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Morotti A, Boulouis G, Nawabi J, Li Q, Charidimou A, Pasi M, Schlunk F, Shoamanesh A, Katsanos AH, Mazzacane F, Busto G, Arba F, Brancaleoni L, Giacomozzi S, Simonetti L, Warren AD, Laudisi M, Cavallini A, Gurol ME, Viswanathan A, Zini A, Casetta I, Fainardi E, Greenberg SM, Padovani A, Rosand J, Goldstein JN. Association Between Hematoma Expansion Severity and Outcome and Its Interaction With Baseline Intracerebral Hemorrhage Volume. Neurology 2023; 101:e1606-e1613. [PMID: 37604661 PMCID: PMC10585678 DOI: 10.1212/wnl.0000000000207728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/14/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Hematoma expansion (HE) is a major determinant of neurologic deterioration and poor outcome in intracerebral hemorrhage (ICH) and represents an appealing therapeutic target. We analyzed the prognostic effect of different degrees of HE. METHODS This was a retrospective analysis of patients with ICH admitted at 8 academic institutions in Italy, Germany, Canada, China, and the United States. All patients underwent baseline and follow-up imaging for HE assessment. Relative HE (rHE) was classified as follows: none (<0%), mild (0%-33%), moderate (33.1%-66%), and severe (>66%). Absolute HE (aHE) was classified as none (<0 mL), mild (0-6.0 mL), moderate (6.1-12.5 mL), and severe (>12.5 mL). Predictors of poor functional outcome (90 days modified Rankin Scale 4-6) were explored with logistic regression. RESULTS We included 2,163 patients, of whom 1,211 (56.0%) had poor outcome. The occurrence of severe aHE or rHE was more common in patients with unfavorable outcome (13.9% vs 6.5%, p < 0.001 and 18.3% vs 7.2%, p < 0.001 respectively). This association was confirmed in logistic regression (rHE odds ratio [OR] 1.98, 95% CI 1.38-2.82, p < 0.001; aHE OR 1.73, 95% CI 1.23-2.45, p = 0.002) while there was no association between mild or moderate HE and poor outcome. The association between severe HE and poor outcome was significant only in patients with baseline ICH volume below 30 mL. DISCUSSION The strongest association between HE and outcome was observed in patients with smaller initial volume experiencing severe HE. These findings may inform clinical trial design and guide clinicians in selecting patients for antiexpansion therapies.
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Affiliation(s)
- Andrea Morotti
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston.
| | - Gregoire Boulouis
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Jawed Nawabi
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Qi Li
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Andreas Charidimou
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Marco Pasi
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Frieder Schlunk
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Ashkan Shoamanesh
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Aristeidis H Katsanos
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Federico Mazzacane
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Giorgio Busto
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Francesco Arba
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Laura Brancaleoni
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Sebastiano Giacomozzi
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Luigi Simonetti
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Andrew D Warren
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Michele Laudisi
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Anna Cavallini
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - M Edip Gurol
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Anand Viswanathan
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Andrea Zini
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Ilaria Casetta
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Enrico Fainardi
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Steven M Greenberg
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Alessandro Padovani
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Jonathan Rosand
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Joshua N Goldstein
