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Monocyte to HDL cholesterol ratio is associated with discharge and 3-month outcome in patients with acute intracerebral hemorrhage. J Neurol Sci 2017; 372:157-161. [DOI: 10.1016/j.jns.2016.11.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/11/2016] [Accepted: 11/11/2016] [Indexed: 11/15/2022]
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152
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Tao C, Hu X, Wang J, Ma J, Li H, You C. Admission neutrophil count and neutrophil to lymphocyte ratio predict 90-day outcome in intracerebral hemorrhage. Biomark Med 2017; 11:33-42. [PMID: 27917647 DOI: 10.2217/bmm-2016-0187] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aim: Inflammation plays a role in secondary brain injury after intracerebral hemorrhage (ICH). We aimed to determine the prognostic significance of admission white blood cell (AWC), neutrophil count (ANC), lymphocyte count, monocyte count and neutrophil to lymphocyte ratio (NLR) for 90-day outcome after ICH. Patients & methods: A total of 336 patients with spontaneous ICH were retrospectively investigated. Clinical outcome was assessed by modified Rankin Scale at 90 days. Results: Multivariate analysis showed that higher AWC, ANC, NLR were independently associated with mortality and worse outcome. Moreover, NLR showed a higher predictive ability in mortality than in poor outcome in receiver operating characteristic analysis. Linear regression analyses revealed admission Glasgow Coma Scale score and ICH volume were mostly correlated with these indices. Conclusion: Elevated levels of AWC, ANC and NLR were independently related to poor 90-day outcome after ICH. NLR may be a novel inflammatory biomarker following ICH.
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Affiliation(s)
- Chuanyuan Tao
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Xin Hu
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Jiajing Wang
- Department of Critical Care Medicine, Neurosurgical Intensive Care Unit, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Junpeng Ma
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Hao Li
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, PR China
| | - Chao You
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, PR China
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154
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Factors Associated with the Need for Intensive Care Unit Admission Following Supratentorial Intracerebral Hemorrhage: The Triage ICH Model. Neurocrit Care 2016; 27:75-81. [DOI: 10.1007/s12028-016-0346-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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155
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Akhtar W, Khan MF, Verma G, Shaquiquzzaman M, Rizvi MA, Mehdi SH, Akhter M, Alam MM. Therapeutic evolution of benzimidazole derivatives in the last quinquennial period. Eur J Med Chem 2016; 126:705-753. [PMID: 27951484 DOI: 10.1016/j.ejmech.2016.12.010] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/10/2016] [Accepted: 12/03/2016] [Indexed: 12/21/2022]
Abstract
Benzimidazole, a fused heterocycle bearing benzene and imidazole has gained considerable attention in the field of contemporary medicinal chemistry. The moiety is of substantial importance because of its wide array of pharmacological activities. This nitrogen containing heterocycle is a part of a number of therapeutically used agents. Moreover, a number of patents concerning this moiety in the last few years further highlight its worth. The present review covers the recent work published by scientists across the globe during last five years.
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Affiliation(s)
- Wasim Akhtar
- Drug Design and Medicinal Chemistry Lab, Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard, New Delhi 110062, India
| | - Mohemmed Faraz Khan
- Drug Design and Medicinal Chemistry Lab, Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard, New Delhi 110062, India
| | - Garima Verma
- Drug Design and Medicinal Chemistry Lab, Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard, New Delhi 110062, India
| | - M Shaquiquzzaman
- Drug Design and Medicinal Chemistry Lab, Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard, New Delhi 110062, India
| | - M A Rizvi
- Department of Biosciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Syed Hassan Mehdi
- Department of Biosciences, Jamia Millia Islamia, New Delhi 110025, India
| | - Mymoona Akhter
- Drug Design and Medicinal Chemistry Lab, Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard, New Delhi 110062, India
| | - M Mumtaz Alam
- Drug Design and Medicinal Chemistry Lab, Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Jamia Hamdard, New Delhi 110062, India.
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156
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Sun Y, You S, Zhong C, Huang Z, Hu L, Zhang X, Shi J, Cao Y, Liu CF. Neutrophil to lymphocyte ratio and the hematoma volume and stroke severity in acute intracerebral hemorrhage patients. Am J Emerg Med 2016; 35:429-433. [PMID: 27876538 DOI: 10.1016/j.ajem.2016.11.037] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/01/2016] [Accepted: 11/14/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Neutrophil to lymphocyte ratio (NLR) serves as a powerful inflammatory marker for predicting cardiovascular events. Here, we investigate whether admission NLR is associated with hematoma volume, stroke severity, and 3-month outcomes in patients with acute intracerebral hemorrhage (ICH). METHODS 352 patients with acute ICH were prospectively identified in this study. Demographic characteristics, lifestyle risk factors, NIHSS score, hematoma volumes, and other clinical features were recorded for all participants. Patients was divided into quartiles based on the admission NLR levels (Q1: <2.78; Q2: 2.78-4.08; Q3: 4.08-7.85; Q4: ≥7.85). Multivariable linear regression models and logistic regression models were used to evaluate the association between NLR and hematoma volume, admission severity, or the outcomes after ICH. RESULTS Median NIHSS scores for each quartile (Q1 to Q4) were 6.0, 6.0, 6.0, and 11.0 (P=.001), and median hematoma volumes were 9.5, 9.3, 9.1, and 15.0ml (P=.005), respectively. After adjusting the age, sex, and other potential risk factors, the patients in Q4 had higher NIHSS scores (P=.042) and larger hematoma volume (P=.014). After 3-month follow-up, 148 poor outcomes (mRS, 3-6) and 47 all-cause deaths were documented. There were more patients with poor outcomes in Q4 than Q1. However, compared with the patients in Q1, those in Q4 were not associated with poor outcomes (P-trend=0.379), and all-cause mortality (P-trend=0.843) after adjust for other risk factors. CONCLUSIONS Higher admission NLR are associated with larger hematoma volume and more serious stroke, but not 3-month outcomes in patients with acute ICH.
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Affiliation(s)
- Yaming Sun
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; Department of Neurology, Zhangjiagang Hospital of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Suzhou 215600, China
| | - Shoujiang You
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, 215123, China
| | - Zhichao Huang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Lifang Hu
- Institutes of Neuroscience, Soochow University, Suzhou 215123, China
| | - Xia Zhang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Jijun Shi
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China
| | - Yongjun Cao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; Institutes of Neuroscience, Soochow University, Suzhou 215123, China.
| | - Chun-Feng Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou 215004, China; Institutes of Neuroscience, Soochow University, Suzhou 215123, China.
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157
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Camps-Renom P, Alejaldre-Monforte A, Delgado-Mederos R, Martínez-Domeño A, Prats-Sánchez L, Pascual-Goñi E, Martí-Fàbregas J. Does prior antiplatelet therapy influence hematoma volume and hematoma growth following intracerebral hemorrhage? Results from a prospective study and a meta-analysis. Eur J Neurol 2016; 24:302-308. [DOI: 10.1111/ene.13193] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/27/2016] [Indexed: 11/30/2022]
Affiliation(s)
- P. Camps-Renom
- Biomedical Research Institute Sant Pau (IIB-Sant Pau); Department of Neurology; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - A. Alejaldre-Monforte
- Biomedical Research Institute Sant Pau (IIB-Sant Pau); Department of Neurology; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - R. Delgado-Mederos
- Biomedical Research Institute Sant Pau (IIB-Sant Pau); Department of Neurology; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - A. Martínez-Domeño
- Biomedical Research Institute Sant Pau (IIB-Sant Pau); Department of Neurology; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - L. Prats-Sánchez
- Biomedical Research Institute Sant Pau (IIB-Sant Pau); Department of Neurology; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - E. Pascual-Goñi
- Biomedical Research Institute Sant Pau (IIB-Sant Pau); Department of Neurology; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
| | - J. Martí-Fàbregas
- Biomedical Research Institute Sant Pau (IIB-Sant Pau); Department of Neurology; Hospital de la Santa Creu i Sant Pau; Barcelona Spain
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158
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Guan J, Hawryluk GWJ. Targeting Secondary Hematoma Expansion in Spontaneous Intracerebral Hemorrhage - State of the Art. Front Neurol 2016; 7:187. [PMID: 27826284 PMCID: PMC5078502 DOI: 10.3389/fneur.2016.00187] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/13/2016] [Indexed: 12/20/2022] Open
Abstract
Spontaneous intracerebral hemorrhage (SICH), defined broadly as intracerebral hemorrhage not related to trauma, results in long-term disability or death in a large proportion of afflicted patients. Current management of this disease is predominantly supportive, including airway protection, optimization of hemodynamic parameters, and management of intracranial pressure. No active treatments that demonstrate beneficial effects on clinical outcome are currently available. Animal models of SICH have allowed for the elucidation of multiple pathways that may be attractive therapeutic targets. A minority of these, such as aggressive blood pressure management and recombinant activated factor VII administration, have led to large-scale clinical trials. There remains a critical need for further translational research in the realm of SICH.
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Affiliation(s)
- Jian Guan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah , Salt Lake City, UT , USA
| | - Gregory W J Hawryluk
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah , Salt Lake City, UT , USA
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159
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Zhou YT, Wang SD, Wang GS, Chen XD, Tong DM. Risk factors for nosocomial nontraumatic coma: sepsis and respiratory failure. J Multidiscip Healthc 2016; 9:463-468. [PMID: 27713634 PMCID: PMC5045239 DOI: 10.2147/jmdh.s113682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Coma’s are a major cause of clinical deterioration or death. Identification of risks that predispose to coma are important in managing patients; however, the risk factors for nosocomial nontraumatic coma (NNC) are not well known. Our aim was to investigate the risk factors in patients with NNC. Methods A retrospective case–control design was used to compare patients with NNC and a control group of patients without coma in a population-based cohort of 263 participants from the neurological intensive care unit in Shuyang County People’s Hospital of Northern China. Coma was diagnosed by a Glasgow Coma Scale score ≤8. Adjusted odds ratios for patients with NNC were derived from multivariate logistic regression analyses. Results A total of 96 subjects had NNC. The prevalence of NNC was 36.5% among the subjects. Among these, 82% had acute cerebrovascular etiology. Most of the NNC usually occurred at day 3 after admission to the neurological intensive care unit. Patients with NNC had higher hospital mortality rates (67.7% vs 3%, P<0.0001) and were more likely to have a central herniation (47.9% vs 0%, P<0.001) or uncal herniation (11.5% vs 0%, P<0.001) than those without NNC. Multiple logistic regression showed that systemic inflammatory response syndrome-positive sepsis (odds ratio =4, 95% confidence interval =1.875−8.567, P<0.001) and acute respiratory failure (odds ratio =3.275, 95% confidence interval =1.014−10.573, P<0.05) were the factors independently associated with a higher risk of NNC. Conclusion Systemic inflammatory response syndrome-positive sepsis and acute respiratory failure are independently associated with an increased risk of NNC. This information may be important for patients with NNC.
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Affiliation(s)
- Ye-Ting Zhou
- Department of Clinical Research; Department of General Surgery
| | | | - Guang-Sheng Wang
- Department of Neurology, Affiliated Shuyang People' Hospital, XuZhou Medical University, Jiangsu, People's Republic of China
| | - Xiao-Dong Chen
- Department of Neurology, Affiliated Shuyang People' Hospital, XuZhou Medical University, Jiangsu, People's Republic of China
| | - Dao-Ming Tong
- Department of Neurology, Affiliated Shuyang People' Hospital, XuZhou Medical University, Jiangsu, People's Republic of China
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160
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Boulouis G, Morotti A, Brouwers HB, Charidimou A, Jessel MJ, Auriel E, Pontes-Neto O, Ayres A, Vashkevich A, Schwab KM, Rosand J, Viswanathan A, Gurol ME, Greenberg SM, Goldstein JN. Noncontrast Computed Tomography Hypodensities Predict Poor Outcome in Intracerebral Hemorrhage Patients. Stroke 2016; 47:2511-6. [PMID: 27601380 DOI: 10.1161/strokeaha.116.014425] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/02/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Noncontrast computed tomographic (CT) hypodensities have been shown to be associated with hematoma expansion in intracerebral hemorrhage (ICH), but their impact on functional outcome is yet to be determined. We evaluated whether baseline noncontrast CT hypodensities are associated with poor clinical outcome. METHODS We performed a retrospective review of a prospectively collected cohort of consecutive patients with primary ICH presenting to a single academic medical center between 1994 and 2016. The presence of CT hypodensities was assessed by 2 independent raters on the baseline CT. Unfavorable outcome was defined as a modified Rankin score >3 at 90 days. The associations between CT hypodensities and unfavorable outcome were investigated using uni- and multivariable logistic regression models. RESULTS During the study period, 1342 patients presented with ICH and 800 met restrictive inclusion criteria (baseline CT available for review, and 90-day outcome available). Three hundred and four (38%) patients showed hypodensities on CT, and 520 (65%) patients experienced unfavorable outcome. In univariate analysis, patients with unfavorable outcome were more likely to demonstrate hypodensities (48% versus 20%; P<0.0001). After adjustment for age, admission Glasgow coma scale, warfarin use, intraventricular hemorrhage, baseline ICH volume, and location, CT hypodensities were found to be independently associated with an increase in the odds of unfavorable outcome (odds ratio 1.70, 95% confidence interval [1.10-2.65]; P=0.018). CONCLUSIONS The presence of noncontract CT hypodensities at baseline independently predicts poor outcome and comes as a useful and widely available addition to our ability to predict ICH patients' clinical evolution.
