (T.Y.W., N.Y., D.G.S., M.M., B.C.V.C., B.Y., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), the Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Helsinki University Hospital, Finland (J.P., D.S., T.T., A.M.); Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, People's Republic of China (M.M.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).,Guest Editor for this article was Giuseppe Lanzino, MD.,Presented in part at the International Stroke Conference of the American Heart Association, Houston, TX, February 22-24, 2017
| | - Atte Meretoja
- From the Department of Medicine and Neurology, Melbourne Brain Centre (T.Y.W., N.Y., D.G.S., M.M., B.C.V.C., B.Y., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), the Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Helsinki University Hospital, Finland (J.P., D.S., T.T., A.M.); Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, People's Republic of China (M.M.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.). .,Guest Editor for this article was Giuseppe Lanzino, MD. .,Presented in part at the International Stroke Conference of the American Heart Association, Houston, TX, February 22-24, 2017.
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103
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Maxwell AE, MacLeod MJ, Joyson A, Johnson S, Ramadan H, Bellfield R, Byrne A, McGhee C, Rudd A, Price F, Vasileiadis E, Holden M, Hewitt J, Carpenter M, Needle A, Valentine S, Patel F, Harrington F, Mudd P, Emsley H, Gregary B, Kane I, Muir K, Tiwari D, Owusu-Agyei P, Temple N, Sekaran L, Ragab S, England T, Hedstrom A, Jones P, Jones S, Doherty M, McCarron MO, Cohen DL, Tysoe S, Al-Shahi Salman R. Reasons for non-recruitment of eligible patients to a randomised controlled trial of secondary prevention after intracerebral haemorrhage: observational study. Trials 2017; 18:162. [PMID: 28381307 PMCID: PMC5382439 DOI: 10.1186/s13063-017-1909-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/18/2017] [Indexed: 11/19/2022] Open
Abstract
Background Recruitment to randomised prevention trials is challenging, not least for intracerebral haemorrhage (ICH) associated with antithrombotic drug use. We investigated reasons for not recruiting apparently eligible patients at hospital sites that keep screening logs in the ongoing REstart or STop Antithrombotics Randomised Trial (RESTART), which seeks to determine whether to start antiplatelet drugs after ICH. Method By the end of May 2015, 158 participants had been recruited at 108 active sites in RESTART. The trial coordinating centre invited all sites that kept screening logs to submit screening log data, followed by one reminder. We checked the integrity of data, focused on the completeness of data about potentially eligible patients and categorised the reasons they were not randomised. Results Of 108 active sites, 39 (36%) provided usable screening log data over a median of ten (interquartile range = 5–13) months of recruitment per site. During this time, sites screened 633 potentially eligible patients and randomised 53 (8%) of them. The main reasons why 580 patients were not randomised were: 43 (7%) patients started anticoagulation, 51 (9%) patients declined, 148 (26%) patients’ stroke physicians were not uncertain about using antiplatelet drugs, 162 (28%) patients were too unwell and 176 (30%) patients were not randomised due to other reasons. Conclusion RESTART recruited ~8% of eligible patients. If more physicians were uncertain about the therapeutic dilemma that RESTART is addressing, RESTART could have recruited up to four times as many participants. The trial coordinating centre continues to engage with physicians about their uncertainty. Trial registration EU Clinical Trials, EudraCT 2012-003190-26. Registered on 3 July 2012.