- From the Neurology Unit (A.M.), Department of Neurological Sciences and Vision, ASST-SpedaliCivili, Brescia, Italy; Neuroradiology Department (G. Boulouis), University Hospital of Tours, CEDEX 09, France; Department of Radiology (CCM) (J.N.), Charité-Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin Institute of Health; Berlin Institute of Health (BIH) (J.N., F.S.), BIH Biomedical Innovation Academy, Germany; Department of Neurology (Q.L.), The First Affiliated Hospital of Chongqing Medical University; Department of Neurology (Q.L.), The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Department of Neurology (A. Charidimou), Boston University Medical Center and Boston University School of Medicine, MA; Neurology Department (M.P.), University Hospital of Tours, CEDEX 09, France; Department of Neuroradiology (F.S.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Division of Neurology (A.S., A.H.K.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; U.O. Neurologia d'Urgenza e Stroke Unit (F.M., A. Cavallini), IRCCS Fondazione Mondino, Pavia; Department of Biomedical Experimental and Clinical Neuroradiology (G. Busto, E.F.), University of Firenze, AOU Careggi; Stroke Unit (F.A.), AOU Careggi, Firenze; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.B., S.G., A.Z.),UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore; IRCCS Istituto delle Scienze Neurologiche di Bologna (L.S.), Unità di Neuroradiologia, Ospedale Maggiore, Italy; J.P. Kistler Stroke Research Center (A.D.W., M.E.G., A.V., S.M.G., J.R., J.N.G.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Clinica Neurologica (M.L., I.C.), Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara; Department of Clinical and Experimental Sciences (A.P.), Neurology Unit, University of Brescia, Italy; Division of Neurocritical Care and Emergency Neurology (J.R.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; and Henry and Allison McCance Center for Brain Health (J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
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2
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Morotti A, Busto G, Boulouis G, Scola E, Padovani A, Casetta I, Fainardi E. Added value of non-contrast CT and CT perfusion markers for prediction of intracerebral hemorrhage expansion and outcome. Eur Radiol 2023; 33:690-698. [PMID: 35895123 DOI: 10.1007/s00330-022-08987-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/20/2022] [Accepted: 06/26/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To test the hypothesis that the combined analysis of non-contrast CT (NCCT) and CT perfusion (CTP) imaging markers improves prediction of hematoma expansion (HE) and outcome in intracerebral hemorrhage (ICH). METHODS Retrospective, single-center analysis of patients with primary ICH undergoing NCCT and CTP within 6 h from onset. NCCT images were assessed for the presence of intrahematomal hypodensity and shape irregularity. Perihematomal cerebral blood volume and spot sign were assessed on CTP. The main outcomes of the analysis were HE (growth > 6 mL and/or > 33%) and poor functional prognosis (90 days modified Rankin Scale 3-6). Predictors of HE and outcome were explored with logistic regression. RESULTS A total of 150 subjects were included (median age 68, 47.1% males) of whom 54 (36%) had HE and 52 (34.7%) had poor outcome. The number of imaging markers on baseline imaging was independently associated with HE (odds ratio 2.66, 95% confidence interval 1.70-4.17, p < 0.001) and outcome (odds ratio 1.64, 95% CI 1.06-2.56, p = 0.027). Patients with the simultaneous presence of all the four markers had the highest risk of HE and unfavorable prognosis (mean predicted probability of 91% and 79% respectively). The combined-markers analysis outperformed the sensitivity of the single markers analyzed separately. In particular, the presence of at least one marker identified patients with HE and poor outcome with 91% and 87% sensitivity respectively. CONCLUSION NCCT and CTP markers provide additional yield in the prediction of HE and ICH outcome. KEY POINTS • Perihematomal hypoperfusion is associated with hematoma expansion and poor outcome in acute intracerebral hemorrhage. • Non-contrast CT and CT perfusion markers improve prediction of hematoma expansion and unfavorable prognosis. • A multimodal CT protocol including CT perfusion will help the identification of patients at high risk of clinical deterioration and poor outcome.
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Affiliation(s)
- Andrea Morotti
- Neurology Unit, Department of Neurological Sciences and Vision, ASST Spedali Civili, Brescia, P.le Spedali Civili 1, 25100, Brescia, Italy.
| | - Giorgio Busto
- Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Gregoire Boulouis
- Department of Neuroradiology, University Hospital of Tours, Tours, Centre Val de Loire Region, France
| | - Elisa Scola
- Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Ilaria Casetta
- Section of Neurology, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Enrico Fainardi
- Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.,Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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3
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Kuramatsu JB, Gerner ST, Ziai W, Bardutzky J, Sembill JA, Sprügel MI, Mrochen A, Kölbl K, Ram M, Avadhani R, Falcone GJ, Selim MH, Lioutas VA, Endres M, Zweynert S, Vajkoczy P, Ringleb PA, Purrucker JC, Volkmann J, Neugebauer H, Erbguth F, Schellinger PD, Knappe UJ, Fink GR, Dohmen C, Minnerup J, Reichmann H, Schneider H, Röther J, Reimann G, Schwarz M, Bäzner H, Claßen J, Michalski D, Witte OW, Günther A, Hamann GF, Lücking H, Dörfler A, Ishfaq MF, Chang JJ, Testai FD, Woo D, Alexandrov AV, Staykov D, Goyal N, Tsivgoulis G, Sheth KN, Awad IA, Schwab S, Hanley DF, Huttner HB. Association of Intraventricular Fibrinolysis With Clinical Outcomes in Intracerebral Hemorrhage: An Individual Participant Data Meta-Analysis. Stroke 2022; 53:2876-2886. [PMID: 35521958 PMCID: PMC9398945 DOI: 10.1161/strokeaha.121.038455] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with intracerebral hemorrhage (ICH), the presence of intraventricular hemorrhage constitutes a promising therapeutic target. Intraventricular fibrinolysis (IVF) reduces mortality, yet impact on functional disability remains unclear. Thus, we aimed to determine the influence of IVF on functional outcomes. METHODS This individual participant data meta-analysis pooled 1501 patients from 2 randomized trials and 7 observational studies enrolled during 2004 to 2015. We compared IVF versus standard of care (including placebo) in patients treated with external ventricular drainage due to acute hydrocephalus caused by ICH with intraventricular hemorrhage. The primary outcome was functional disability evaluated by the modified Rankin Scale (mRS; range: 0-6, lower scores indicating less disability) at 6 months, dichotomized into mRS score: 0 to 3 versus mRS: 4 to 6. Secondary outcomes included ordinal-shift analysis, all-cause mortality, and intracranial adverse events. Confounding and bias were adjusted by random effects and doubly robust models to calculate odds ratios and absolute treatment effects (ATE). RESULTS Comparing treatment of 596 with IVF to 905 with standard of care resulted in an ATE to achieve the primary outcome of 9.3% (95% CI, 4.4-14.1). IVF treatment showed a significant shift towards improved outcome across the entire range of mRS estimates, common odds ratio, 1.75 (95% CI, 1.39-2.17), reduced mortality, odds ratio, 0.47 (95% CI, 0.35-0.64), without increased adverse events, absolute difference, 1.0% (95% CI, -2.7 to 4.8). Exploratory analyses provided that early IVF treatment (≤48 hours) after symptom onset was associated with an ATE, 15.2% (95% CI, 8.6-21.8) to achieve the primary outcome. CONCLUSIONS As compared to standard of care, the administration of IVF in patients with acute hydrocephalus caused by intracerebral and intraventricular hemorrhage was significantly associated with improved functional outcome at 6 months. The treatment effect was linked to an early time window <48 hours, specifying a target population for future trials.
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Affiliation(s)
| | - Stefan T. Gerner
- Department of Neurology, University of Erlangen-Nuremberg, Germany
| | - Wendy Ziai
- Division of Brain Injury Outcomes, Johns Hopkins University, USA
| | | | | | | | - Anne Mrochen
- Department of Neurology, University of Erlangen-Nuremberg, Germany
| | - Kathrin Kölbl
- Department of Neurology, University of Erlangen-Nuremberg, Germany
| | - Malathi Ram
- Division of Brain Injury Outcomes, Johns Hopkins University, USA
| | - Radhika Avadhani
- Division of Brain Injury Outcomes, Johns Hopkins University, USA
| | - Guido J. Falcone
- Department of Neurology, Yale University School of Medicine, USA
- Department of Neurosurgery, Yale University School of Medicine, USA
| | - Magdy H. Selim
- Beth Israel Deaconess Medical Center, Harvard Medical School, USA
| | | | - Matthias Endres
- Department of Neurology, Charité–Universitätsmedizin Berlin, Germany
- Center for Stroke Research Berlin, Germany
- German Centre for Cardiovascular Research(DZHK), Germany
- German Center for Neurodegenerative Diseases(DZNE), Germany
| | - Sarah Zweynert
- Department of Neurology, Charité–Universitätsmedizin Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité–Universitätsmedizin Berlin, Germany
| | - Peter A. Ringleb
- Department of Neurology, Heidelberg University Hospital, Germany
| | - Jan C. Purrucker
- Department of Neurology, Heidelberg University Hospital, Germany
| | - Jens Volkmann
- Department of Neurology, University of Würzburg, Germany