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Affiliation(s)
- Gregoire Boulouis
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.).
| | - Andrea Morotti
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - H Bart Brouwers
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Andreas Charidimou
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Michael J Jessel
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Eitan Auriel
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Octavio Pontes-Neto
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Alison Ayres
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Anastasia Vashkevich
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Kristin M Schwab
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Jonathan Rosand
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Anand Viswanathan
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Mahmut E Gurol
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Steven M Greenberg
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
| | - Joshua N Goldstein
- From the Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston (G.B., A.M., H.B.B., A.C., M.J.J., E.A., O.P.-N., A.A., A. Vashkevich, K.M.S., J.R., A. Viswanathan, M.E.G., S.M.G., J.N.G.); Department of Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands (H.B.B.); Stroke Service, Department of Neuroscience and Behavioral Sciences, Ribeirao Pre- to School of Medicine, University of Sao Paulo (O.P.-N.); Division of Neurocritical Care and Emergency Neurology, Massachusetts General Hospital, Harvard Medical School, Boston (J.R., J.N.G.); Department of Emergency Medicine, Massachusetts General Hospital, Boston (J.N.G.)
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Prognostic value of perihematomal edema area at the initial ED presentation in patients with intracranial hematoma. Am J Emerg Med 2016; 34:1241-6. [DOI: 10.1016/j.ajem.2016.03.048] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/18/2016] [Accepted: 03/19/2016] [Indexed: 11/18/2022] Open
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162
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Ziai WC, Siddiqui AA, Ullman N, Herrick DB, Yenokyan G, McBee N, Lane K, Hanley DF. Early Therapy Intensity Level (TIL) Predicts Mortality in Spontaneous Intracerebral Hemorrhage. Neurocrit Care 2016; 23:188-97. [PMID: 26025213 DOI: 10.1007/s12028-015-0150-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Outcome from spontaneous intracerebral hemorrhage (sICH) may depend on patient-care variability. We developed as ICH-specific therapy intensity level (TIL) metric using evidence-based elements in a high severity sICH cohort. METHODS This is a cohort study of 170 patients with sICH and any intraventricular hemorrhage treated in 2 academic neuroICUs. Pre-defined quality indicators were identified based on current guidelines, scientific evidence, and likelihood of care documentation in first 72 h of hospital admission. We assessed performance on each indicator and association with discharge mortality. Significant indicators were aggregated to develop a TIL score. The predictive validity of the best fit TIL score was tested with threefold cross-validation of multivariate logistic regression models of in-hospital survival and good outcome (modified Rankin score 0-3). RESULTS Median ICH score was 3; discharge mortality was 51.2%. Five/19 tested variables were significantly associated with lower discharge mortality: no DNR/withdrawal of treatment within 24 h of admission, target glucose within 4 h of high glucose, no recurrent hyperpyrexia, clinical reversal of herniation/intracranial pressure >20 mmHg within 60 min of detection, and reversal of INR (<1.4) within 2 h of first elevation. One point was given for each or if not applicable. Median TIL score was significantly higher in survivors versus non-survivors (5[1] vs. 3[1]; P < 0.001). A 4-point aggregated TIL score was most predictive of discharge survival (area under receiving operating characteristic curve 0.85, 95% CI 0.80-0.90) and good outcome (AUC 0.84) and was an independent predictor of both (survival: OR 7.10; 95% CI 3.57-14.11; P < 0.001; good outcome: OR 3.10; 95% CI 1.06-8.79; P < 0.001). CONCLUSION A simplified TIL score using evidenced-based patient-care parameters within first 3 days of admission after sICH was significantly associated with early mortality and good outcome. The next step is prospective validation of the simplified TIL score in a large clinical trial.
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Affiliation(s)
- Wendy C Ziai
- Division of Neurosciences Critical Care, Departments of Neurology, Anesthesiology/Critical Care Medicine, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, 600 Wolf Street/Phipps 455, Baltimore, MD, 21287, USA,
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163
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Yao X, Xu Y, Siwila-Sackman E, Wu B, Selim M. The HEP Score: A Nomogram-Derived Hematoma Expansion Prediction Scale. Neurocrit Care 2016; 23:179-87. [PMID: 25963292 DOI: 10.1007/s12028-015-0147-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Identification of intracerebral hemorrhage (ICH) patients at risk of substantial hematoma expansion (SHE) could facilitate the selection of candidates likely to benefit from therapies aiming to minimize ICH growth. We aimed to develop a grading tool that can be quickly used during the hyperacute phase to predict the risk of SHE. METHODS We reviewed data from 237 spontaneous ICH patients who had baseline head CT scan within 12 h of symptom onset and follow-up CT during the following 72 h. We performed logistic regression analyses to determine the predictors of SHE (defined as an absolute increase in ICH volume >6 ml or an increase >33% on follow-up CT). We identified 6 predictors; each was assigned a point in the graphic interface of a nomogram which was used to construct a scoring system-The Hematoma Expansion Prediction (HEP) Score, varying from 0 to 18 points. We evaluated the ability of the model to predict the probability of SHE using c-statistics. RESULTS SHE occurred in 74 patients (31.2%). The final model to predict SHE included 6 variables: time from onset to baseline CT (<3 vs. 3-12 h), history of dementia, current smoking, antiplatelet use, Glasgow Comma Scale score, and the presence of subarachnoid hemorrhage on baseline scan. The model had satisfactory discrimination ability with a bootstrap corrected c-index of 0.76 (95% CI 0.69-0.83) and good calibration. Patients with a total HEP score >3 were at greatest risk for SHE. CONCLUSIONS We developed and internally validated a novel nomogram and an easy to use score which accurately predict the probability of SHE based on six easily obtainable parameters. This could be useful for treatment decision and stratification. External prospective validation of the HEP score is warranted before its application to other populations.
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Affiliation(s)
- Xiaoying Yao
- Department of Neurology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China
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164
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Moussa WMM, Khedr W. Decompressive craniectomy and expansive duraplasty with evacuation of hypertensive intracerebral hematoma, a randomized controlled trial. Neurosurg Rev 2016; 40:115-127. [PMID: 27235128 DOI: 10.1007/s10143-016-0743-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/22/2016] [Accepted: 05/05/2016] [Indexed: 12/25/2022]
Abstract
Hypertensive intracerebral hemorrhage (ICH) has high morbidity and mortality rates. Decompressive craniectomy (DC) is generally used for the treatment of cases associated with refractory increased intracranial pressure (ICP). In this study, we investigated the beneficial effects of adding DC and expansive duraplasty (ED) to hematoma evacuation in patients who underwent surgery for large hypertensive ICH. A prospective randomized controlled clinical trial where 40 patients diagnosed having large hypertensive ICH was randomly allocated to either group A or B, each comprised 20 patients. Group A patients, the treatment group, were submitted to hematoma evacuation together with DC and ED, whereas group B patients, the control group, were submitted only to hematoma evacuation. Twenty-three (57.5 %) of the patients were males, with an overall age range of 34-79 years (mean 59.3 years). Preoperative Glasgow Coma Scale (GCS) scores in group A ranged from 4 to 13 (mean 7.1), while in group B it ranged from 4 to 12 (mean 6.8). Postoperative hydrocephalus occurred in 3 (15 %) patients in group A and in 4 (20 %) patients in group B, whereas meningitis occurred in one patient (5 %) in group A. The mortality rate was 2 (10 %) patients in group A as compared to 5 (25 %) patients in group B (p = 0.407). High admission GCS (p = 0.0032), younger age (p = 0.0023), smaller hematoma volume (p = 0.044), subcortical hematoma location (p = 0.041), absent or minimal preoperative (p = 0.0068), and postoperative (p = 0.0031) midline shift as well as absent intraventricular extension of the hematoma (p = 0.036) contributed significantly to a better outcome. Selected patients' subgroups who benefited from adding DC and ED to ICH evacuation were age category of 30 to less than 50 (p = 0.0015) and from 50 to less than 70 (p = 0.00619) as well as immediate preoperative GCS from 6 to 8 (p = 0.000436) and from 9 to 12 (p = 0.00774). At 6 months' follow-up, 14 (70 %) patients of group A had favorable outcome as compared to 4 (20 %) patients of group B (p = 0.0015). Adding DC with ED to evacuation of a large hypertensive hemispheric ICH might improve the outcome in selected group of patients.
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Affiliation(s)
- Wael Mohamed Mohamed Moussa
- Department of Neurosurgery, Faculty of Medicine, Alexandria University, Champolion Street, Khartoum Square, Azareeta, Alexandria, Egypt.
| | - Wael Khedr
- Department of Neurosurgery, Faculty of Medicine, Alexandria University, Champolion Street, Khartoum Square, Azareeta, Alexandria, Egypt
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165
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Morotti A, Phuah CL, Anderson CD, Jessel MJ, Schwab K, Ayres AM, Pezzini A, Padovani A, Gurol ME, Viswanathan A, Greenberg SM, Goldstein JN, Rosand J. Leukocyte Count and Intracerebral Hemorrhage Expansion. Stroke 2016; 47:1473-8. [PMID: 27103016 DOI: 10.1161/strokeaha.116.013176] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/22/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Acute leukocytosis is a well-established response to intracerebral hemorrhage (ICH). Leukocytes, because of their interaction with platelets and coagulation factors, may in turn play a role in hemostasis. We investigated whether admission leukocytosis was associated with reduced bleeding after acute ICH. METHODS Consecutive patients with primary ICH were prospectively collected from 1994 to 2015 and retrospectively analyzed. We included subjects with a follow-up computed tomographic scan available and automated complete white blood cell count performed within 48 hours from onset. Baseline and follow-up hematoma volumes were calculated with semiautomated software, and hematoma expansion was defined as volume increase >30% or 6 mL. The association between white blood cell count and ICH expansion was investigated with multivariate logistic regression. RESULTS A total of 1302 subjects met eligibility criteria (median age, 75 years; 55.8% men), of whom 207 (15.9%) experienced hematoma expansion. Higher leukocyte count on admission was associated with reduced risk of hematoma expansion (odds ratio for 1000 cells increase, 0.91; 95% confidence interval, 0.86-0.96; P=0.001). The risk of hematoma expansion was inversely associated with neutrophil count (odds ratio, 0.90; 95% confidence interval, 0.85-0.96; P=0.001) and directly associated with monocyte count (odds ratio, 2.71; 95% confidence interval, 1.08-6.83; P=0.034). There was no association between lymphocyte count and ICH expansion (odds ratio, 0.96; 95% confidence interval, 0.79-1.17; P=0.718). CONCLUSIONS Higher admission white blood cell count is associated with lower risk of hematoma expansion. This highlights a potential role of the inflammatory response in modulating the coagulation cascade after acute ICH.
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Affiliation(s)
- Andrea Morotti
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston.
| | - Chia-Ling Phuah
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Christopher D Anderson
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Michael J Jessel
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Kristin Schwab
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Alison M Ayres
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Alessandro Pezzini
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Alessandro Padovani
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - M Edip Gurol
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Anand Viswanathan
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Steven M Greenberg
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Joshua N Goldstein
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Jonathan Rosand
- From the Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy (A.M., A. Pezzini, A. Padovani); Division of Neurocritical Care and Emergency Neurology, Department of Neurology (A.M., C.-L.P., C.D.A., M.J.J., J.N.G., J.R.), Hemorrhagic Stroke Research Center (A.M., C.-L.P., C.D.A., M.J.J., K.S., A.A., M.E.G., A.V., S.M.G., J.N.G., J.R.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
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Abstract
OPINION STATEMENT Fever in the neurocritical care unit has a high prevalence and is associated with worse outcomes in patients with severe neurologic illness. While it is well accepted that fever is associated with worse outcomes in this patient population, it is unclear if aggressive temperature management will improve outcomes. Temperature should be monitored routinely in this high-risk population, fever worked up appropriately to identify infectious etiology, and reasonable measures taken to control elevated temperature. While infection is a common source of fever in patients with significant neurologic illness, the fever may also be exacerbated by the underlying brain injury. The clinician must decide at which point to initiate fever control measures, how aggressively to manage the fever, and which temperature to target for normothermia. Several pharmacological agents are available as first-line therapy. Depending on the degree and severity of the febrile response, advanced temperature-control devices should be added to pharmacological measures. Several types of temperature-control devices are available, including invasive (intravascular catheters) and noninvasive (external cooling pads) technologies. The clinician should utilize both pharmacologic and device-based temperature therapies to minimize the amount of time spent in a febrile state and help to mitigate the secondary brain injury brought on by fever.