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Affiliation(s)
- Amy E Maxwell
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Paul Mudd
- Royal Devon & Exeter Hospital, Exeter, UK
| | | | | | | | - Keith Muir
- South Glasgow University Hospital, Glasgow, UK
| | | | | | | | | | | | | | | | | | | | - Mandy Doherty
- South West Acute Hospital, Enniskillen, UK.,Altnagelvin Hospital, Londonderry, UK
| | | | | | - Sharon Tysoe
- Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
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104
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Correlation of Cerebral Microbleed Distribution to Amyloid Burden in Patients with Primary Intracerebral Hemorrhage. Sci Rep 2017; 7:44715. [PMID: 28303922 PMCID: PMC5356186 DOI: 10.1038/srep44715] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/13/2017] [Indexed: 12/11/2022] Open
Abstract
The underlying pathology of cerebral microbleeds (CMBs) with mixed lobar and deep distribution remains contentious. The aim of this study was to correlate CMBs distribution to β-amyloid burden in patients with primary intracerebral hemorrhage (ICH). Fourty-seven ICH patients underwent magnetic resonance susceptibility-weighted imaging and 11C-Pittsburgh Compound B positron emission tomography. The amyloid burden was expressed as standardized uptake value ratio with reference to cerebellum, and presented as median (interquartile range). Patients were categorized into the lobar, mixed (both lobar and deep regions), and deep types of CMB. Comparing the lobar (17%), mixed (59.6%) and deep (23.4%) CMB types, the global amyloid burden was significantly higher in the mixed type than the deep type (1.10 [1.03–1.25] vs 1.00 [0.97–1.09], p = 0.011), but lower than in the lobar type (1.48 [1.18–1.50], p = 0.048). On multivariable analysis, the ratio of lobar to deep CMB number was positively correlated with global (p = 0.028) and occipital (p = 0.031) amyloid burden. In primary ICH, patients with lobar and mixed CMB types are associated with increased amyloid burden than patients with deep type. The ratio of lobar to deep CMB number is an independent indicator of cerebral β-amyloid deposition.
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105
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Maxwell AE, Dennis M, Rudd A, Weir CJ, Parker RA, Al-Shahi Salman R. Promoting Recruitment using Information Management Efficiently (PRIME): study protocol for a stepped-wedge cluster randomised controlled trial within the REstart or STop Antithrombotics Randomised Trial (RESTART). Trials 2017; 18:22. [PMID: 28245843 PMCID: PMC5331676 DOI: 10.1186/s13063-016-1692-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/10/2016] [Indexed: 11/29/2022] Open
Abstract
Background Research into methods to boost recruitment has been identified as the highest priority for randomised controlled trial (RCT) methodological research in the United Kingdom. Slow recruitment delays the delivery of research and inflates costs. Using electronic patient records has been shown to boost recruitment to ongoing RCTs in primary care by identifying potentially eligible participants, but this approach remains relatively unexplored in secondary care, and for stroke in particular. Methods/design The REstart or STop Antithrombotics Randomised Trial (RESTART; ISRCTN71907627) is an ongoing RCT of secondary prevention after stroke due to intracerebral haemorrhage. Promoting Recruitment using Information Management Efficiently (PRIME) is a stepped-wedge cluster randomised trial of a complex intervention to help RESTART sites increase their recruitment and attain their own target numbers of participants. Seventy-two hospital sites that were located in England, Wales or Scotland and were active in RESTART in June 2015 opted into PRIME. Sites were randomly allocated (using a computer-generated block randomisation algorithm, stratified by hospital location in Scotland vs. England/Wales) to one of 12 months in which the intervention would be delivered. All sites began in the control state. The intervention was delivered by a recruitment co-ordinator via a teleconference with each site. The intervention involved discussing recruitment strategies, providing software for each site to extract from their own stroke audit data lists of patients who were potentially eligible for RESTART, and a second teleconference to review progress 6 months later. The recruitment co-ordinator was blinded to the timing of the intervention until 2 months before it was due at a site. Staff at RESTART sites were blinded to the nature and timing of the intervention. The primary outcome is the total number of patients randomised into RESTART per month per site and will be analysed in a negative binomial generalised linear mixed model. PRIME began in September 2015. The last intervention was delivered in August 2016. Six-month follow-up will be complete in February 2017. Discussion The final results of PRIME will be analysed and disseminated in 2017. Trial registration The PRIME study was registered in the Northern Ireland Hub for Trials Methodology Research Studies Within a Trial (SWAT) repository (SWAT22) on 23 December 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1692-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amy E Maxwell
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Martin Dennis
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Anthony Rudd
- St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - Christopher J Weir
- Edinburgh Clinical Trials Unit and Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Teviot Place, Edinburgh, UK