| | - Hermann Neugebauer
- Department of Neurology, University of Würzburg, Germany
- Department of Neurology, University of Ulm, Germany
| | - Frank Erbguth
- Department of Neurology, Nuremberg General Hospital, Germany
| | - Peter D. Schellinger
- Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, Germany
| | - Ulrich J. Knappe
- Department of Neurosurgery, Johannes Wesling Medical Center Minden, Germany
| | | | - Christian Dohmen
- Department of Neurology, University of Cologne, Germany
- Department of Neurology, LVR-Hospital Bonn, Germany
| | - Jens Minnerup
- Department of Neurology, University of Münster, Germany
| | | | - Hauke Schneider
- Department of Neurology, University of Dresden, Germany
- Department of Neurology, Klinikum Augsburg, Germany
| | - Joachim Röther
- Department of Neurology, Asklepios Klinikum Hamburg Altona, Germany
| | | | | | | | - Joseph Claßen
- Department of Neurology, University of Leipzig, Germany
| | | | - Otto W. Witte
- Department of Neurology, University of Jena, Germany
| | | | - Gerhard F. Hamann
- Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Günzburg, Germany
| | - Hannes Lücking
- Department of Neuroradiology, University of Erlangen-Nuremberg, Germany
| | - Arnd Dörfler
- Department of Neuroradiology, University of Erlangen-Nuremberg, Germany
| | | | - Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, USA
| | - Fernando D. Testai
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, USA
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, USA
| | | | - Dimitre Staykov
- Department of Neurology, University of Erlangen-Nuremberg, Germany
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, USA
| | - Georgios Tsivgoulis
- Department of Neurology, University of Tennessee Health Science Center, USA
- Second Department of Neurology, Attikon University Hospital, School of Medicine, Greece
| | - Kevin N Sheth
- Department of Neurosurgery, Yale University School of Medicine, USA
| | - Issam A. Awad
- Department of Neurosurgery, University of Chicago, USA
| | - Stefan Schwab
- Department of Neurology, University of Erlangen-Nuremberg, Germany
| | - Daniel F. Hanley
- Division of Brain Injury Outcomes, Johns Hopkins University, USA
| | - Hagen B. Huttner
- Department of Neurology, University of Erlangen-Nuremberg, Germany
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4
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Morotti A, Boulouis G, Charidimou A, Poli L, Costa P, Giuli VD, Leuci E, Mazzacane F, Busto G, Arba F, Brancaleoni L, Giacomozzi S, Simonetti L, Laudisi M, Cavallini A, Gamba M, Magoni M, Cornali C, Fontanella MM, Warren AD, Gurol EM, Viswanathan A, Gasparotti R, Casetta I, Fainardi E, Zini A, Pezzini A, Padovani A, Greenberg SM, Rosand J, Goldstein JN. Imaging markers of intracerebral hemorrhage expansion in patients with unclear symptom onset. Int J Stroke 2022; 17:1013-1020. [DOI: 10.1177/17474930211068662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Hematoma expansion (HE) is common and associated with poor outcome in intracerebral hemorrhage (ICH) with unclear symptom onset (USO). Aims: We tested the association between non-contrast computed tomography (NCCT) markers and HE in this population. Methods: Retrospective analysis of patients with primary spontaneous ICH admitted at five centers in the United States and Italy. Baseline NCCT was analyzed for presence of the following markers: intrahematoma hypodensities, heterogeneous density, blend sign, and irregular shape. Variables associated with HE (hematoma growth > 6 mL and/or > 33% from baseline to follow-up imaging) were explored with multivariable logistic regression. Results: Of 2074 patients screened, we included 646 subjects (median age = 75, 53.9% males), of whom 178 (27.6%) had HE. Hypodensities (odds ratio (OR) = 2.67, 95% confidence interval (CI) = 1.79–3.98), heterogeneous density (OR = 2.16, 95% CI = 1.46–3.21), blend sign (OR = 2.28, 95% CI = 1.38–3.75) and irregular shape (OR = 1.82, 95% CI = 1.21–2.75) were independently associated with a higher risk of HE, after adjustment for confounders (ICH volume, anticoagulation, and time from last seen well (LSW) to NCCT). Hypodensities had the highest sensitivity for HE (0.69), whereas blend sign was the most specific marker (0.90). All NCCT markers were more frequent in early presenters (time from LSW to NCCT ⩽ 6 h, n = 189, 29.3%), and more sensitive in this population as well (hypodensities had 0.77 sensitivity). Conclusion: NCCT markers are associated with HE in ICH with USO. These findings require prospective replication and suggest that NCCT features may help the stratification of HE in future studies on USO patients.