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Sukumari-Ramesh S, Alleyne CH. Post-Injury Administration of Tert-butylhydroquinone Attenuates Acute Neurological Injury After Intracerebral Hemorrhage in Mice. J Mol Neurosci 2016; 58:525-31. [PMID: 26867538 DOI: 10.1007/s12031-016-0722-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/18/2016] [Indexed: 12/11/2022]
Abstract
Intracerebral hemorrhage (ICH) is a severe form of stroke with substantial public health impact. Notably, there is no effective treatment for ICH. Given the role of transcription factor Nrf2 (NF-E2-related factor 2) in antioxidant signaling, herein, we tested the efficacy of tert-butylhydroquinone (TBHQ), a selective inducer of Nrf2 in a preclinical model of ICH. Male CD1 mice were subjected to experimental intracerebral hemorrhage and administered intraperitoneally with TBHQ. The administration of TBHQ enhanced the DNA-binding activity of Nrf2 in the brain and reduced oxidative brain damage in comparison to vehicle-treated ICH. In addition, TBHQ treatment reduced microglial activation with concomitant reduction in the release of proinflammatory cytokine interleukin-1β (IL-1 β). Furthermore, TBHQ treatment attenuated neurodegeneration and improved neurological outcomes after ICH. Altogether, the data demonstrate the efficacy of post-injury administration of TBHQ in attenuating acute neurological injury after ICH.
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Affiliation(s)
- Sangeetha Sukumari-Ramesh
- Department of Neurosurgery, Georgia Regents University, 1120 15th Street, CA1010, Augusta, GA, 30912, USA.
| | - Cargill H Alleyne
- Department of Neurosurgery, Georgia Regents University, 1120 15th Street, CA1010, Augusta, GA, 30912, USA
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168
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Dowlatshahi D, Brouwers HB, Demchuk AM, Hill MD, Aviv RI, Ufholz LA, Reaume M, Wintermark M, Hemphill JC, Murai Y, Wang Y, Zhao X, Wang Y, Li N, Sorimachi T, Matsumae M, Steiner T, Rizos T, Greenberg SM, Romero JM, Rosand J, Goldstein JN, Sharma M. Predicting Intracerebral Hemorrhage Growth With the Spot Sign: The Effect of Onset-to-Scan Time. Stroke 2016; 47:695-700. [PMID: 26846857 DOI: 10.1161/strokeaha.115.012012] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/06/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Hematoma expansion after acute intracerebral hemorrhage is common and is associated with early deterioration and poor clinical outcome. The computed tomographic angiography (CTA) spot sign is a promising predictor of expansion; however, frequency and predictive values are variable across studies, possibly because of differences in onset-to-CTA time. We performed a patient-level meta-analysis to define the relationship between onset-to-CTA time and frequency and predictive ability of the spot sign. METHODS We completed a systematic review for studies of CTA spot sign and hematoma expansion. We subsequently pooled patient-level data on the frequency and predictive values for significant hematoma expansion according to 5 predefined categorized onset-to-CTA times. We calculated spot-sign frequency both as raw and frequency-adjusted rates. RESULTS Among 2051 studies identified, 12 met our inclusion criteria. Baseline hematoma volume, spot-sign status, and time-to-CTA were available for 1176 patients, and 1039 patients had follow-up computed tomographies for hematoma expansion analysis. The overall spot sign frequency was 26%, decreasing from 39% within 2 hours of onset to 13% beyond 8 hours (P<0.001). There was a significant decrease in hematoma expansion in spot-positive patients as onset-to-CTA time increased (P=0.004), with positive predictive values decreasing from 53% to 33%. CONCLUSIONS The frequency of the CTA spot sign is inversely related to intracerebral hemorrhage onset-to-CTA time. Furthermore, the positive predictive value of the spot sign for significant hematoma expansion decreases as time-to-CTA increases. Our results offer more precise risk stratification for patients with acute intracerebral hemorrhage and will help refine clinical prediction rules for intracerebral hemorrhage expansion.
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Affiliation(s)
- Dar Dowlatshahi
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.).
| | - H Bart Brouwers
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Andrew M Demchuk
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Michael D Hill
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Richard I Aviv
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Lee-Anne Ufholz
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Michael Reaume
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Max Wintermark
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - J Claude Hemphill
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Yasuo Murai
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Yongjun Wang
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Xingquan Zhao
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Yilong Wang
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Na Li
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Takatoshi Sorimachi
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Mitsunori Matsumae
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Thorsten Steiner
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Timolaos Rizos
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Steven M Greenberg
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Javier M Romero
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Jonathan Rosand
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Joshua N Goldstein
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
| | - Mukul Sharma
- From the Department of Medicine, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (D.D., M.R.); Departments of Neurology (H.B.B., S.M.G., J.R.), Radiology (J.M.R.) and Emergency Medicine (J.N.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands (H.B.B.); Department of Clinical Neurosciences, Hotchkiss Brain Institute and Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada (A.M.D., M.D.H.); Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Toronto, ON, Canada (R.I.A.); Health Sciences Library, University of Ottawa, Ottawa, Ontario, Canada (L.-A.U.); Department of Radiology, Neuroradiology Division, Stanford University, Stanford, CA (M.W.); Department of Neurology, University of California, San Francisco (J.C.H.); Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan (Y.M.); Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (Yongjun Wang, X.Z., Yilong Wang, N.L.); Department of Neurosurgery, Tokai University, Japan (T. Sorimachi, M.M.); Department of Neurology, University of Heidelberg, Germany (T. Steiner, T.R.); Klinikum Frankfurt Höchst, Germany (T. Steiner); and Department of Medicine, McMaster University, Population Health Research Institute, Hamilton, Ontario, Canada (M.S.)
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Krishnan K, Scutt P, Woodhouse L, Adami A, Becker JL, Cala LA, Casado AM, Chen C, Dineen RA, Gommans J, Koumellis P, Christensen H, Collins R, Czlonkowska A, Lees KR, Ntaios G, Ozturk S, Phillips SJ, Sprigg N, Szatmari S, Wardlaw JM, Bath PM. Continuing versus Stopping Prestroke Antihypertensive Therapy in Acute Intracerebral Hemorrhage: A Subgroup Analysis of the Efficacy of Nitric Oxide in Stroke Trial. J Stroke Cerebrovasc Dis 2016; 25:1017-1026. [PMID: 26853137 PMCID: PMC4851456 DOI: 10.1016/j.jstrokecerebrovasdis.2016.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 12/29/2015] [Accepted: 01/02/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND PURPOSE More than 50% of patients with acute intracerebral hemorrhage (ICH) are taking antihypertensive drugs before ictus. Although antihypertensive therapy should be given long term for secondary prevention, whether to continue or stop such treatment during the acute phase of ICH remains unclear, a question that was addressed in the Efficacy of Nitric Oxide in Stroke (ENOS) trial. METHODS ENOS was an international multicenter, prospective, randomized, blinded endpoint trial. Among 629 patients with ICH and systolic blood pressure between 140 and 220 mmHg, 246 patients who were taking antihypertensive drugs were assigned to continue (n = 119) or to stop (n = 127) taking drugs temporarily for 7 days. The primary outcome was the modified Rankin Score at 90 days. Secondary outcomes included death, length of stay in hospital, discharge destination, activities of daily living, mood, cognition, and quality of life. RESULTS Blood pressure level (baseline 171/92 mmHg) fell in both groups but was significantly lower at 7 days in those patients assigned to continue antihypertensive drugs (difference 9.4/3.5 mmHg, P < .01). At 90 days, the primary outcome did not differ between the groups; the adjusted common odds ratio (OR) for worse outcome with continue versus stop drugs was .92 (95% confidence interval, .45-1.89; P = .83). There was no difference between the treatment groups for any secondary outcome measure, or rates of death or serious adverse events. CONCLUSIONS Among patients with acute ICH, immediate continuation of antihypertensive drugs during the first week did not reduce death or major disability in comparison to stopping treatment temporarily.
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Affiliation(s)
- Kailash Krishnan
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Polly Scutt
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Lisa Woodhouse
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Alessandro Adami
- Stroke Centre, Ospedale Sacro Cuore Via Sempreboni, Verona, Italy
| | - Jennifer L Becker
- Department of Medical Imaging, College of Medicine, The University of Arizona, Tucson, Arizona
| | - Lesley A Cala
- School of Pathology and Laboratory Medicine, The University of Western Australia, Nedlands, Australia
| | - Ana M Casado
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom
| | - Christopher Chen
- Department of Pharmacology, National University Hospital of Singapore, Singapore
| | - Robert A Dineen
- Radiological Sciences Research Group, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - John Gommans
- Department of Medicine, Hawke's Bay Hospital, Hastings, New Zealand
| | - Panos Koumellis
- Department of Neuroradiology, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, United Kingdom
| | | | - Ronan Collins
- Stroke Service, Adelaide and Meath Hospital, Dublin, Ireland
| | - Anna Czlonkowska
- Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Kennedy R Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - George Ntaios
- Department of Medicine, University of Thessaly, Larissa, Greece
| | - Serefnur Ozturk
- Department of Neurology, Selcuk University Medical Faculty, Konya, Turkey
| | - Stephen J Phillips
- Division of Neurology, Queen Elizabeth II Health Sciences Centre, and Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nikola Sprigg
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom
| | - Szabolcs Szatmari
- Department of Neurology, Clinical County Emergency Hospital, Targu Mures, Romania
| | - Joanna M Wardlaw
- Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, Western General Hospital, Edinburgh, United Kingdom
| | - Philip M Bath
- Stroke Trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom.
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170
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Dowlatshahi D, Yogendrakumar V, Aviv RI, Rodriguez-Luna D, Molina CA, Silva Y, Dzialowski I, Czlonkowska A, Boulanger JM, Lum C, Gubitz G, Padma V, Roy J, Kase CS, Bhatia R, Hill MD, Demchuk AM. Small intracerebral hemorrhages have a low spot sign prevalence and are less likely to expand. Int J Stroke 2016; 11:191-7. [DOI: 10.1177/1747493015616635] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Hematoma expansion is a major predictor of morbidity and mortality after intracerebral hemorrhage (ICH). Both baseline hematoma volume and the CT-angiogram (CTA) spot sign predict hematoma expansion. Because the CTA spot sign may represent foci of active hemorrhage, we hypothesized that patients with smaller baseline hematoma volumes are less likely to be spot sign positive, and therefore less likely to expand. Aim We sought to validate our prior finding that small hematomas are unlikely to expand, and to determine the relationship between baseline hematoma volume, spot sign status, and risk of hematoma expansion. Methods Data were from the prospective PREDICT ICH study. Patients presenting within 6 h of symptom onset with completed baseline CT, CTA, and follow-up CT were included. Baseline hematoma volume was categorized a priori (<3 mL, 3–10 mL, 10–20 mL, >20 mL). The primary outcome was significant hematoma expansion (≥6 mL, ≥12.5 mL or ≥33%) and secondary outcomes were early neurological worsening, good clinical outcome (modified Rankin Scale 0–3), and mortality at 90 days. Results Among 315 patients meeting the inclusion criteria, baseline hematoma volume category predicted absolute hematoma expansion ( p < 0.001), spot sign prevalence ( p < 0.001), early neurologic worsening ( p = 0.002), clinical outcome ( p < 0.001), and mortality ( p < 0.001). Very small hematomas (<3 mL) were unlikely to be spot positive (7.7%), unlikely to expand (2.6%), and were associated with a 73% chance of good clinical outcome. Spot sign appeared to be most predictive of expansion in the 3–10 mL baseline hematoma volume category. Conclusion Very small hematomas are unlikely to expand and have a low spot sign prevalence. Hemostatic therapy trials may be best targeted at hemorrhages >3 mL in volume.
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Affiliation(s)
- Dar Dowlatshahi
- Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
| | - Vignan Yogendrakumar
- Department of Medicine (Neurology), University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
| | - Richard I Aviv
- Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - David Rodriguez-Luna
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Yolanda Silva
- Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona (IDIBGi) Foundation, Girona, Spain
| | - Imanuel Dzialowski
- Department of Neurology, Elblandklinikum Meissen Academic Teaching Hospital of the Technische University, Dresden, Germany
| | - Anna Czlonkowska
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Jean-Martin Boulanger
- Department of Medicine, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, Canada
| | - Cheemun Lum
- Department of Diagnostic Imaging, Neuroradiology Section, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Gord Gubitz
- Department of Neurology, Dalhousie University, Halifax, Canada
| | - Vasantha Padma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Jayanta Roy
- AMRI Neurosciences Center, Mukundapurz, Kolkata, India
| | - Carlos S Kase
- Department of Neurology, Boston Medical Center, Boston, USA
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Michael D Hill
- Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Calgary Stroke Program, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Andrew M Demchuk
- Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
- Calgary Stroke Program, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
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172
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Yu S, Arima H, Heeley E, Delcourt C, Krause M, Peng B, Yang J, Wu G, Chen X, Chalmers J, Anderson CS. White blood cell count and clinical outcomes after intracerebral hemorrhage: The INTERACT2 trial. J Neurol Sci 2015; 361:112-6. [PMID: 26810526 DOI: 10.1016/j.jns.2015.12.033] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 12/19/2015] [Accepted: 12/21/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Increased inflammatory reaction can aggravate brain injury after acute intracerebral hemorrhage, but the clinical effect of such response is not fully understood. The aim of this study was to determine associations of peripheral white blood cell (WBC) count on clinical outcome among participants of the INTERACT2 study. METHODS INTERACT2 was a randomized controlled trial of early intensive (target systolic level<140 mm Hg) compared to guideline-recommended (target systolic level < 180 mm Hg) blood pressure (BP) lowering in 2839 patients with acute ICH (<6h) and elevated systolic BP (150-220 mm Hg). Blood samples were collected on admission and WBC count was measured at local laboratories. The primary outcome was death or major disability, defined by scores 3-6 on the modified Rankin Scale at 90 days. Secondary outcome was death at 90 days. Associations of baseline WBC count and outcomes were evaluated in logistic regression models. INTERACT2 is registered with http://www.clinicaltrials.gov NCT00716079. RESULTS There were 2630 participants with relevant data who were classified into quartiles of WBC counts (≤ 6.22, 6.24-7.89, 7.90-10.17, and ≥ 10.20 × 10(9)/L, respectively). Increased WBC count was associated with younger age, elevated body temperature, increased glucose level, stroke severity, larger baseline hematoma volume, and intraventricular extension. Risks of death or major disability at 90 days increased progressively with higher WBC count: frequencies of 49.9%, 52.0%, 52.3% and 58.1% for quartile groups, respectively (P=0.004 for trend). However, after adjustment for baseline clinical and imaging variables including age, sex, region, lipid lowering therapy, body temperature, glucose, systolic BP, heart rate, high NIHSS scores, volume and location of hematoma, intraventricular extension, time from onset to CT scan, and randomized treatment, the association between WBC count and primary outcome was no longer significant (P=0.426 for trend). Patients with increased WBC count had significantly higher risk of death (P=0.0003 for trend), but again the association was no longer significant after adjustment for baseline clinical and imaging variables. CONCLUSIONS Elevated WBC count on admission is not an independent prognostic variable in patients with acute ICH.