| | - Richard A Parker
- Edinburgh Clinical Trials Unit and Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Teviot Place, Edinburgh, UK
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
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106
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Qiu L, Upadhyaya T, See AAQ, Ng YP, Kon Kam King N. Incidence of Recurrent Intracerebral Hemorrhages in a Multiethnic South Asian Population. J Stroke Cerebrovasc Dis 2017; 26:666-672. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/09/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022] Open
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107
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Delcourt C, Sato S, Zhang S, Sandset EC, Zheng D, Chen X, Hackett ML, Arima H, Hata J, Heeley E, Al-Shahi Salman R, Robinson T, Davies L, Lavados PM, Lindley RI, Stapf C, Chalmers J, Anderson CS. Intracerebral hemorrhage location and outcome among INTERACT2 participants. Neurology 2017; 88:1408-1414. [PMID: 28235817 PMCID: PMC5386433 DOI: 10.1212/wnl.0000000000003771] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 01/18/2017] [Indexed: 02/05/2023] Open
Abstract
Objective: To clarify associations between intracerebral hemorrhage (ICH) location and clinical outcomes among participants of the main phase Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). Methods: Associations between ICH sites and poor outcomes (death [6] or major disability [3–5] of modified Rankin Scale) and European Quality of Life Scale (EQ-5D) utility scores at 90 days were assessed in logistic regression models. Results: Of 2,066 patients included in the analyses, associations were identified between ICH sites and poor outcomes: involvement of posterior limb of internal capsule increased risks of death or major disability (odds ratio [OR] 2.10) and disability (OR 1.81); thalamic involvement increased risks of death or major disability (OR 2.24) and death (OR 1.97). Involvement of the posterior limb of the internal capsule, thalamus, and infratentorial sites were each associated with poor EQ-5D utility score (≤0.7 [median]; OR 1.87, 2.14, and 2.81, respectively). Posterior limb of internal capsule involvement was strongly associated with low scores across all health-related quality of life domains. ICH encompassing the thalamus and posterior limb of internal capsule were associated with death or major disability, major disability, and poor EQ-5D utility score (OR 1.72, 2.26, and 1.71, respectively). Conclusion: Poor clinical outcomes are related to ICH affecting the posterior limb of internal capsule, thalamus, and infratentorial sites. The highest association with death or major disability and poor EQ-5D utility score was seen in ICH encompassing the thalamus and posterior limb of internal capsule. ClinicalTrials.gov registration: NCT00716079.
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Affiliation(s)
- Candice Delcourt
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China
| | - Shoichiro Sato
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China
| | - Shihong Zhang
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China
| | - Else Charlotte Sandset
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China
| | - Danni Zheng
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China
| | - Xiaoying Chen
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China
| | - Maree L Hackett
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China
| | - Hisatomi Arima
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China
| | - Jun Hata
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China
| | - Emma Heeley
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China
| | - Rustam Al-Shahi Salman
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China
| | - Thompson Robinson
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China
| | - Leo Davies
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China
| | - Pablo M Lavados
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China
| | - Richard I Lindley
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China
| | - Christian Stapf
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China
| | - John Chalmers
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China
| | - Craig S Anderson
- From The George Institute for Global Health and The University of Sydney (C.D., S.S., E.C.S., D.Z., X.C., M.L.H., E.H., R.I.L., J.C., C.S.A.); Royal Prince Alfred Hospital (C.D., L.D., J.C., C.S.A.), Camperdown, Australia; National Cerebral and Cardiovascular Center (S.S.), Osaka, Japan; Department of Neurology (S.Z.), West China Hospital, Sichuan University, Chengdu; Oslo University Hospital (C.S.), Norway; The University of Central Lancashire (M.L.H.), UK; Department of Preventive Medicine and Public Health (H.A.), Faculty of Medicine, Fukuoka University; Center for Cohort Studies (J.H.), Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Division of Clinical Neurosciences (R.A.-S.S.), Centre for Clinical Brain Sciences, University of Edinburgh; Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases (T.R.), University of Leicester, UK; Clínica Alemana de Santiago (P.M.L.), Facultad de Medicina Clinica Alemana Universidad del Desarrollo; Facultad de Medicina (P.M.L.), Universidad de Chile, Santiago; Westmead Hospital Clinical School (R.I.L.), Westmead, Australia; Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) (C.S.), Département de Neurosciences, Université de Montréal, Canada; and The George Institute China (C.S.A.), Peking University Health Sciences Center, Beijing, China.