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Affiliation(s)
- Andrea Morotti
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, Brescia, Italy
| | | | - Andreas Charidimou
- J.P. Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Loris Poli
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, Brescia, Italy
| | - Paolo Costa
- U.O. Neurologia, Fondazione Poliambulanza, Brescia, Italy
| | | | - Eleonora Leuci
- U.C. Malattie Cerebrovascolari e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
| | - Federico Mazzacane
- U.C. Malattie Cerebrovascolari e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
| | - Giorgio Busto
- Department of Biomedical, Experimental and Clinical Sciences, Neuroradiology, University of Firenze, AOU Careggi, Firenze, Italy
| | | | - Laura Brancaleoni
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italy
| | - Sebastiano Giacomozzi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italy
| | - Luigi Simonetti
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unità di Neuroradiologia, Ospedale Maggiore, Bologna, Italy
| | - Michele Laudisi
- Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara, Italy
| | - Anna Cavallini
- U.C. Malattie Cerebrovascolari e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
| | - Massimo Gamba
- Stroke Unit, Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy
| | - Mauro Magoni
- Stroke Unit, Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy
| | - Claudio Cornali
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco M Fontanella
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Andrew D Warren
- J.P. Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Edip M Gurol
- J.P. Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Viswanathan
- J.P. Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Roberto Gasparotti
- Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Ilaria Casetta
- Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli studi di Ferrara, Ospedale Universitario S. Anna, Ferrara, Italy
| | - Enrico Fainardi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italy
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | - Steven M Greenberg
- J.P. Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Rosand
- J.P. Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua N Goldstein
- J.P. Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
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5
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Arba F, Rinaldi C, Boulouis G, Fainardi E, Charidimou A, Morotti A. Noncontrast Computed Tomography Markers of Cerebral Hemorrhage Expansion: Diagnostic Accuracy Meta-Analysis. Int J Stroke 2021; 17:17474930211061639. [PMID: 34842473 DOI: 10.1177/17474930211061639] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Assess the diagnostic accuracy of noncontrast computed tomography (NCCT) markers of hematoma expansion in patients with primary intracerebral hemorrhage. METHODS We performed a meta-analysis of observational studies and randomized controlled trials with available data for calculation of sensitivity and specificity of NCCT markers for hematoma expansion (absolute growth >6 or 12.5 mL and/or relative growth >33%). The following NCCT markers were analyzed: irregular shape, island sign (shape-related features); hypodensity, heterogeneous density, blend sign, black hole sign, and swirl sign (density-related features). Pooled accuracy values for each marker were derived from hierarchical logistic regression models. RESULTS A total of 10,363 subjects from 23 eligible studies were included. Significant risk of bias of included studies was noted. Hematoma expansion frequency ranged from 7% to 40%, mean intracerebral hemorrhage volume from 9 to 27.8 ml, presence of NCCT markers from 9% (island sign) to 82% (irregular shape). Among shape features, sensitivity ranged from 0.32 (95%CI = 0.20-0.47) for island sign to 0.68 (95%CI = 0.57-0.77) for irregular shape, specificity ranged from 0.47 (95%CI = 0.36-0.59) for irregular shape to 0.92 (95%CI = 0.85-0.96) for island sign; among density features sensitivity ranged from 0.28 (95%CI = 0.21-0.35) for black hole sign to 0.63 (95%CI = 0.44-0.78) for hypodensity, specificity ranged from 0.65 (95%CI = 0.56-0.73) for heterogeneous density to 0.89 (95%CI = 0.85-0.92) for blend sign. CONCLUSION Diagnostic accuracy of NCCT markers remains suboptimal for implementation in clinical trials although density features performed better than shape-related features. This analysis may help in better tailoring patients' selection for hematoma expansion targeted trials.