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Affiliation(s)
- Sungwook Yu
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea; The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Hisatomi Arima
- The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Emma Heeley
- The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Candice Delcourt
- The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Martin Krause
- Department of Neurology, Royal North Shore Hospital, St Leonards, University of Sydney, Sydney, Australia
| | - Bin Peng
- Peking Union Medical College Hospital, Beijing, China
| | - Jie Yang
- The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia; Department of Neurology, Nanjing, Hospital affiliated to Nanjing Medical University, China
| | - Guojun Wu
- The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia; Department of Neurology, Hebei Yutian Hospital, China
| | - Xiaoying Chen
- The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - John Chalmers
- The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Craig S Anderson
- The George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
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Rodriguez-Luna D, Stewart T, Dowlatshahi D, Kosior JC, Aviv RI, Molina CA, Silva Y, Dzialowski I, Lum C, Czlonkowska A, Boulanger JM, Kase CS, Gubitz G, Bhatia R, Padma V, Roy J, Subramaniam S, Hill MD, Demchuk AM. Perihematomal Edema Is Greater in the Presence of a Spot Sign but Does Not Predict Intracerebral Hematoma Expansion. Stroke 2015; 47:350-5. [PMID: 26696644 DOI: 10.1161/strokeaha.115.011295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/10/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Perihematomal edema volume may be related to intracerebral hemorrhage (ICH) volume at baseline and, consequently, with hematoma expansion. However, the relationship between perihematomal edema and hematoma expansion has not been well established. We aimed to investigate the relationship among baseline perihematomal edema, the computed tomographic angiography spot sign, hematoma expansion, and clinical outcome in patients with acute ICH. METHODS Predicting Hematoma Growth and Outcome in Intracerebral Hemorrhage Using Contrast Bolus CT (PREDICT) was a prospective observational cohort study of ICH patients presenting within 6 hours from onset. Patients underwent computed tomography and computed tomographic angiography scans at baseline and 24-hour computed tomography scan. A post hoc analysis of absolute perihematomal edema and relative perihematomal edema (absolute perihematomal edema divided by ICH) volumes was performed on baseline computed tomography scans (n=353). Primary outcome was significant hematoma expansion (>6 mL or >33%). Secondary outcomes were early neurological deterioration, 90-day mortality, and poor outcome. RESULTS Absolute perihematomal edema volume was higher in spot sign patients (24.5 [11.5-41.8] versus 12.6 [6.9-22] mL; P<0.001), but it was strongly correlated with ICH volume (ρ=0.905; P<0.001). Patients who experienced significant hematoma expansion had higher absolute perihematomal edema volume (18.4 [10-34.6] versus 11.8 [6.5-22] mL; P<0.001) but similar relative perihematomal edema volume (1.09 [0.89-1.37] versus 1.12 [0.88-1.54]; P=0.400). Absolute perihematomal edema volume and poorer outcomes were higher by tertiles of ICH volume, and perihematomal edema volume did not independently predict significant hematoma expansion. CONCLUSIONS Perihematomal edema volume is greater at baseline in the presence of a spot sign. However, it is strongly correlated with ICH volume and does not independently predict hematoma expansion.
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Affiliation(s)
- David Rodriguez-Luna
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Teri Stewart
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Dar Dowlatshahi
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Jayme C Kosior
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Richard I Aviv
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Carlos A Molina
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Yolanda Silva
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Imanuel Dzialowski
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Cheemun Lum
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Anna Czlonkowska
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Jean-Martin Boulanger
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Carlos S Kase
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Gord Gubitz
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Rohit Bhatia
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Vasantha Padma
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Jayanta Roy
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Suresh Subramaniam
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Michael D Hill
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.)
| | - Andrew M Demchuk
- From the Stroke Unit, Department of Neurology, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute, Barcelona, Spain (D.R.-L., C.A.M.); Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (D.R.-L., T.S., S.S., M.D.H., A.M.D.); Department of Medicine, Neurology, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (D.D.); Cybertrial Medical Software Inc, Edmonton, Canada (J.C.K.); Division of Neuroradiology and Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (R.I.A.); Department of Neurology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica Girona Foundation, Girona, Spain (Y.S.); Department of Neurology, Elblandkliniken Meissen, Academic Teaching Hospital of University of Dresden, Dresden, Germany (I.D.); Department of Diagnostic Imaging, Neuroradiology Section, The Ottawa Hospital, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada (C.L.); 2nd Department of Neurology, Institute of Psychiatry and Neurology of Warsaw, and Department of Clinical and Experimental Pharmacology, Medical University of Warsaw, Warsaw, Poland (A.C.); Department of Neurology, Charles LeMoyne Hospital, University of Sherbrooke, Montreal, QC, Canada (J.M.B.); Department of Neurology, Boston Medical Center, MA (C.S.K.); Department of Neurology, Dalhousie University, Halifax, NS, Canada (G.G.); Department of Neurology, All India Institute of Medical Sciences, New Delhi, India (R.B., V.P.); and Department of Neurology, Apollo Gleneagles Hospitals, Kolkata, India (J.R.).
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Experimental animal models and inflammatory cellular changes in cerebral ischemic and hemorrhagic stroke. Neurosci Bull 2015; 31:717-34. [PMID: 26625873 DOI: 10.1007/s12264-015-1567-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 09/25/2015] [Indexed: 01/04/2023] Open
Abstract
Stroke, including cerebral ischemia, intracerebral hemorrhage, and subarachnoid hemorrhage, is the leading cause of long-term disability and death worldwide. Animal models have greatly contributed to our understanding of the risk factors and the pathophysiology of stroke, as well as the development of therapeutic strategies for its treatment. Further development and investigation of experimental models, however, are needed to elucidate the pathogenesis of stroke and to enhance and expand novel therapeutic targets. In this article, we provide an overview of the characteristics of commonly-used animal models of stroke and focus on the inflammatory responses to cerebral stroke, which may provide insights into a framework for developing effective therapies for stroke in humans.
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John S, Stock S, Cerejo R, Uchino K, Winners S, Russman A, Masaryk T, Rasmussen P, Hussain MS. Brain Imaging Using Mobile CT: Current Status and Future Prospects. J Neuroimaging 2015; 26:5-15. [PMID: 26593629 DOI: 10.1111/jon.12319] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/22/2015] [Accepted: 09/27/2015] [Indexed: 11/28/2022] Open
Abstract
Computed tomography (CT) is an invaluable tool in the diagnosis of many clinical conditions. Several advancements in biomedical engineering have achieved increase in speed, improvements in low-contrast detectability and image quality, and lower radiation. Portable or mobile CT constituted one such important advancement. It is especially useful in evaluating critically ill, intensive care unit patients by scanning them at bedside. A paradigm shift in utilization of mobile CT was its installation in ambulances for the management of acute stroke. Given the time sensitive nature of acute ischemic stroke, Mobile stroke units (MSU) were developed in Germany consisting of an ambulance equipped with a CT scanner, point of care laboratory system, along with teleradiological support. In a radical reconfiguration of stroke care, the MSU would bring the CT scanner to the stroke patient, without waiting for the patient at the emergency room. Two separate MSU projects in Saarland and Berlin demonstrated the safety and feasibility of this concept for prehospital stroke care, showing increased rate of intravenous thrombolysis and significant reduction in time to treatment compared to conventional care. MSU also improved the triage of patients to appropriate and specialized hospitals. Although multiple issues remain yet unanswered with the MSU concept including clinical outcome and cost-effectiveness, the MSU venture is visionary and enables delivery of life-saving and enhancing treatment for ischemic and hemorrhagic stroke. In this review, we discuss the development of mobile CT and its applications, with specific focus on its use in MSUs along with our institution's MSU experience.
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Affiliation(s)
- Seby John
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH
| | - Sarah Stock
- Department of Neuroradiology, Cleveland Clinic, Cleveland, OH
| | | | - Ken Uchino
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH
| | | | | | - Thomas Masaryk
- Department of Neuroradiology, Cleveland Clinic, Cleveland, OH
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176
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Gu SJ, Lu M, Xuan HF, Chen XZ, Dong WF, Yan XF, Si Y, Gao GL, Hu DX, Miao JQ. Predictive value of serum caspase-cleaved cytokeratin-18 concentrations after acute intracerebral hemorrhage. Clin Chim Acta 2015; 452:124-8. [PMID: 26569346 DOI: 10.1016/j.cca.2015.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 11/06/2015] [Accepted: 11/09/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Caspase-cleaved Cytokeratin-18 (CCCK-18) is released during apoptosis. Serum CCCK-18 concentrations are associated with prognosis of some critical illness. We investigated the potential relationships between serum CCCK-18 concentrations and disease severity and long-term clinical outcomes after intracerebral hemorrhage. METHODS Serum CCCK-18 concentrations were determined in a total of 102 patients and 102 controls. Multivariate models were used to predict high concentration of CCCK-18 and 6-month clinical outcomes. The predictive values were evaluated based on areas under receiver operating curve. RESULTS Compared with controls, serum CCCK-18 concentrations were increased in patients (245.8±108.3U/l vs. 23.6±18.1U/l, P<0.001). National Institute of Health Stroke Scale scores [odds ratio (OR), 1.164; 95% confidence interval (CI), 1.027-1.320; P=0.003] and hematoma volumes (OR, 1.079; 95% CI, 1.018-1.205; P=0.008) were independent predictors of high concentration of CCCK-18. CCCK-18 was identified as an independent predictor of 6-month mortality (OR, 1.019; 95% CI, 1.010-1.038; P=0.013) and 6-month unfavorable outcome (OR, 1.017; 95% CI, 1.008-1.029; P=0.032) and possessed high predictive values. CONCLUSION Increased serum CCCK-18 concentrations are associated with disease severity and clinical outcomes, suggesting that CCCK represent a novel prognostic predictive biomarker after intracerebral hemorrhage.
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Affiliation(s)
- Shui-Jun Gu
- Department of Neurosurgery, The first people's Hospital of Xiaoshan District of Hangzhou City, 199 Shixin South Road, Xiaoshan District, Hangzhou 311200, China
| | - Ming Lu
- Department of Neurosurgery, The first people's Hospital of Xiaoshan District of Hangzhou City, 199 Shixin South Road, Xiaoshan District, Hangzhou 311200, China.
| | - Hong-Fei Xuan
- Department of Neurosurgery, The first people's Hospital of Xiaoshan District of Hangzhou City, 199 Shixin South Road, Xiaoshan District, Hangzhou 311200, China
| | - Xin-Zhi Chen
- Department of Neurosurgery, The first people's Hospital of Xiaoshan District of Hangzhou City, 199 Shixin South Road, Xiaoshan District, Hangzhou 311200, China
| | - Wei-Feng Dong
- Department of Neurosurgery, The first people's Hospital of Xiaoshan District of Hangzhou City, 199 Shixin South Road, Xiaoshan District, Hangzhou 311200, China
| | - Xiao-Feng Yan
- Department of Neurosurgery, The first people's Hospital of Xiaoshan District of Hangzhou City, 199 Shixin South Road, Xiaoshan District, Hangzhou 311200, China
| | - Yun Si
- Department of Neurosurgery, The first people's Hospital of Xiaoshan District of Hangzhou City, 199 Shixin South Road, Xiaoshan District, Hangzhou 311200, China
| | - Guo-Liang Gao
- Department of Neurosurgery, The first people's Hospital of Xiaoshan District of Hangzhou City, 199 Shixin South Road, Xiaoshan District, Hangzhou 311200, China
| | - Dian-Xiang Hu
- Department of Neurosurgery, The first people's Hospital of Xiaoshan District of Hangzhou City, 199 Shixin South Road, Xiaoshan District, Hangzhou 311200, China
| | - Jian-Qing Miao
- Department of Neurosurgery, The first people's Hospital of Xiaoshan District of Hangzhou City, 199 Shixin South Road, Xiaoshan District, Hangzhou 311200, China
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177
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Chou SHY, Robertson CS. Monitoring biomarkers of cellular injury and death in acute brain injury. Neurocrit Care 2015; 21 Suppl 2:S187-214. [PMID: 25208676 DOI: 10.1007/s12028-014-0039-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Molecular biomarkers have revolutionalized diagnosis and treatment of many diseases, such as troponin use in myocardial infarction. Urgent need for high-fidelity biomarkers in neurocritical care has resulted in numerous studies reporting potential candidate biomarkers. METHODS We performed an electronic literature search and systematic review of English language articles on cellular/molecular biomarkers associated with outcome and with disease-specific secondary complications in adult patients with acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), traumatic brain injury (TBI), and post-cardiac arrest hypoxic ischemic encephalopathic injuries (HIE). RESULTS A total of 135 articles were included. Though a wide variety of potential biomarkers have been identified, only neuron-specific enolase has been validated in large cohorts and shows 100% specificity for poor outcome prediction in HIE patients not treated with therapeutic hypothermia. There are many promising candidate blood and CSF biomarkers in SAH, AIS, ICH, and TBI, but none yet meets criteria for routine clinical use. CONCLUSION Current studies vary significantly in patient selection, biosample collection/processing, and biomarker measurement protocols, thereby limiting the generalizability of overall results. Future large prospective studies with standardized treatment, biosample collection, and biomarker measurement and validation protocols are necessary to identify high-fidelity biomarkers in neurocritical care.