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Gerner ST, Kuramatsu JB, Moeller S, Huber A, Lücking H, Kloska SP, Madžar D, Sembill JA, Schwab S, Huttner HB. Specific Lobar Affection Reveals a Rostrocaudal Gradient in Functional Outcome in Spontaneous Intracerebral Hemorrhage. Stroke 2017; 48:587-595. [PMID: 28179560 DOI: 10.1161/strokeaha.116.015890] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/08/2016] [Accepted: 12/28/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Several studies have reported a better functional outcome in lobar intracerebral hemorrhage (ICH) compared with deep location. However, among lobar ICH, a correlation of hemorrhage site-involving the specific lobes-with functional outcome has not been established. METHODS Conservatively treated patients with supratentorial ICH, admitted to our hospital over a 5-year period (2008-2012), were retrospectively analyzed. Lobar patients were classified as isolated or overlapping ICH according to affected lobes. Demographic, clinical, and radiological characteristics were recorded and compared among lobar ICH patients using above subclassification. Functional outcome-dichotomized into favorable (modified Rankin Scale, 0-3) and unfavorable (modified Rankin Scale, 4-6)-was assessed after 3 and 12 months. Multivariate regression analysis was performed to identify predictors for favorable outcome. RESULTS Of overall 553 patients, 260 had lobar ICH. In isolated lobar ICH, median hematoma-volume decreased from rostral (frontal, 22.4 mL [7.3-55.5 mL]) to caudal (occipital, 7.1 mL [5.2-16.4 mL]; P=0.045), whereas the proportion of patients with favorable outcome increased (frontal: 23/63 [36.5%] versus occipital: 10/12 [83.3%]; P=0.003). Patients with overlapping lobar ICH had larger ICH volumes than isolated lobar ICH (overlapping, 48.9 mL [22.6-78.5 mL] versus 15.3 mL [5.0-44.6 mL]; P<0.001) and poorer clinical status on admission (Glasgow Coma Scale and National Institutes of Health Stroke Scale). Correlations with anatomic aspects provided evidence of a rostrocaudal gradient with increasing gray/white-matter ratio and decreasing hematoma-volume and rate of hematoma enlargement from frontal to occipital ICH location. Multivariate analysis revealed affection of occipital lobe (odds ratio, 3.75 [1.38-10.22]) and affection of frontal lobe (odds ratio, 0.52 [0.28-0.94]) to be independent predictors for favorable outcome and unfavorable outcome, respectively. CONCLUSIONS Among patients with lobar ICH radiological and outcome characteristics differed according to location. Especially affection of the frontal lobe was frequent and associated with unfavorable outcome after 3 months.
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Affiliation(s)
- Stefan T Gerner
- From the Department of Neurology (S.T.G., J.B.K., S.M., A.H., D.M., J.A.S., S.S., H.B.H.) and Department of Neuroradiology (H.L., S.P.K.), University Hospital Erlangen, Germany.
| | - Joji B Kuramatsu
- From the Department of Neurology (S.T.G., J.B.K., S.M., A.H., D.M., J.A.S., S.S., H.B.H.) and Department of Neuroradiology (H.L., S.P.K.), University Hospital Erlangen, Germany
| | - Sebastian Moeller
- From the Department of Neurology (S.T.G., J.B.K., S.M., A.H., D.M., J.A.S., S.S., H.B.H.) and Department of Neuroradiology (H.L., S.P.K.), University Hospital Erlangen, Germany
| | - Angelika Huber
- From the Department of Neurology (S.T.G., J.B.K., S.M., A.H., D.M., J.A.S., S.S., H.B.H.) and Department of Neuroradiology (H.L., S.P.K.), University Hospital Erlangen, Germany
| | - Hannes Lücking
- From the Department of Neurology (S.T.G., J.B.K., S.M., A.H., D.M., J.A.S., S.S., H.B.H.) and Department of Neuroradiology (H.L., S.P.K.), University Hospital Erlangen, Germany
| | - Stephan P Kloska
- From the Department of Neurology (S.T.G., J.B.K., S.M., A.H., D.M., J.A.S., S.S., H.B.H.) and Department of Neuroradiology (H.L., S.P.K.), University Hospital Erlangen, Germany
| | - Dominik Madžar
- From the Department of Neurology (S.T.G., J.B.K., S.M., A.H., D.M., J.A.S., S.S., H.B.H.) and Department of Neuroradiology (H.L., S.P.K.), University Hospital Erlangen, Germany
| | - Jochen A Sembill