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Affiliation(s)
- Francesco Arba
- Stroke Unit, Careggi University Hospital, Florence, Italy
| | - Chiara Rinaldi
- Stroke Unit, Careggi University Hospital, Florence, Italy
| | - Gregoire Boulouis
- Neuroradiology Department, Centre Hospitalier Sainte-Anne, Paris, France
| | - Enrico Fainardi
- Department of Experimental and Clinical Medicine, 9300University of Florence, Florence, Italy
| | - Andreas Charidimou
- Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, USA
| | - Andrea Morotti
- Neurology Unit, Department of Clinical and Experimental Sciences, 9297University of Brescia, Brescia, Italy
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6
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Ren R, Lu Q, Sherchan P, Fang Y, Lenahan C, Tang L, Huang Y, Liu R, Zhang JH, Zhang J, Tang J. Inhibition of Aryl Hydrocarbon Receptor Attenuates Hyperglycemia-Induced Hematoma Expansion in an Intracerebral Hemorrhage Mouse Model. J Am Heart Assoc 2021; 10:e022701. [PMID: 34622690 PMCID: PMC8751882 DOI: 10.1161/jaha.121.022701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Hyperglycemia is associated with greater hematoma expansion (HE) and worse clinical prognosis after intracerebral hemorrhage (ICH). However, the clinical benefits of intensive glucose normalization remain controversial, and there are no approved therapies for reducing HE. The aryl hydrocarbon receptor (AHR) has been shown to participate in hyperglycemia‐induced blood–brain barrier (BBB) dysfunction and brain injury after stroke. Herein, we investigated the role of AHR in hyperglycemia‐induced HE in a male mouse model of ICH. Methods and Results CD1 mice (n=387) were used in this study. Mice were subjected to ICH by collagenase injection. Fifty percent dextrose was injected intraperitoneally 3 hours after ICH. AHR knockout clustered regularly interspaced short palindromic repeat was administered intracerebroventricularly to evaluate the role of AHR after ICH. A selective AHR inhibitor, 6,2′,4′‐trimethoxyflavone, was administered intraperitoneally 2 hours or 6 hours after ICH for outcome study. To evaluate the effect of AHR on HE, 3‐methylcholanthrene, an AHR agonist, was injected intraperitoneally 2 hours after ICH. The results showed hyperglycemic ICH upregulated AHR accompanied by greater HE. AHR inhibition provided neurological benefits by restricting HE and preserving BBB function after hyperglycemic ICH. In vivo knockdown of AHR further limited HE and enhanced the BBB integrity. Hyperglycemia directly activated AHR as a physiological stimulus in vivo. The thrombospondin‐1/transforming growth factor‐β/vascular endothelial growth factor axis partly participated in AHR signaling after ICH, which inhibited the expressions of BBB‐related proteins, ZO‐1 and Claudin‐5. Conclusions AHR may serve as a potential therapeutic target to attenuate hyperglycemia‐induced hematoma expansion and to preserve the BBB in patients with ICH.
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Affiliation(s)
- Reng Ren
- Department of Neurosurgery The Second Affiliated HospitalZhejiang University School of Medicine Hangzhou Zhejiang China.,Department of Neurointensive Care Unit The Second Affiliated HospitalZhejiang University School of Medicine Hangzhou Zhejiang China.,Department of Physiology and Pharmacology Loma Linda University School of Medicine Loma Linda CA
| | - Qin Lu
- Department of Physiology and Pharmacology Loma Linda University School of Medicine Loma Linda CA
| | - Prativa Sherchan
- Department of Physiology and Pharmacology Loma Linda University School of Medicine Loma Linda CA
| | - Yuanjian Fang
- Department of Neurosurgery The Second Affiliated HospitalZhejiang University School of Medicine Hangzhou Zhejiang China.,Department of Physiology and Pharmacology Loma Linda University School of Medicine Loma Linda CA
| | - Cameron Lenahan
- Department of Physiology and Pharmacology Loma Linda University School of Medicine Loma Linda CA
| | - Lihui Tang
- Department of Physiology and Pharmacology Loma Linda University School of Medicine Loma Linda CA
| | - Yi Huang
- Department of Neurosurgery The Second Affiliated HospitalZhejiang University School of Medicine Hangzhou Zhejiang China.,Department of Physiology and Pharmacology Loma Linda University School of Medicine Loma Linda CA
| | - Rui Liu
- Department of Physiology and Pharmacology Loma Linda University School of Medicine Loma Linda CA
| | - John H Zhang
- Department of Physiology and Pharmacology Loma Linda University School of Medicine Loma Linda CA.,Department of Neurosurgery Loma Linda University School of Medicine Loma Linda CA.,Department of Anesthesiology Loma Linda University School of Medicine Loma Linda CA
| | - Jianmin Zhang
- Department of Neurosurgery The Second Affiliated HospitalZhejiang University School of Medicine Hangzhou Zhejiang China
| | - Jiping Tang
- Department of Physiology and Pharmacology Loma Linda University School of Medicine Loma Linda CA