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Affiliation(s)
- Sherry H-Y Chou
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA,
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178
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Kim HT, Lee JM, Koh EJ, Choi HY. Surgery versus Conservative Treatment for Spontaneous Supratentorial Intracerebral Hemorrhage in Spot Sign Positive Patients. J Korean Neurosurg Soc 2015; 58:309-15. [PMID: 26587182 PMCID: PMC4651989 DOI: 10.3340/jkns.2015.58.4.309] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 08/05/2015] [Accepted: 09/03/2015] [Indexed: 12/04/2022] Open
Abstract
Objective An advantage of surgical treatment over conservative treatment of spontaneous intracerebral hemorrhage (ICH) is controversial. Recent reports suggest that contrast extravasations on CT angiography (CTA) might serve as a crucial predictor of hematoma expansion and mortality. The purpose of this study was aimed at investigating the efficacy of surgical treatment in patients with spot sign positive ICH. Methods We used our institutional medical data search system to identify all adult patients who admitted for treatment of ICH between January 1, 2007 and January 31, 2012. Patients were classified two groups into a surgical group (n=27) and a conservative treatment group (n=28). Admission criteria were the following: age 20-79 years, spontaneous supratentorial ICH, Glasgow Coma Score Ranging from 9 to 14, ICH volume ≥20 mL, and treatment within 24 hours. Results Fifty-five patients were analyzed. There was no significant difference in the ICU stay between the conservative treatment group (7.36±3.66 days) and the surgical treatment group (6.93±2.20 days; p=0.950). There was a significant difference in the in-hospital stay between the conservative treatment group (13.93±8.87 days) and the surgical treatment group (20.33±6.37 days; p=0.001). Overall mortality at day 90 after ICH was 36.4%; this included 16 of 28 patients (57.1%) in the conservative group and 4 of 27 patients (14.8%) in the surgical group. In univariate analysis, there was a positive effect of the surgical treatment in reducing mortality at 90 days (p=0.002), Glasgow Outcome Scale (GOS) at 90-day (p=0.006), and modified Rankin Scale (mRS) at 90-day (p=0.023). In multivariate logistic analysis, there was a significant difference in mortality (odds ratio, 0.211; 95% confidence interval, 0.049-0.906; p=0.036) between the groups at 90-day follow-up. However, there was no significant difference in GOS (odds ratio, 0.371; 95% confidence interval, 0.031-4.446; p=0.434) and mRS (odds ratio, 1.041; 95% confidence interval, 0.086-12.637; p=0.975) between the groups at 90-day follow-up. Conclusion In this study of surgical treatment of supratentorial ICH in patients with spot sign positive in CTA was associated with less mortality despite of long duration of in-hospital stay. We failed to show that clinical outcome benefit of surgical treatment compared with conservative treatment in patients with spot sign positive ICH.
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Affiliation(s)
- Hui-Tae Kim
- Department of Neurosurgery, Chonbuk National University Hospital and Medical School, Jeonju, Korea
| | - Jong-Myong Lee
- Department of Neurosurgery, Chonbuk National University Hospital and Medical School, Jeonju, Korea
| | - Eun-Jeong Koh
- Department of Neurosurgery, Chonbuk National University Hospital and Medical School, Jeonju, Korea
| | - Ha-Young Choi
- Department of Neurosurgery, Chonbuk National University Hospital and Medical School, Jeonju, Korea
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179
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Wang F, Hu S, Ding Y, Ju X, Wang L, Lu Q, Wu X. Neutrophil-to-Lymphocyte Ratio and 30-Day Mortality in Patients with Acute Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2015; 25:182-7. [PMID: 26500171 DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 08/22/2015] [Accepted: 09/15/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although a highly significant association has been described between neutrophil-to-lymphocyte ratio (NLR) and mortality in patients with various types of stroke, the association between NLR and mortality in intracerebral hemorrhage (ICH) patients remains unclear. METHODS In this observational study, we enrolled 224 ICH patients. They were divided into 2 groups based on their 30-day outcomes. Multivariate logistic regression was performed to identify independent risk factors of 30-day mortality. An optimal cutoff value for the continuous NLR was calculated by applying a receiver operating curve analysis to discriminate between the survival and death groups. RESULTS Among 224 patients, 26 died. No significant difference in NLR at admission was observed between the 2 groups (surviving: 2.39 ± 1.75 versus nonsurviving: 3.09 ± 2.16, P= .065), whereas NLR on the next morning following admission was significantly higher in the patients who died (12.53 ± 9.33) than in those who survived (5.53 ± 4.68) (P <.001). On multivariate logistic analysis, Glasgow Coma Scale score (odds ratio [OR] .805, 95% confidence interval [CI] .661-.979, P = .030), age (≥80 years; OR .203, CI .055-.750, P = .017), ICH volume (≥30 cm(3); OR .112, CI .108-.699, P = .019), and NLR on the next morning (OR 1.091, CI 1.002-1.188, P = .044) were independent risk factors of 30-day mortality. An NLR of 7.35 was identified as the optimal cutoff value. The area under the curve of NLR for 30-day mortality was .762 (P < .001). The mortality was significantly higher in patients with an NLR of 7.35 or higher than in those with an NLR less than 7.35 (31.6% versus 4.8%, P <.001). CONCLUSIONS Higher NLR exhibited an increased mortality in ICH patients. NLR could be used to predict 30-day outcome in ICH patients.
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Affiliation(s)
- Fei Wang
- Emergency Department, Jiading District Center Hospital, Shanghai, China
| | - Shanyou Hu
- Emergency Department, Jiading District Center Hospital, Shanghai, China
| | - Yong Ding
- Community Health Center, Shanghai, China
| | - Xuefeng Ju
- Emergency Department, Jiading District Center Hospital, Shanghai, China
| | - Li Wang
- Emergency Department, Jiading District Center Hospital, Shanghai, China
| | - Qiuxia Lu
- Community Health Center, Shanghai, China
| | - Xiao Wu
- Emergency Department, Jiading District Center Hospital, Shanghai, China.
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180
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Sato S, Carcel C, Anderson CS. Blood Pressure Management After Intracerebral Hemorrhage. Curr Treat Options Neurol 2015; 17:49. [PMID: 26478247 DOI: 10.1007/s11940-015-0382-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OPINION STATEMENT Elevated blood pressure (BP), which presents in approximately 80 % of patients with acute intracerebral hemorrhage (ICH), is associated with increased risk of poor outcome. The Second Intensive Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT2) study, a multinational, multicenter, randomized controlled trial published in 2013, demonstrated better functional outcomes with no harm for patients with acute spontaneous ICH within 6 h of onset who received target-driven, early intensive BP lowering (systolic BP target <140 mmHg within 1 h, continued for 7 days) and suggested that greater and faster reduction in BP might enhance the treatment effect by limiting hematoma growth. The trial resulted in revisions of guidelines for acute management of ICH, in which intensive BP lowering in patients with acute ICH is recommended as safe and effective treatment for improving functional outcome. BP lowering is also the only intervention that is proven to reduce the risk of recurrent ICH. Current evidences from several randomized trials, including PROGRESS and SPS3, indicate that long-term strict BP control in patients with ICH is safe and could offer additional benefits in major reduction in risk of recurrent ICH. The latest American Heart Association/American Stroke Association (AHA/ASA) guidelines recommended a target BP of <130/80 mmHg after ICH, but supporting evidence is limited. Randomized controlled trials are needed that focus on strict BP control, initiated early after onset of the disease and continued long-term, to demonstrate effective prevention of recurrent stroke and other major vascular events without additional harms in the ICH population.
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Affiliation(s)
- Shoichiro Sato
- Neurological & Mental Health Division, The George Institute for Global Health, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, Sydney, 2050, NSW, Australia
| | - Cheryl Carcel
- Neurological & Mental Health Division, The George Institute for Global Health, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, Sydney, 2050, NSW, Australia.,Sydney Medical School, The University of Sydney, Edward Ford Building A27, Sydney, 2006, NSW, Australia.,Royal Prince Alfred Hospital, Level 11, King George V Building, 83-117 Missenden Rd, Camperdown, Sydney, 2050, NSW, Australia
| | - Craig S Anderson
- Neurological & Mental Health Division, The George Institute for Global Health, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, Sydney, 2050, NSW, Australia. .,Sydney Medical School, The University of Sydney, Edward Ford Building A27, Sydney, 2006, NSW, Australia. .,Royal Prince Alfred Hospital, Level 11, King George V Building, 83-117 Missenden Rd, Camperdown, Sydney, 2050, NSW, Australia.
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181
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Hu X, Li YK, You C. Letter by Hu et al Regarding Article, "Monocyte Count and 30-Day Case Fatality in Intracerebral Hemorrhage". Stroke 2015; 46:e243. [PMID: 26463693 DOI: 10.1161/strokeaha.115.011206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Xin Hu
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yun-Ke Li
- West China Hospital/West China Medical School, Sichuan University, Chengdu, People's Republic of China
| | - Chao You
- Stroke Clinical Research Unit, Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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182
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Behrouz R, Hafeez S, Mutgi SA, Zakaria A, Miller CM. Hypomagnesemia in Intracerebral Hemorrhage. World Neurosurg 2015; 84:1929-32. [PMID: 26341430 DOI: 10.1016/j.wneu.2015.08.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/08/2015] [Accepted: 08/10/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Magnesium (Mg) is an essential element for the body's normal physiological functioning. It has a major role in modulating vascular smooth muscle tone and peripheral arterial resistance. A low serum Mg level on admission (HMg0) has been associated with more severe presentation in patients with subarachnoid hemorrhage. However, data on HMg0 specifically in relation to intracerebral hemorrhage (ICH) are scarce. We sought to determine the incidence and clinical significance of HMg0 in patients with ICH. METHODS We reviewed the records of consecutive patients with ICH over a 2-year period. Data collected included initial Mg levels (Mg0), clinical and radiologic characteristics on presentation, and discharge outcomes. Regression analysis was performed to look for any association of low Mg0 with admission blood pressure (BP) and Glasgow Coma Scale (GCS) scores. We also examined the correlation of HMg0 with clinical/radiologic features, admission severity (based on the ICH score), and poor outcome on discharge. RESULTS In all, 33.6% presented with HMg0. Mg0 levels were negatively associated with systolic BP presentation (P < 0.0001) and positively associated with the initial GCS scores (P = 0.01). Multivariate logistic regression showed an association between HMg0 and severity at presentation (P = 0.03), but not with poor outcome on discharge (P = 0.26). CONCLUSIONS HMg0 occurs in one third of patients with ICH and is associated with more severe presentation and intraventricular hemorrhage. Mg levels on admission correlate inversely with systolic BP and directly with GCS scores at presentation. HMg0 does not influence outcomes at discharge.
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Affiliation(s)
- Réza Behrouz
- Division of Cerebrovascular Diseases, Department of Neurology, School of Medicine, University of Texas Health Science Center San Antonio, San Antonio, Texas, USA.
| | - Shaheryar Hafeez
- Department of Neurology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Sunil A Mutgi
- Department of Neurology, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Asma Zakaria
- Neuro Critical Care Unit, Division of Neurosciences, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Chad M Miller
- Neurological Intensive Care Unit, Neuroscience Regional Development and Clinical Integration, OhioHealth, Columbus, Ohio, USA
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183
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Ovesen C, Christensen AF, Havsteen I, Krarup Hansen C, Rosenbaum S, Kurt E, Christensen H. Prediction and prognostication of neurological deterioration in patients with acute ICH: a hospital-based cohort study. BMJ Open 2015. [PMID: 26220872 PMCID: PMC4521514 DOI: 10.1136/bmjopen-2015-008563] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Patients with intracerebral haemorrhage (ICH) are at high risk of neurological deterioration (ND). We aimed at establishing predictors of early ND (END) as well as late ND (LND) and at exploring the impact of neurological stability during the first week on long-term prognosis. DESIGN We conducted this study as a retrospective cohort study. ND was evaluated based on the consciousness and severity of neurological symptoms. ND during the first 24 h after admission was defined as early ND and from 24 h to 7 days as LND. Patients were followed up until February 2015. PARTICIPANTS We included 300 patients with acute ICH (≤4.5 h from symptom onset) who were admitted to our institution from March 2009 to January 2015. SETTING Section of Acute Neurology, Department of Neurology, Bispebjerg Hospital is a specialised referral centre receiving patients with acute stroke from the entire capital region of Denmark. RESULTS We found that a spot sign on CT angiography (OR 10.7 CI 4.79 to 24.3) and extensive degree of interventricular haemorrhage (IVH) (OR 8.73 CI 2.87 to 26.5) were independent predictors of END, whereas a degree of comorbidity (Charlton Index), admission stroke severity and degree of IVH predicted LND. On follow-up imaging, haematoma expansion was independently associated with END (OR 6.1 CI 2.2 to 17.3), and expansion of IVH was independently associated with both END (OR 1.7 CI 1.2 to 2.3 per point increase) and LND (OR 2.3 CI 1.3 to 4.2 per point increase). ND during the first week was associated with a 1-year mortality of 60.5%, compared with 9.2% among the patients who remained stable. CONCLUSIONS These results suggest that stability during the first week entails an optimistic prognosis. A relatively easy and effective risk stratification of END and LND is possible on admission based on the spot sign, IVH and clinical parameters.