- From the Department of Neurology (S.T.G., J.B.K., S.M., A.H., D.M., J.A.S., S.S., H.B.H.) and Department of Neuroradiology (H.L., S.P.K.), University Hospital Erlangen, Germany
| | - Stefan Schwab
- From the Department of Neurology (S.T.G., J.B.K., S.M., A.H., D.M., J.A.S., S.S., H.B.H.) and Department of Neuroradiology (H.L., S.P.K.), University Hospital Erlangen, Germany
| | - Hagen B Huttner
- From the Department of Neurology (S.T.G., J.B.K., S.M., A.H., D.M., J.A.S., S.S., H.B.H.) and Department of Neuroradiology (H.L., S.P.K.), University Hospital Erlangen, Germany
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To the Editor— Anticoagulation in atrial fibrillation after intracranial hemorrhage: Could the hemorrhage location influence the outcome? Heart Rhythm 2017; 14:e45. [DOI: 10.1016/j.hrthm.2016.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Indexed: 11/20/2022]
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Reply to the Editor- Anticoagulation in atrial fibrillation after intracranial hemorrhage: could the hemorrhage location influence the outcome? Heart Rhythm 2016; 14:e46. [PMID: 27871984 DOI: 10.1016/j.hrthm.2016.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Indexed: 11/23/2022]
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111
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Renard D, Thouvenot E. Evolution of Subarachnoid Hemorrhage Extension in Lobar Hemorrhage in the Early Chronic Phase and the Impact on Cerebral Amyloid Angiopathy Criteria. J Stroke Cerebrovasc Dis 2016; 25:2502-5. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/09/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022] Open
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Baharoglu MI, Al-Shahi Salman R, Cordonnier C, de Haan RJ, Roos YBWEM. Statistical analysis plan for the PlAtelet Transfusion in Cerebral Haemorrhage (PATCH) trial: a multicentre randomised controlled trial. Trials 2016; 17:379. [PMID: 27484334 PMCID: PMC4970239 DOI: 10.1186/s13063-016-1478-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/01/2016] [Indexed: 11/12/2022] Open
Abstract
Background Use of antiplatelet therapy shortly before stroke due to spontaneous primary intracerebral haemorrhage (ICH) is associated with higher case fatality in comparison to ICH without prior antithrombotic drug use. The PlAtelet Transfusion in Cerebral Haemorrhage (PATCH) trial aimed to assess the effect of platelet transfusion in patients presenting with ICH while using antiplatelet therapy. The main hypothesis of PATCH was that platelet transfusion would reduce death or dependence by reducing ICH growth. Methods/Design PATCH was a multicentre prospective, randomised, open, blinded endpoint (PROBE) parallel group trial, conducted at 60 hospitals in The Netherlands, Scotland and France. Forty-one sites enrolled 190 patients with spontaneous supratentorial ICH aged ≥18 years, who had used antiplatelet therapy for ≥7 days preceding ICH, if Glasgow Coma Scale was ≥8. Participants were randomised (1:1, with a secure web-based system using permuted blocks, stratified by study centre and type of antiplatelet therapy pre-ICH) to receive either platelet transfusion within 6 hours of symptom onset and 90 minutes of diagnostic brain imaging, or standard care without platelet transfusion. The primary outcome was modified Rankin Scale (mRS) score assessed blind to treatment allocation at 3 months after ICH. Planned secondary outcomes included ICH growth on brain imaging performed approximately 24 hours after randomisation, survival at 3 months, disability at 3 months scored using the Amsterdam Medical Centre linear disability score, heterogeneity of treatment effect on mRS and ICH growth according to presence of the computed tomography angiography spot sign, causes of poor outcome, and cost-effectiveness. Safety outcomes were transfusion reactions, thromboembolic complications, and serious adverse events occurring during hospitalisation. This statistical analysis plan was written without knowledge of the unblinded data. Trial registration The trial was registered with the Netherlands Trial Register on 29 April 2008 (NTR1303).