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7
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Morotti A, Boulouis G, Charidimou A, Li Q, Poli L, Costa P, De Giuli V, Leuci E, Mazzacane F, Busto G, Arba F, Brancaleoni L, Giacomozzi S, Simonetti L, Laudisi M, Micieli G, Cavallini A, Candeloro E, Gamba M, Magoni M, Warren AD, Anderson CD, Gurol ME, Biffi A, Viswanathan A, Casetta I, Fainardi E, Zini A, Pezzini A, Padovani A, Greenberg SM, Rosand J, Goldstein JN. Hematoma Expansion in Intracerebral Hemorrhage With Unclear Onset. Neurology 2021; 96:e2363-e2371. [PMID: 33795389 DOI: 10.1212/wnl.0000000000011895] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/18/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To investigate the prevalence, predictors, and prognostic effect of hematoma expansion (HE) in patients with intracerebral hemorrhage (ICH) with unclear symptom onset (USO). METHODS We performed a retrospective analysis of patients with primary spontaneous ICH admitted at 5 academic medical centers in the United States and Italy. HE (volume increase >6 mL or >33% from baseline to follow-up noncontrast CT [NCCT]) and mortality at 30 days were the outcomes of interest. Baseline NCCT was also analyzed for presence of hypodensities (any hypodense region within the hematoma margins). Predictors of HE and mortality were explored with multivariable logistic regression. RESULTS We enrolled 2,165 participants, 1,022 in the development cohort and 1,143 in the replication cohort, of whom 352 (34.4%) and 407 (35.6%) had ICH with USO, respectively. When compared with participants having a clear symptom onset, patients with USO had a similar frequency of HE (25.0% vs 21.9%, p = 0.269 and 29.9% vs 31.5%, p = 0.423). Among patients with USO, HE was independently associated with mortality after adjustment for confounders (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.43-4.89, p = 0.002). This finding was similar in the replication cohort (OR 3.46, 95% CI 1.86-6.44, p < 0.001). The presence of NCCT hypodensities in patients with USO was an independent predictor of HE in the development (OR 2.59, 95% CI 1.27-5.28, p = 0.009) and replication (OR 2.43, 95% CI 1.42-4.17, p = 0.001) population. CONCLUSION HE is common in patients with USO and independently associated with worse outcome. These findings suggest that patients with USO may be enrolled in clinical trials of medical treatments targeting HE.
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Affiliation(s)
- Andrea Morotti
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston.
| | - Gregoire Boulouis
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Andreas Charidimou
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Qi Li
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Loris Poli
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Paolo Costa
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Valeria De Giuli
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Eleonora Leuci
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Federico Mazzacane
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Giorgio Busto
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Francesco Arba
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Laura Brancaleoni
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Sebastiano Giacomozzi
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Luigi Simonetti
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Michele Laudisi
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Giuseppe Micieli
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Anna Cavallini
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Elisa Candeloro
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Massimo Gamba
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Mauro Magoni
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Andrew D Warren
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Christopher D Anderson
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - M Edip Gurol
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Alessandro Biffi
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Anand Viswanathan
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Ilaria Casetta
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Enrico Fainardi
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Andrea Zini
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Alessandro Pezzini
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Alessandro Padovani
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Steven M Greenberg
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Jonathan Rosand
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
| | - Joshua N Goldstein