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Affiliation(s)
- Christian Ovesen
- Section of Acute Neurology, Departments of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Inger Havsteen
- Department of Radiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Christine Krarup Hansen
- Section of Acute Neurology, Departments of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Sverre Rosenbaum
- Section of Acute Neurology, Departments of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Engin Kurt
- Department of Radiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Hanne Christensen
- Section of Acute Neurology, Departments of Neurology, Bispebjerg Hospital, Copenhagen, Denmark
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184
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Maas MB, Berman MD, Guth JC, Liotta EM, Prabhakaran S, Naidech AM. Neurochecks as a Biomarker of the Temporal Profile and Clinical Impact of Neurologic Changes after Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2015; 24:2026-31. [PMID: 26143415 DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/12/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We sought to determine whether a quantitative neurocheck biomarker could characterize the temporal pattern of early neurologic changes after intracerebral hemorrhage (ICH), and the impact of those changes on long-term functional outcomes. METHODS We enrolled cases of spontaneous ICH in a prospective observational study. Patients underwent a baseline Glasgow Coma Scale (GCS) assessment, then hourly neurochecks using the GCS in a neuroscience intensive care unit. We identified a period of heightened neurologic instability by analyzing the average hourly rate of GCS change over 5 days from symptom onset. We used a multivariate regression model to test whether those early GCS score changes were independently associated with 3-month outcome measured by the modified Rankin Scale (mRS). RESULTS We studied 13,025 hours of monitoring from 132 cases. The average rate of neurologic change declined from 1.0 GCS points per hour initially to a stable baseline of .1 GCS points per hour beyond 12 hours from symptom onset (P < .05 for intervals before 12 hours). Change in GCS score within the initial 12 hours was an independent predictor of mRS at 3 months (odds ratio, .81 [95% confidence interval, .66-.99], P = .043) after adjustment for age, hematoma volume, hematoma location, initial GCS, and intraventricular hemorrhage. CONCLUSIONS Neurochecks are effective at detecting clinically important neurologic changes in the intensive care unit setting that are relevant to patients' long-term outcomes. The initial 12 hours is a period of frequent and prognostically important neurologic changes in patients with ICH.
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Affiliation(s)
- Matthew B Maas
- Department of Neurology, Northwestern University, Chicago, Illinois.
| | - Michael D Berman
- Department of Neurology, Northwestern University, Chicago, Illinois
| | - James C Guth
- Department of Neurology, Loma Linda University, Loma Linda, California
| | - Eric M Liotta
- Department of Neurology, Northwestern University, Chicago, Illinois
| | | | - Andrew M Naidech
- Department of Neurology, Northwestern University, Chicago, Illinois
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185
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Walsh KB, Sekar P, Langefeld CD, Moomaw CJ, Elkind MSV, Boehme AK, James ML, Osborne J, Sheth KN, Woo D, Adeoye O. Monocyte Count and 30-Day Case Fatality in Intracerebral Hemorrhage. Stroke 2015; 46:2302-4. [PMID: 26130090 DOI: 10.1161/strokeaha.115.009880] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/04/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Monocytes may contribute to secondary injury after intracerebral hemorrhage (ICH). We tested the association of absolute monocyte count with 30-day ICH case fatality in a multiethnic cohort. METHODS Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a prospective, multicenter, case-control study of ICH among white, black, and Hispanic patients. In 240 adults with nontraumatic ICH within 24 hours of symptom onset, we evaluated the influence of ICH score and complete blood count components on 30-day case fatality using generalized linear models. RESULTS Mean age was 62.8 years (SD, 14 years); 61.7% were men, 33.3% black, and 29.6% Hispanic. Median ICH volume was 9.9 mL (interquartile range, 4.4-26.7). After adjusting for patient age and initial hemoglobin, higher total white blood cell count (P=0.0011), driven by higher absolute neutrophil count (P=0.002), was associated with larger ICH volume, whereas absolute monocyte count was not (P=0.15). After adjusting for age, Glasgow Coma Scale, ICH volume, location, and the presence or absence of intraventricular hemorrhage, baseline absolute monocyte count was independently associated with higher 30-day case-fatality (odds ratio, 5.39; 95% confidence interval, 1.87-15.49; P=0.0018), whereas absolute neutrophil count (odds ratio, 1.04; 0.46-2.32; P=0.93) and white blood cell count (odds ratio, 1.62; 0.58-4.54; P=0.36) were not. CONCLUSIONS These data support an independent association between higher admission absolute monocyte count and 30-day case-fatality in ICH. Inquiry into monocyte-mediated pathways of inflammation and apoptosis may elucidate the basis for the observed association and may be targets for ICH neuroprotection.
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Affiliation(s)
- Kyle B Walsh
- From the Department of Emergency Medicine (K.B.W., O.A.) and Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati (UC), OH; Department of Biostatistics, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); Department of Neurology, College of Physicians and Surgeons, and Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E., A.K.B.); Departments of Anesthesiology and Neurology, Duke University, Durham, NC (M.L.J.); Department of Neurology, Yale University, New Haven, CT (K.N.S.); and UC Neuroscience Institute, OH (D.W., O.A.)
| | - Padmini Sekar
- From the Department of Emergency Medicine (K.B.W., O.A.) and Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati (UC), OH; Department of Biostatistics, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); Department of Neurology, College of Physicians and Surgeons, and Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E., A.K.B.); Departments of Anesthesiology and Neurology, Duke University, Durham, NC (M.L.J.); Department of Neurology, Yale University, New Haven, CT (K.N.S.); and UC Neuroscience Institute, OH (D.W., O.A.)
| | - Carl D Langefeld
- From the Department of Emergency Medicine (K.B.W., O.A.) and Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati (UC), OH; Department of Biostatistics, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); Department of Neurology, College of Physicians and Surgeons, and Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E., A.K.B.); Departments of Anesthesiology and Neurology, Duke University, Durham, NC (M.L.J.); Department of Neurology, Yale University, New Haven, CT (K.N.S.); and UC Neuroscience Institute, OH (D.W., O.A.)
| | - Charles J Moomaw
- From the Department of Emergency Medicine (K.B.W., O.A.) and Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati (UC), OH; Department of Biostatistics, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); Department of Neurology, College of Physicians and Surgeons, and Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E., A.K.B.); Departments of Anesthesiology and Neurology, Duke University, Durham, NC (M.L.J.); Department of Neurology, Yale University, New Haven, CT (K.N.S.); and UC Neuroscience Institute, OH (D.W., O.A.)
| | - Mitchell S V Elkind
- From the Department of Emergency Medicine (K.B.W., O.A.) and Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati (UC), OH; Department of Biostatistics, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); Department of Neurology, College of Physicians and Surgeons, and Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E., A.K.B.); Departments of Anesthesiology and Neurology, Duke University, Durham, NC (M.L.J.); Department of Neurology, Yale University, New Haven, CT (K.N.S.); and UC Neuroscience Institute, OH (D.W., O.A.)
| | - Amelia K Boehme
- From the Department of Emergency Medicine (K.B.W., O.A.) and Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati (UC), OH; Department of Biostatistics, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); Department of Neurology, College of Physicians and Surgeons, and Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E., A.K.B.); Departments of Anesthesiology and Neurology, Duke University, Durham, NC (M.L.J.); Department of Neurology, Yale University, New Haven, CT (K.N.S.); and UC Neuroscience Institute, OH (D.W., O.A.)
| | - Michael L James
- From the Department of Emergency Medicine (K.B.W., O.A.) and Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati (UC), OH; Department of Biostatistics, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); Department of Neurology, College of Physicians and Surgeons, and Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E., A.K.B.); Departments of Anesthesiology and Neurology, Duke University, Durham, NC (M.L.J.); Department of Neurology, Yale University, New Haven, CT (K.N.S.); and UC Neuroscience Institute, OH (D.W., O.A.)
| | - Jennifer Osborne
- From the Department of Emergency Medicine (K.B.W., O.A.) and Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati (UC), OH; Department of Biostatistics, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); Department of Neurology, College of Physicians and Surgeons, and Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E., A.K.B.); Departments of Anesthesiology and Neurology, Duke University, Durham, NC (M.L.J.); Department of Neurology, Yale University, New Haven, CT (K.N.S.); and UC Neuroscience Institute, OH (D.W., O.A.)
| | - Kevin N Sheth
- From the Department of Emergency Medicine (K.B.W., O.A.) and Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati (UC), OH; Department of Biostatistics, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); Department of Neurology, College of Physicians and Surgeons, and Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E., A.K.B.); Departments of Anesthesiology and Neurology, Duke University, Durham, NC (M.L.J.); Department of Neurology, Yale University, New Haven, CT (K.N.S.); and UC Neuroscience Institute, OH (D.W., O.A.)
| | - Daniel Woo
- From the Department of Emergency Medicine (K.B.W., O.A.) and Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati (UC), OH; Department of Biostatistics, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); Department of Neurology, College of Physicians and Surgeons, and Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E., A.K.B.); Departments of Anesthesiology and Neurology, Duke University, Durham, NC (M.L.J.); Department of Neurology, Yale University, New Haven, CT (K.N.S.); and UC Neuroscience Institute, OH (D.W., O.A.)
| | - Opeolu Adeoye
- From the Department of Emergency Medicine (K.B.W., O.A.) and Department of Neurology and Rehabilitation Medicine (P.S., C.J.M., J.O., D.W.), University of Cincinnati (UC), OH; Department of Biostatistics, Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC (C.D.L.); Department of Neurology, College of Physicians and Surgeons, and Epidemiology, Mailman School of Public Health, Columbia University, New York, NY (M.S.V.E., A.K.B.); Departments of Anesthesiology and Neurology, Duke University, Durham, NC (M.L.J.); Department of Neurology, Yale University, New Haven, CT (K.N.S.); and UC Neuroscience Institute, OH (D.W., O.A.).
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186
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Lord AS, Karinja S, Lantigua H, Carpenter A, Schmidt JM, Claassen J, Agarwal S, Connolly ES, Mayer SA, Badjatia N. Therapeutic temperature modulation for fever after intracerebral hemorrhage. Neurocrit Care 2015; 21:200-6. [PMID: 24420694 DOI: 10.1007/s12028-013-9948-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND We sought to determine whether therapeutic temperature modulation (TTM) to treat fever after intracerebral hemorrhage (ICH) is associated with improved hospital complications and discharge outcomes. METHODS We performed a retrospective case-control study of patients admitted with spontaneous ICH having two consecutive fevers ≥38.3 °C despite acetaminophen administration. Cases were enrolled from a prospective database of patients receiving TTM from 2006 to 2010. All cases received TTM for fever control with goal temperature of 37 °C with a shiver-control protocol. Controls were matched in severity by ICH score and retrospectively obtained from 2001 to 2004, before routine use of TTM for ICH. Primary outcome was discharge-modified Rankin score. RESULTS Forty patients were enrolled in each group. Median admission ICH Score, ICH volume, and GCS were similar. TTM was initiated with a median of 3 days after ICH onset and for a median duration of 7 days. Mean daily T max was significantly higher in the control group over the first 12 days (38.1 vs. 38.7 °C, p ≤ 0.001). The TTM group had more days of IV sedation (median 8 vs. 1, p < 0.001) and mechanical ventilation (18 vs. 9, p = 0.003), and more frequently underwent tracheostomy (55 vs. 23 %, p = 0.005). Mean NICU length of stay was longer for TTM patients (15 vs. 11 days, p = 0.007). There was no difference in discharge outcomes between the two groups (overall mortality 33 %, moderate or severe disability 67 %). CONCLUSIONS Therapeutic normothermia is associated with increased duration of sedation, mechanical ventilation, and NICU stay, but is not clearly associated with improved discharge outcome.
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Affiliation(s)
- Aaron S Lord
- Department of Neurology, New York University, New York, NY, USA,
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Hemphill JC, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015; 46:2032-60. [PMID: 26022637 DOI: 10.1161/str.0000000000000069] [Citation(s) in RCA: 1979] [Impact Index Per Article: 219.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of spontaneous intracerebral hemorrhage. METHODS A formal literature search of PubMed was performed through the end of August 2013. The writing committee met by teleconference to discuss narrative text and recommendations. Recommendations follow the American Heart Association/American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Oversight Committee and Stroke Council Leadership Committee. RESULTS Evidence-based guidelines are presented for the care of patients with acute intracerebral hemorrhage. Topics focused on diagnosis, management of coagulopathy and blood pressure, prevention and control of secondary brain injury and intracranial pressure, the role of surgery, outcome prediction, rehabilitation, secondary prevention, and future considerations. Results of new phase 3 trials were incorporated. CONCLUSIONS Intracerebral hemorrhage remains a serious condition for which early aggressive care is warranted. These guidelines provide a framework for goal-directed treatment of the patient with intracerebral hemorrhage.