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Affiliation(s)
- M Irem Baharoglu
- Department of Neurology, Academic Medical Centre, H2-222, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, Royal Infirmary of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Charlotte Cordonnier
- Univ. Lille, Inserm U1171, Degenerative & Vascular Cognitive Disorders, CHU Lille, Department of neurology, F-59000, Lille, France
| | - Rob J de Haan
- Clinical Research Unit, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Yvo B W E M Roos
- Department of Neurology, Academic Medical Centre, H2-222, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
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Sacco S, Ornello R, Degan D, Tiseo C, Pistoia F, Carolei A. Declining incidence of intracerebral hemorrhage over two decades in a population-based study. Eur J Neurol 2016; 23:1627-1634. [DOI: 10.1111/ene.13099] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/08/2016] [Indexed: 11/29/2022]
Affiliation(s)
- S. Sacco
- Institute of Neurology; Department of Applied Clinical Sciences and Biotechnology; University of L'Aquila; L'Aquila Italy
| | - R. Ornello
- Institute of Neurology; Department of Applied Clinical Sciences and Biotechnology; University of L'Aquila; L'Aquila Italy
| | - D. Degan
- Institute of Neurology; Department of Applied Clinical Sciences and Biotechnology; University of L'Aquila; L'Aquila Italy
| | - C. Tiseo
- Institute of Neurology; Department of Applied Clinical Sciences and Biotechnology; University of L'Aquila; L'Aquila Italy
| | - F. Pistoia
- Institute of Neurology; Department of Applied Clinical Sciences and Biotechnology; University of L'Aquila; L'Aquila Italy
| | - A. Carolei
- Institute of Neurology; Department of Applied Clinical Sciences and Biotechnology; University of L'Aquila; L'Aquila Italy
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Becattini C, Sembolini A, Paciaroni M. Resuming anticoagulant therapy after intracerebral bleeding. Vascul Pharmacol 2016; 84:15-24. [PMID: 27260938 DOI: 10.1016/j.vph.2016.05.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/14/2016] [Accepted: 05/28/2016] [Indexed: 12/24/2022]
Abstract
The clinical benefit of resuming anticoagulant treatment after an anticoagulants-associated intracranial hemorrhage (ICH) is debated. No randomized trial has been conducted on this particular clinical issue. The risk of ICH recurrence from resuming anticoagulant therapy is expected to be higher after index lobar than deep ICH and in patients with not amendable risk factors for ICH. Retrospective studies have recently shown improved survival with resumption of treatment after index anticoagulants-associated ICH. Based on these evidences and on the risk for thromboembolic events without anticoagulant treatment, resumption of anticoagulation should be considered in all patients with mechanical heart valve prosthesis and in those with amendable risk factors for anticoagulants-associated ICH. Resumption with direct oral anticoagulants appears a reasonable option for non-valvular atrial fibrillation (NVAF) patients at moderate to high thromboembolic risk after deep ICH and for selected NVAF patients at high thromboembolic risk after lobar ICH. For VTE patients at high risk for recurrence, resumption of anticoagulation or insertion of vena cava filter should be tailored on the estimated risk for ICH recurrence.
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Affiliation(s)
- Cecilia Becattini
- Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Italy.
| | - Agnese Sembolini
- Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Italy
| | - Maurizio Paciaroni
- Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Italy
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Intraoperative Transcranial Motor-Evoked Potentials Predict Motor Function Outcome in Intracerebral Hemorrhage Surgery. World Neurosurg 2016; 90:518-523. [PMID: 27025454 DOI: 10.1016/j.wneu.2016.03.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 03/19/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Prediction of motor function after intracerebral hemorrhage (ICH) often poses a diagnostic challenge. This study was performed to investigate whether intraoperative monitoring of motor-evoked potentials (MEPs) could predict postoperative motor function recovery. METHODS We reviewed 16 consecutive patients undergoing evacuation of supratentorial ICH with hemiplegia between June 2011 and October 2014. Patients were categorized according to the results of MEPs before and after evacuation of hematoma. The correlation between detection of MEPs and prognosis of motor function was analyzed. RESULTS In 10 of 16 cases (62%), stable MEPs were detected before and after evacuation of hematoma, and postoperative motor function was improved in all cases, including 3 cases with severe preoperative motor impairment on manual muscle test (1-2). In 3 cases (19%) in which MEPs were not detected throughout the procedure, motor function was not improved. In the other 3 cases (19%), MEPs were not measured before evacuation of ICH but were detected after evacuation despite poor prognosis of motor function. The results of postevacuation MEPs were considered false-negative results. Predictions using pre-evacuation MEP results were completely consistent with prognosis for recovery, whereas MEPs obtained during and after evaluation were useful for monitoring. CONCLUSIONS Intraoperative MEPs may indicate preservation of pyramidal tracts, and pre-evacuation MEPs can predict motor function outcome after ICH surgery.