- From UO Neurologia (A.M.), Azienda Socio-Sanitaria Territoriale (ASST) Valcamonica, Esine, Italy; Neuroradiology Department (G. Boulouis), Centre Hospitalier Sainte-Anne, Paris, France; J.P. Kistler Stroke Research Center, Department of Neurology (A. Charidimou, Q.L., A.D.W., C.D.A., M.E.G., A.B., A.V., S.M.G., J.R., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston; Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica (L.P., A. Pezzini, A. Padovani), Università degli Studi di Brescia; UO di Neurologia (P.C.), Istituto Clinico Fondazione Poliambulanza, Brescia; UOC Neurologia (V.D.G.), ASST Cremona; UC Malattie Cerebrovascolari e Stroke Unit (E.L., F.M., A. Cavallini) and UC Neurologia d'Urgenza (E.L., F.M., G.M.), IRCCS Fondazione Mondino, Pavia; Dipartimento di Dipartimento di Scienze Biomediche, Sperimentali e Cliniche, Neuroradiologia, Università degliStudi di Firenze (G. Busto, E.F.), and Stroke Unit (F.A., A.Z.), Ospedale Universitario Careggi, Firenze; UOC Neurologia e Rete Stroke, Metropolitana (L.B., S.G.), and Unità di Neuroradiologia (L.S.), IRCCS Istituto delle Scienze Neurologiche di Bologna, Ospedale Maggiore; Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche (M.L., I.C.), Università degli studi diFerrara, Ospedale Universitario S. Anna, Ferrara; Neurologia e Stroke Unit (E.C.), Ospedale di Circolo, ASST Settelaghi, Varese; Stroke Unit (M.G., M.M.), Neurologia Vascolare, ASST Spedali Civili, Brescia, Italy; Division of Neurocritical Care and Emergency Neurology, Department of Neurology (C.D.A., J.R., J.N.G.), Harvard Medical School, Henry and Allison McCance Center for Brain Health (C.D.A., J.R., J.N.G.), and Department of Emergency Medicine (J.N.G.), Massachusetts General Hospital, Boston
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Morotti A, Arba F, Boulouis G, Charidimou A. Noncontrast CT markers of intracerebral hemorrhage expansion and poor outcome: A meta-analysis. Neurology 2020; 95:632-643. [PMID: 32847959 DOI: 10.1212/wnl.0000000000010660] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/22/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To provide precise estimates of the association between noncontrast CT (NCCT) markers, hematoma expansion (HE), and functional outcome in patients presenting with intracerebral hemorrhage (ICH) through a systematic review and meta-analysis. METHODS We searched PubMed for English-written observational studies or randomized controlled trials reporting data on NCCT markers of HE and outcome in spontaneous ICH including at least 50 subjects. The outcomes of interest were HE (hematoma growth >33%, >33% and/or >6 mL, >33% and/or >12.5 mL), poor functional outcome (modified Rankin Scale 3-6 or 4-6) at discharge or at 90 days, and mortality. We pooled data in random-effects models and extracted cumulative odds ratio (OR) for each NCCT marker. RESULTS We included 25 eligible studies (n = 10,650). The following markers were associated with increased risk of HE and poor outcome, respectively: black hole sign (OR = 3.70, 95% confidence interval [CI] = 1.42-9.64 and OR = 5.26, 95% CI = 1.75-15.76), swirl sign (OR = 3.33, 95% CI = 2.42-4.60 and OR = 3.70; 95% CI = 2.47-5.55), heterogeneous density (OR = 2.74; 95% CI = 1.71-4.39 and OR = 2.80; 95% CI = 1.78-4.39), blend sign (OR = 3.49; 95% CI = 2.20-5.55 and OR = 2.21; 95% CI 1.16-4.18), hypodensities (OR = 3.47; 95% CI = 2.18-5.50 and OR = 2.94; 95% CI = 2.28-3.78), irregular shape (OR = 2.01, 95% CI = 1.27-3.19 and OR = 3.43; 95% CI = 2.33-5.03), and island sign (OR = 7.87, 95% CI = 2.17-28.47 and OR = 6.05, 95% CI = 4.44-8.24). CONCLUSION Our results suggest that multiple NCCT ICH shape and density features, with different effect size, are important markers for HE and clinical outcome and may provide useful information for future randomized controlled trials.
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Affiliation(s)
- Andrea Morotti
- Neurology Unit (A.M.), ASST Valcamonica, Esine, Brescia; Stroke Unit (F.A.), Careggi University Hospital, Florence, Italy; Neuroradiology Department (G.B.), Centre Hospitalier Sainte-Anne, Paris, France; and Hemorrhagic Stroke Research Program (A.C.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston.
| | - Francesco Arba
- Neurology Unit (A.M.), ASST Valcamonica, Esine, Brescia; Stroke Unit (F.A.), Careggi University Hospital, Florence, Italy; Neuroradiology Department (G.B.), Centre Hospitalier Sainte-Anne, Paris, France; and Hemorrhagic Stroke Research Program (A.C.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - Gregoire Boulouis
- Neurology Unit (A.M.), ASST Valcamonica, Esine, Brescia; Stroke Unit (F.A.), Careggi University Hospital, Florence, Italy; Neuroradiology Department (G.B.), Centre Hospitalier Sainte-Anne, Paris, France; and Hemorrhagic Stroke Research Program (A.C.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
| | - Andreas Charidimou
- Neurology Unit (A.M.), ASST Valcamonica, Esine, Brescia; Stroke Unit (F.A.), Careggi University Hospital, Florence, Italy; Neuroradiology Department (G.B.), Centre Hospitalier Sainte-Anne, Paris, France; and Hemorrhagic Stroke Research Program (A.C.), Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston
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