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189
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Tong DM, Zhou YT, Wang GS, Chen XD, Yang TH. Early prediction and outcome of septic encephalopathy in acute stroke patients with nosocomial coma. J Clin Med Res 2015; 7:534-9. [PMID: 26015818 PMCID: PMC4432895 DOI: 10.14740/jocmr2176w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2015] [Indexed: 12/05/2022] Open
Abstract
Background Septic encephalopathy (SE) is the most common acute encephalopathy in ICU; however, little attention has been focused on risk of SE in the course of acute stroke. Our aim is to investigate the early prediction and outcome of SE in stroke patients with nosocomial coma (NC). Methods A retrospective cohort study was conducted in an ICU of the tertiary teaching hospital in China from January 2006 to December 2009. Ninety-four acute stroke patients with NC were grouped according to with or without SE. Risk factors for patients with SE were compared with those without SE by univariate and multivariate analysis. Results Of 94 stroke patients with NC, 46 (49%) had NC with SE and 48 (51%) had NC without SE. The onset-to-NC time was significant later in stroke patients with SE than those without SE (P < 0.01). There was a significant difference in body temperature, heart rate, respiratory rate, white blood cell (WBC), systolic blood pressure (SBP), diastolic blood pressure (DBP), systemic inflammatory response syndrome (SIRS), acute respiratory failure, septic shock, hypernatremia, and sequential organ failure assessment (SOFA) score between the SE and non-SE group (P < 0.05). On a repeat head imaging, vasogenic edema (P = 0.023) and subcortical white matter lesions (P = 0.011) were significantly higher in patients with SE than those without SE, while hematoma growth (P = 0.000), infarction progress (P = 0.003), and recurrent subarachnoid hemorrhage (SAH) (P = 0.011) were significantly lower in patients with SE than those without SE. Patients with SE had higher adjusted rates of fever ≥ 39 °C (odds ratio (OR): 2.753; 95% confidence interval (CI): 1.116 - 6.794; P = 0.028) and SIRS ≥ 3 items (OR: 6.459; 95% CI: 2.050 - 20.351; P = 0.001). The 30-day mortality in stroke patients with SE was higher than those without SE (76.1% vs. 45.8%, P = 0.003). Conclusion High fever and severe SIRS are two early predictors of stroke patients with SE, and survival rates were worse in stroke patients with SE than those without SE.
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Affiliation(s)
- Dao-Ming Tong
- Department of Neurology, Affiliated Shuyang People's Hospital, XuZhou Medical College, Jiangsu, China ; Department of Neurology, the Affiliated Pingxiang Hospital, Southern Medical University, China ; These authors contributed equally to this work and shared first authorship
| | - Ye-Ting Zhou
- Medical Evaluation Unit, Affiliated Shuyang People's Hospital, XuZhou Medical College, Jiangsu, China ; These authors contributed equally to this work and shared first authorship
| | - Guang-Sheng Wang
- Department of Neurology, Affiliated Shuyang People's Hospital, XuZhou Medical College, Jiangsu, China
| | - Xiao-Dong Chen
- Department of Neurology, Affiliated Shuyang People's Hospital, XuZhou Medical College, Jiangsu, China
| | - Tong-Hui Yang
- Department of Neurology, Affiliated Shuyang People's Hospital, XuZhou Medical College, Jiangsu, China
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190
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Relative systolic blood pressure reduction and clinical outcomes in hyperacute intracerebral hemorrhage. J Hypertens 2015; 33:1069-73. [DOI: 10.1097/hjh.0000000000000512] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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191
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Blood Pressure Guideline Adherence in Patients with Ischemic and Hemorrhagic Stroke in the Neurointensive Care Unit Setting. Neurocrit Care 2015; 23:313-20. [DOI: 10.1007/s12028-015-0116-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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192
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Blood Pressure Variability and Clinical Outcome in Patients with Acute Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2015; 24:1493-9. [PMID: 25873472 DOI: 10.1016/j.jstrokecerebrovasdis.2015.03.014] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/06/2015] [Accepted: 03/12/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate whether fluctuations of blood pressure (BP) levels occurring in the acute stage of spontaneous intracerebral hemorrhage (ICH) affect the 3-month clinical outcome. METHODS We retrospectively identified consecutive patients hospitalized for acute spontaneous ICH. BP measurements over the first 72 hours from the onset of symptoms were recorded, and standard deviation (SD), coefficient of variation (CV), and maximum-minimum difference (max-min) were determined to characterize both systolic and diastolic BP variability (BPV). The measure of outcome was the 3-month functional status assessed by the modified Rankin Scale following a baseline severity-adjusted analysis. RESULTS Among the 138 enrolled patients with ICH, 67 (48.6%) were classified as having a poor 3-month functional recovery. A dose-response relationship with poor outcome was found for each measure of systolic BPV--adjusted odds ratios (ORs) for the highest thirds of SD 7.95 (95% confidence interval [CI], 2.88-21.90), CV 7.74 (95% CI, 2.88-20.80), and max-min 8.36 (95% CI, 2.72-25.62; P < .001). The strength of association with diastolic BPV turned out to be weaker and significant only for the higher values (adjusted ORs for the highest thirds of SD 6.74 [95% CI, 2.52-18.04], CV 4.57 [95% CI, 1.77-11.81], and max-min 4.34 [95% CI, 1.72-10.93]). CONCLUSIONS In patients with acute ICH, BPV was a strong predictor of the 3-month clinical outcome and may represent a still neglected potential therapeutic target.
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Yang J, Arima H, Wu G, Heeley E, Delcourt C, Zhou J, Chen G, Wang X, Zhang S, Yu S, Chalmers J, Anderson CS. Prognostic Significance of Perihematomal Edema in Acute Intracerebral Hemorrhage. Stroke 2015; 46:1009-13. [PMID: 25712944 DOI: 10.1161/strokeaha.114.007154] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jie Yang
- From the Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.Y., J.Z.); The George Institute for Global Health, Central Clinical School, University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (J.Y., H.A., G.W., E.H., C.D., G.C., X.W., S.Z., S.Y., J.C., C.S.A.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W.); Department of Neurology, Xuzhou Central Hospital, Xuzhou, China (G
| | - Hisatomi Arima
- From the Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.Y., J.Z.); The George Institute for Global Health, Central Clinical School, University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (J.Y., H.A., G.W., E.H., C.D., G.C., X.W., S.Z., S.Y., J.C., C.S.A.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W.); Department of Neurology, Xuzhou Central Hospital, Xuzhou, China (G
| | - Guojun Wu
- From the Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.Y., J.Z.); The George Institute for Global Health, Central Clinical School, University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (J.Y., H.A., G.W., E.H., C.D., G.C., X.W., S.Z., S.Y., J.C., C.S.A.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W.); Department of Neurology, Xuzhou Central Hospital, Xuzhou, China (G
| | - Emma Heeley
- From the Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.Y., J.Z.); The George Institute for Global Health, Central Clinical School, University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (J.Y., H.A., G.W., E.H., C.D., G.C., X.W., S.Z., S.Y., J.C., C.S.A.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W.); Department of Neurology, Xuzhou Central Hospital, Xuzhou, China (G
| | - Candice Delcourt
- From the Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.Y., J.Z.); The George Institute for Global Health, Central Clinical School, University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (J.Y., H.A., G.W., E.H., C.D., G.C., X.W., S.Z., S.Y., J.C., C.S.A.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W.); Department of Neurology, Xuzhou Central Hospital, Xuzhou, China (G
| | - Junshan Zhou
- From the Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.Y., J.Z.); The George Institute for Global Health, Central Clinical School, University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (J.Y., H.A., G.W., E.H., C.D., G.C., X.W., S.Z., S.Y., J.C., C.S.A.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W.); Department of Neurology, Xuzhou Central Hospital, Xuzhou, China (G
| | - Guofang Chen
- From the Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.Y., J.Z.); The George Institute for Global Health, Central Clinical School, University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (J.Y., H.A., G.W., E.H., C.D., G.C., X.W., S.Z., S.Y., J.C., C.S.A.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W.); Department of Neurology, Xuzhou Central Hospital, Xuzhou, China (G
| | - Xia Wang
- From the Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.Y., J.Z.); The George Institute for Global Health, Central Clinical School, University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (J.Y., H.A., G.W., E.H., C.D., G.C., X.W., S.Z., S.Y., J.C., C.S.A.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W.); Department of Neurology, Xuzhou Central Hospital, Xuzhou, China (G
| | - Shihong Zhang
- From the Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.Y., J.Z.); The George Institute for Global Health, Central Clinical School, University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (J.Y., H.A., G.W., E.H., C.D., G.C., X.W., S.Z., S.Y., J.C., C.S.A.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W.); Department of Neurology, Xuzhou Central Hospital, Xuzhou, China (G
| | - Sungwook Yu
- From the Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.Y., J.Z.); The George Institute for Global Health, Central Clinical School, University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (J.Y., H.A., G.W., E.H., C.D., G.C., X.W., S.Z., S.Y., J.C., C.S.A.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W.); Department of Neurology, Xuzhou Central Hospital, Xuzhou, China (G
| | - John Chalmers
- From the Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.Y., J.Z.); The George Institute for Global Health, Central Clinical School, University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (J.Y., H.A., G.W., E.H., C.D., G.C., X.W., S.Z., S.Y., J.C., C.S.A.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W.); Department of Neurology, Xuzhou Central Hospital, Xuzhou, China (G
| | - Craig S. Anderson
- From the Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China (J.Y., J.Z.); The George Institute for Global Health, Central Clinical School, University of Sydney and Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia (J.Y., H.A., G.W., E.H., C.D., G.C., X.W., S.Z., S.Y., J.C., C.S.A.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W.); Department of Neurology, Xuzhou Central Hospital, Xuzhou, China (G
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Chan E, Anderson CS, Wang X, Arima H, Saxena A, Moullaali TJ, Heeley E, Delcourt C, Wu G, Wang J, Chen G, Lavados PM, Stapf C, Robinson T, Chalmers J, Huang Y. Significance of Intraventricular Hemorrhage in Acute Intracerebral Hemorrhage. Stroke 2015; 46:653-8. [PMID: 25677598 DOI: 10.1161/strokeaha.114.008470] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Edward Chan
- From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de
| | - Craig S. Anderson
- From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de
| | - Xia Wang
- From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de
| | - Hisatomi Arima
- From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de
| | - Anubhav Saxena
- From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de
| | - Tom J. Moullaali
- From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de
| | - Emma Heeley
- From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de
| | - Candice Delcourt
- From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de
| | - Guojun Wu
- From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de
| | - Jinchao Wang
- From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de
| | - Guofang Chen
- From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de
| | - Pablo M. Lavados
- From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de
| | - Christian Stapf
- From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de
| | - Thompson Robinson
- From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de
| | - John Chalmers
- From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de
| | - Yining Huang
- From the George Institute for Global Health, Neurological and Mental Health Division, Royal Prince Alfred Hospital, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., T.J.M., E.H., C.D., J.C.); Central Clinical School, University of Sydney, Sydney, Australia (E.C., C.S.A., X.W., H.A., A.S., E.H., C.D., J.C.); Department of Neurology, Hebei Yutian Hospital, Tangshan, China (G.W., J.W.); Department of Neurology, Xuzhou Central Hospital, Jiangsu, China (G.C.); Servicio de Neurología, Departamento de
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Lord AS, Gilmore E, Choi HA, Mayer SA. Time course and predictors of neurological deterioration after intracerebral hemorrhage. Stroke 2015; 46:647-52. [PMID: 25657190 DOI: 10.1161/strokeaha.114.007704] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Neurological deterioration (ND) is a devastating complication after intracerebral hemorrhage but little is known about time course and predictors. METHODS We performed a retrospective cohort study of placebo patients in intracerebral hemorrhage trials. We performed computed tomographic scans within 3 hours of symptoms and at 24 and 72 hours; and clinical evaluations at baseline, 1-hour, and days 1, 2, 3, and 15. Timing of ND was predefined as follows: hyperacute (within 1 hour), acute (1-24 hours), subacute (1-3 days), and delayed (3-15 days). RESULTS We enrolled 376 patients and 176 (47%) had ND within 15 days. In multivariate analyses of ND by category, hyperacute ND was associated with hematoma expansion (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.7-7.6) and baseline intracerebral hemorrhage volume (OR, 1.04 per mL; 95% CI 1.02-1.06); acute ND with hematoma expansion (OR, 7.59; 95% CI, 3.91-14.74), baseline intracerebral hemorrhage volume (OR, 1.02 per mL; 95% CI, 1.01-1.04), admission Glasgow Coma Scale (OR, 0.77 per point; 95% CI, 0.65-0.91), and interventricular hemorrhage (OR, 2.14; 95% CI, 1.05-4.35); subacute ND with 72-hour edema (OR, 1.03 per mL; 95% CI, 1.02-1.05) and fever (OR, 2.49; 95% CI, 1.01-6.14); and delayed ND with age (OR, 1.11 per year; 95% CI, 1.04-1.18), troponin (OR, 4.30 per point; 95% CI, 1.71-10.77), and infections (OR, 3.69; 95% CI, 1.11-12.23). Patients with ND had worse 90-day modified Rankin scores (5 versus 3; P<0.001). CONCLUSIONS ND occurs frequently and predicts poor outcomes. Our results implicate hematoma expansion and interventricular hemorrhage in early ND, and cerebral edema, fever, and medical complications in later ND.