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Intraoperative Targeted Temperature Management in Acute Brain and Spinal Cord Injury. Curr Neurol Neurosci Rep 2016; 16:18. [PMID: 26759319 DOI: 10.1007/s11910-015-0619-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Acute brain and spinal cord injuries affect hundreds of thousands of people worldwide. Though advances in pre-hospital and emergency and neurocritical care have improved the survival of some to these devastating diseases, very few clinical trials of potential neuro-protective strategies have produced promising results. Medical therapies such as targeted temperature management (TTM) have been trialed in traumatic brain injury (TBI), spinal cord injury (SCI), acute ischemic stroke (AIS), subarachnoid hemorrhage (SAH), and intracranial hemorrhage (ICH), but in no study has a meaningful effect on outcome been demonstrated. To this end, patient selection for potential neuro-protective therapies such as TTM may be the most important factor to effectively demonstrate efficacy in clinical trials. The use of TTM as a strategy to treat and prevent secondary neuronal damage in the intraoperative setting is an area of ongoing investigation. In this review we will discuss recent and ongoing studies that address the role of TTM in combination with surgical approaches for different types of brain injury.
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Huang Y, Chen J, Zhong S, Yuan J. Role of APACHE II scoring system in the prediction of severity and outcome of acute intracerebral hemorrhage. Int J Neurosci 2015; 126:1020-4. [PMID: 26393395 DOI: 10.3109/00207454.2015.1099099] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Acute intracerebral hemorrhage (ICH) is prone to multiple organ dysfunction and has high disability and mortality. This study was to determine the role of acute physiology and chronic health evaluation II (APACHE II) scoring system in the prediction of severity and outcome of acute ICH. METHODS A total of 546 ICH patients were prospectively recruited between 1 January 2013 and 31 December 2014. Patients were divided into three groups according to the APACHE II scores: low score group (5-16), moderate score group (17-28) and high score group (≥29). The ICH volume and location, National Institutes of Health Stroke Scale (NIHSS) scores, Glasgow Coma Score and modified Rankin Scale (mRS) scores were used to assess the severity of acute ICH. Global outcome at three months was evaluated with the mRS. RESULTS Of 479 patients, the average age was 56.4 ± 3.4 years, 287 (59.9%) survived and 192 (40.1%) died. Results showed that the higher the APACHE II score, the higher the mortality was; the average hospital stay, ICH volume, NIHSS scores, mRS scores and survival rate were significantly different among three APACHE II groups (p < 0.05). APACHE II scores were able to predict the mortality and correlated positively with actual mortality (r = 0.84, p < 0.01). CONCLUSIONS APACHE II scoring system can be used to predict the severity and outcome of acute ICH.