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Affiliation(s)
- Aaron S Lord
- From the Division of Neurocritical Care, Department of Neurology, New York University School of Medicine (A.S.L.); Division of Neurocritical Care, Department of Neurology, Yale University School of Medicine (E.G.); Division of Neurocritical Care, Department of Neurology, University of Texas, Houston (H.A.C.); and Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, NY (S.A.M.).
| | - Emily Gilmore
- From the Division of Neurocritical Care, Department of Neurology, New York University School of Medicine (A.S.L.); Division of Neurocritical Care, Department of Neurology, Yale University School of Medicine (E.G.); Division of Neurocritical Care, Department of Neurology, University of Texas, Houston (H.A.C.); and Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, NY (S.A.M.)
| | - H Alex Choi
- From the Division of Neurocritical Care, Department of Neurology, New York University School of Medicine (A.S.L.); Division of Neurocritical Care, Department of Neurology, Yale University School of Medicine (E.G.); Division of Neurocritical Care, Department of Neurology, University of Texas, Houston (H.A.C.); and Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, NY (S.A.M.)
| | - Stephan A Mayer
- From the Division of Neurocritical Care, Department of Neurology, New York University School of Medicine (A.S.L.); Division of Neurocritical Care, Department of Neurology, Yale University School of Medicine (E.G.); Division of Neurocritical Care, Department of Neurology, University of Texas, Houston (H.A.C.); and Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, NY (S.A.M.)
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Wang X, Arima H, Al-Shahi Salman R, Woodward M, Heeley E, Stapf C, Lavados PM, Robinson T, Huang Y, Wang J, Delcourt C, Anderson CS. Clinical Prediction Algorithm (BRAIN) to Determine Risk of Hematoma Growth in Acute Intracerebral Hemorrhage. Stroke 2015; 46:376-81. [DOI: 10.1161/strokeaha.114.006910] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Xia Wang
- From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP—HôpitalLariboisière and DHU NeuroVasc Paris—Sorbonne, Univ Paris Diderot—Sorbonne Paris Cité, Paris, France (C.S.); Servicio de
| | - Hisatomi Arima
- From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP—HôpitalLariboisière and DHU NeuroVasc Paris—Sorbonne, Univ Paris Diderot—Sorbonne Paris Cité, Paris, France (C.S.); Servicio de
| | - Rustam Al-Shahi Salman
- From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP—HôpitalLariboisière and DHU NeuroVasc Paris—Sorbonne, Univ Paris Diderot—Sorbonne Paris Cité, Paris, France (C.S.); Servicio de
| | - Mark Woodward
- From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP—HôpitalLariboisière and DHU NeuroVasc Paris—Sorbonne, Univ Paris Diderot—Sorbonne Paris Cité, Paris, France (C.S.); Servicio de
| | - Emma Heeley
- From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP—HôpitalLariboisière and DHU NeuroVasc Paris—Sorbonne, Univ Paris Diderot—Sorbonne Paris Cité, Paris, France (C.S.); Servicio de
| | - Christian Stapf
- From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP—HôpitalLariboisière and DHU NeuroVasc Paris—Sorbonne, Univ Paris Diderot—Sorbonne Paris Cité, Paris, France (C.S.); Servicio de
| | - Pablo M. Lavados
- From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP—HôpitalLariboisière and DHU NeuroVasc Paris—Sorbonne, Univ Paris Diderot—Sorbonne Paris Cité, Paris, France (C.S.); Servicio de
| | - Thompson Robinson
- From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP—HôpitalLariboisière and DHU NeuroVasc Paris—Sorbonne, Univ Paris Diderot—Sorbonne Paris Cité, Paris, France (C.S.); Servicio de
| | - Yining Huang
- From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP—HôpitalLariboisière and DHU NeuroVasc Paris—Sorbonne, Univ Paris Diderot—Sorbonne Paris Cité, Paris, France (C.S.); Servicio de
| | - Jiguang Wang
- From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP—HôpitalLariboisière and DHU NeuroVasc Paris—Sorbonne, Univ Paris Diderot—Sorbonne Paris Cité, Paris, France (C.S.); Servicio de
| | - Candice Delcourt
- From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP—HôpitalLariboisière and DHU NeuroVasc Paris—Sorbonne, Univ Paris Diderot—Sorbonne Paris Cité, Paris, France (C.S.); Servicio de
| | - Craig S. Anderson
- From the The George Institute for Global Health, University of Sydney, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Royal Prince Alfred Hospital, Sydney, Australia (X.W., H.A., M.W., E.H., C.D., C.S.A.); Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK (R.A.-S.S.); Department of Neurology, APHP—HôpitalLariboisière and DHU NeuroVasc Paris—Sorbonne, Univ Paris Diderot—Sorbonne Paris Cité, Paris, France (C.S.); Servicio de
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Rapid Pore Cranial Drilling With External Ventricular Drainage for Treatment of Intraventricular Hemorrhage: A 36-Year Case Series. Int Surg 2015; 100:1117-23. [PMID: 25590642 DOI: 10.9738/intsurg-d-14-00222.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study aimed to describe the technique details of rapid pore cranial drilling with external ventricular drainage and document its clinical outcomes by highlighting the advantages over the traditional and modified cranial drilling technique. Intraventricular hemorrhage is one of the most severe subtypes of hemorrhagic stroke with high mortality. The amount of blood in the ventricles is associated with severity of outcomes, and fast removal of the blood clot is the key to a good prognosis. Between 1977 and 2013, 3773 patients admitted for intraventricular hemorrhage underwent rapid pore cranial drilling drainage. The therapeutic effects and clinical outcomes were retrospectively analyzed. Of these patients, 1049 (27.8%) experienced complete remission, 1788 (47.4%) had improved condition, and 936 (24.8%) died. A total of 3229 (85.6%) patients gained immediate remission. One typical case was illustrated to demonstrate the efficacy of the rapid pore drilling technique. Rapid pore cranial drilling drainage in patients with intraventricular hemorrhage is fast, effective, and provides immediate relief in patients with severe conditions. It could be a better alternative to the conventional drilling approach for treatment of intraventricular hemorrhage. A randomized controlled trial for direct comparison between the rapid pore cranial drilling drainage and conventional drilling technique is in urgent need.
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Senn R, Elkind MSV, Montaner J, Christ-Crain M, Katan M. Potential role of blood biomarkers in the management of nontraumatic intracerebral hemorrhage. Cerebrovasc Dis 2014; 38:395-409. [PMID: 25471997 DOI: 10.1159/000366470] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/06/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intracerebral hemorrhage (ICH), a subtype of stroke associated with high mortality and disability, accounts for 13% of all strokes. Basic and clinical research has contributed to our understanding of the complex pathophysiology of neuronal injury in ICH. Outcome rates, however, remain stable, and questions regarding acute management of ICH remain unanswered. Newer research is aiming at matching measured levels of serum proteins, enzymes, or cells to different stages of brain damage, suggesting that blood biomarkers may assist in acute diagnosis, therapeutic decisions, and prognostication. This paper provides an overview on the most promising blood biomarkers and their potential role in the diagnosis and management of spontaneous ICH. SUMMARY Information was collected from studies, reviews, and guidelines listed in PubMed up to November 2013 on blood biomarkers of nontraumatic ICH in humans. We describe the potential role and limitations of GFAP, S100B/RAGE, and ApoC-III as diagnostic biomarkers, β-Amyloid as a biomarker for etiological classification, and 27 biomarkers for prognosis of mortality and functional outcome. Within the group of prognostic markers we discuss markers involved in coagulation processes (e.g., D-Dimers), neuroendocrine markers (e.g., copeptin), systemic metabolic markers (e.g., blood glucose levels), markers of inflammation (e.g., IL-6), as well as growth factors (e.g., VEGF), and others (e.g., glutamate). Some of those blood biomarkers are agents of pathologic processes associated with hemorrhagic stroke but also other diseases, whereas others play more distinct pathophysiological roles and help in understanding the basic mechanisms of brain damage and/or recovery in ICH. KEY MESSAGES Numerous blood biomarkers are associated with different pathophysiological pathways in ICH, and some of them promise to be useful in the management of ICH, eventually contributing additional information to current tools for diagnosis, therapy monitoring, risk stratification, or intervention. Up to date, however, no blood biomarker of ICH has been studied sufficiently to find its way into clinical routine yet; well-designed, large-scale, clinical studies addressing relevant clinical questions are needed. We suggest that the effectiveness of biomarker research in ICH might be improved by international cooperation and shared resources for large validation studies, such as provided by the consortium on stroke biomarker research (http://stroke-biomarkers.com/page.php?title=Resources).
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Affiliation(s)
- Rebecca Senn
- Department of Endocrinology, University Hospital Basel, Basel, Switzerland
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Han JH, Lee JM, Koh EJ, Choi HY. The spot sign predicts hematoma expansion, outcome, and mortality in patients with primary intracerebral hemorrhage. J Korean Neurosurg Soc 2014; 56:303-9. [PMID: 25371779 PMCID: PMC4219187 DOI: 10.3340/jkns.2014.56.4.303] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 08/01/2014] [Accepted: 10/17/2014] [Indexed: 11/29/2022] Open
Abstract
Objective The purpose of this study was to retrospectively review cases of intracerebral hemorrhage (ICH) medically treated at our institution to determine if the CT angiography (CTA) 'spot sign' predicts in-hospital mortality and clinical outcome at 3 months in patients with spontaneous ICH. Methods We conducted a retrospective review of all consecutive patients who were admitted to the department of neurosurgery. Clinical data of patients with ICH were collected by 2 neurosurgeons blinded to the radiological data and at the 90-day follow-up. Results Multivariate logistic regression analysis identified predictors of poor outcome; we found that hematoma location, spot sign, and intraventricular hemorrhage were independent predictors of poor outcome. In-hospital mortality was 57.4% (35 of 61) in the CTA spot-sign positive group versus 7.9% (10 of 126) in the CTA spot-sign negative group. In multivariate logistic analysis, we found that presence of spot sign and presence of volume expansion were independent predictors for the in-hospital mortality of ICH. Conclusion The spot sign is a strong independent predictor of hematoma expansion, mortality, and poor clinical outcome in primary ICH. In this study, we emphasized the importance of hematoma expansion as a therapeutic target in both clinical practice and research.
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Affiliation(s)
- Ju-Hee Han
- Department of Neurosurgery, Chonbuk National University Hospital and Medical School, Jeonju, Korea
| | - Jong-Myong Lee
- Department of Neurosurgery, Chonbuk National University Hospital and Medical School, Jeonju, Korea
| | - Eun-Jeong Koh
- Department of Neurosurgery, Chonbuk National University Hospital and Medical School, Jeonju, Korea
| | - Ha-Young Choi
- Department of Neurosurgery, Chonbuk National University Hospital and Medical School, Jeonju, Korea
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Aquilani R, Boselli M, Paola B, Pasini E, Iadarola P, Verri M, Viglio S, Condino A, Boschi F. Is stroke rehabilitation a metabolic problem? Brain Inj 2014; 28:161-73. [PMID: 24456056 DOI: 10.3109/02699052.2013.860470] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND This study looks at the impact of inflammation during the rehabilitation stage of strokes and its effect on neuro-functional recovery. METHODS This study investigated 94 patients suffering from strokes and admitted to rehabilitation. Anthropometric characteristics, serum proteins and inflammatory markers, plasma amino acids and neurofunction were all assessed. RESULTS 55.3% patients had an inflammatory status (Interleukin-6 = 19.24 ± 23.01 pg ml⁻¹ vs. 4.1 ± 1.6 pg ml⁻¹ for non-inflamed subjects (p < 0.001). Inflammation was positively linked to positive proteins (alpha-1 globulin, p < 0.02) and negatively linked to negative proteins (albumin, p < 0.02; prealbumin, p < 0.01; transferrin, p < 0.05) of the acute-phase response. Inflammation was associated with low plasma concentrations of total amino acids. For the multiple logistic regression analysis, albumin (p < 0.001) and body weight maintenance (p < 0.001) were independent predictors of patient functional independence. Inflammation in dysphagic stroke (31.9%) patients was associated with more accentuated disability compared to non-inflamed dysphagics. The serum positive reactant alpha 1 globulin was the most powerful predictor of dysphagia severity (p < 0.001). At discharge, dysphagia improvement was associated with improved acute-phase negative proteins. CONCLUSIONS An inflammatory status may persist for most patients with strokes during the rehabiliation stage of the disease, its prevalence being higher in dysphagic compared to non-dysphagic subjects. The improvement in circulating albumin and body weight maintenance are predictors of neuro-function, even in dysphagic subjects.
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Affiliation(s)
- Roberto Aquilani
- Servizio di Fisiopatologia Metabolico-Nutrizionale e Nutrizione Clinica
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