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Affiliation(s)
- Ying Huang
- a 1 Department of Neurology, The First Affiliated Hospital, Gan Nan Medical University , Ganzhou , China
| | - Jianping Chen
- b 2 Department of Surgery, Nan Chang University , Ganzhou , China
| | - Shanquan Zhong
- a 1 Department of Neurology, The First Affiliated Hospital, Gan Nan Medical University , Ganzhou , China
| | - Jianqing Yuan
- a 1 Department of Neurology, The First Affiliated Hospital, Gan Nan Medical University , Ganzhou , China
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Lee SH, Park KJ, Kang SH, Jung YG, Park JY, Park DH. Prognostic Factors of Clinical Outcomes in Patients with Spontaneous Thalamic Hemorrhage. Med Sci Monit 2015; 21:2638-46. [PMID: 26343784 PMCID: PMC4566943 DOI: 10.12659/msm.894132] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Intracerebral hemorrhage (ICH) is a well-known condition, but ICH restricted to the thalamus is less widely studied. We investigated the prognostic factors of thalamic ICHs. Material/Methods Seventy patients from January 2009 to November 2014 were retrospectively reviewed. Patients who demonstrated spontaneous ICH primarily affecting the thalamus on initial brain computed tomography (CT) were enrolled. Patients were categorized into 2 groups based on their Glasgow Outcome Scale (GOS) scores. Various presumptive prognostic factors were analyzed to investigate relationships between various clinical characteristics and outcomes. Results Of the enrolled patients, 39 showed a GOS of 4–5, and were categorized as the good outcome group, while another 31 patients showed a GOS of 1–3 and were categorized as the poor outcome group. Initial GCS score, calculated volume of hematoma, presence of intraventricular hemorrhage (IVH), coexisting complications, hydrocephalus, performance of external ventricular drainage, and modified Graeb’s scores of patients with IVH were significantly different between the 2 groups. In multivariate analysis, among the factors above, initial GCS score (P=0.002, Odds ratio [OR]=1.761, Confidence interval [CI]=1.223–2.536) and the existence of systemic complications (P=0.015, OR=0.059, CI=0.006–0.573) were independently associated with clinical outcomes. Calculated hematoma volume showed a borderline relationship with outcomes (P=0.079, OR=0.920, CI=0.839–1.010). Conclusions Initial GCS score and the existence of systemic complications were strong predictive factors for prognosis of thalamic ICH. Calculated hematoma volume also had predictive value for clinical outcomes.
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Affiliation(s)
- Sang-Hoon Lee
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, South Korea
| | - Kyung-Jae Park
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, South Korea
| | - Shin-Hyuk Kang
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, South Korea
| | - Yong-Gu Jung
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, South Korea
| | - Jung-Yul Park
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, South Korea
| | - Dong-Hyuk Park
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, South Korea
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Samarasekera N, Lerpiniere C, Fonville AF, Farrall AJ, Wardlaw JM, White PM, Torgersen A, Ironside JW, Smith C, Al-Shahi Salman R. Consent for Brain Tissue Donation after Intracerebral Haemorrhage: A Community-Based Study. PLoS One 2015; 10:e0135043. [PMID: 26302447 PMCID: PMC4547774 DOI: 10.1371/journal.pone.0135043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/17/2015] [Indexed: 11/18/2022] Open
Abstract
Background Spontaneous intracerebral haemorrhage is a devastating form of stroke and its incidence increases with age. Obtaining brain tissue following intracerebral haemorrhage helps to understand its cause. Given declining autopsy rates worldwide, the feasibility of establishing an autopsy-based collection and its generalisability are uncertain. Methods We used multiple overlapping sources of case ascertainment to identify every adult diagnosed with intracerebral haemorrhage between 1st June 2010-31st May 2012, whilst resident in the Lothian region of Scotland. We sought consent from patients with intracerebral haemorrhage (or their nearest relative if the patient lacked mental capacity) to conduct a research autopsy. Results Of 295 adults with acute intracerebral haemorrhage, 110 (37%) could not be approached to consider donation. Of 185 adults/relatives approached, 91 (49%) consented to research autopsy. There were no differences in baseline demographic variables or markers of intracerebral haemorrhage severity between consenters and non-consenters. Adults who died and became donors (n = 46) differed from the rest of the cohort (n = 249) by being older (median age 80, IQR 76–86 vs. 75, IQR 65–83, p = 0.002) and having larger haemorrhages (median volume 23ml, IQR 13–50 vs. 13ml, IQR 4–40; p = 0.002). Conclusions Nearly half of those approached consent to brain tissue donation after acute intracerebral haemorrhage. The characteristics of adults who gave consent were comparable to those in an entire community, although those who donate early are older and have larger haemorrhage volumes.
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Affiliation(s)
- Neshika Samarasekera
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Christine Lerpiniere
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Arthur F. Fonville
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew J. Farrall
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna M. Wardlaw
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Brain Research Imaging Centre, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
| | - Philip M. White
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Antonia Torgersen
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - James W. Ironside
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Colin Smith
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Rustam Al-Shahi Salman
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
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