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Wu F, Wang P, Yang H, Wu J, Liu Y, Yang Y, Zuo Z, Wu T, Li J. Research on predicting hematoma expansion in spontaneous intracerebral hemorrhage based on deep features of the VGG-19 network. Postgrad Med J 2024; 100:592-602. [PMID: 38507237 DOI: 10.1093/postmj/qgae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/28/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To construct a clinical noncontrastive computed tomography (NCCT) deep learning joint model for predicting early hematoma expansion (HE) after cerebral hemorrhage (sICH) and evaluate its predictive performance. METHODS All 254 patients with primary cerebral hemorrhage from January 2017 to December 2022 in the General Hospital of the Western Theater Command were included. According to the criteria of hematoma enlargement exceeding 33% or the volume exceeding 6 ml, the patients were divided into the HE group and the hematoma non-enlargement (NHE) group. Multiple models and the 10-fold cross-validation method were used to screen the most valuable features and model the probability of predicting HE. The area under the curve (AUC) was used to analyze the prediction efficiency of each model for HE. RESULTS They were randomly divided into a training set of 204 cases in an 8:2 ratio and 50 cases of the test set. The clinical imaging deep feature joint model (22 features) predicted the area under the curve of HE as follows: clinical Navie Bayes model AUC 0.779, traditional radiology logistic regression (LR) model AUC 0.818, deep learning LR model AUC 0.873, and clinical NCCT deep learning multilayer perceptron model AUC 0.921. CONCLUSION The combined clinical imaging deep learning model has a high predictive effect for early HE in sICH patients, which is helpful for clinical individualized assessment of the risk of early HE in sICH patients.
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Affiliation(s)
- Fa Wu
- Department of Radiology, The General Hospital of Western Theater Command, No. 270, Tianhui Road, Rongdu Avenue, Jinniu District, Chengdu, Sichuan Province 610083, PR China
| | - Peng Wang
- Department of Radiology, The General Hospital of Western Theater Command, No. 270, Tianhui Road, Rongdu Avenue, Jinniu District, Chengdu, Sichuan Province 610083, PR China
| | - Huimin Yang
- Department of Ultrasound, The General Hospital of Western Theater Command, No. 270, Tianhui Road, Rongdu Avenue, Jinniu District, Chengdu, Sichuan Province 610083, PR China
| | - Jie Wu
- Department of Radiology, The General Hospital of Western Theater Command, No. 270, Tianhui Road, Rongdu Avenue, Jinniu District, Chengdu, Sichuan Province 610083, PR China
| | - Yi Liu
- Department of Radiology, The General Hospital of Western Theater Command, No. 270, Tianhui Road, Rongdu Avenue, Jinniu District, Chengdu, Sichuan Province 610083, PR China
| | - Yulin Yang
- Department of Ultrasound, Chengdu 5th People's Hospital, No. 33, Mashi Street, Liucheng Town, Wenjiang District, Chengdu, Sichuan 611100, PR China
| | - Zhiwei Zuo
- Department of Radiology, The General Hospital of Western Theater Command, No. 270, Tianhui Road, Rongdu Avenue, Jinniu District, Chengdu, Sichuan Province 610083, PR China
| | - Tingting Wu
- Neurosurgery Department, The General Hospital of Western Theater Command, No. 270, Tianhui Road, Rongdu Avenue, Jinniu District, Chengdu, Sichuan Province 610083, PR China
| | - Jianghao Li
- Department of Radiology, The General Hospital of Western Theater Command, No. 270, Tianhui Road, Rongdu Avenue, Jinniu District, Chengdu, Sichuan Province 610083, PR China
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Sanner J, Ström JO, von Euler M, Thommessen B, Fure B. Etiological Subclassification of Stroke in Older People ≥80 Years Compared to Younger People: A Systematic Review and Meta-Analysis. J Geriatr Psychiatry Neurol 2024:8919887241254466. [PMID: 38761091 DOI: 10.1177/08919887241254466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
BACKGROUND Due to the rapid growth of the world´s oldest population, the number of older persons with stroke is expected to rise. Knowledge of stroke etiology is essential to offer personalized and equal health care across age groups. The present systematic review aimed to investigate the prevalence of etiological subtypes of ischemic and hemorrhagic stroke in older compared to younger people. METHODS MEDLINE, Embase, Cochrane, Epistemonikos, and Cinahl were systematically searched for studies regarding etiological classification in people ≥80 years compared to those <80 years with ischemic or hemorrhagic stroke. RESULTS Out of 28 441 identified articles, eight met the inclusion criteria. In total, 8223 individuals were included in meta-analyses, of whom 2997 were 80 years or older. We demonstrated a higher prevalence of cardioembolic stroke in people ≥80 years OR 1.68 (95% CI, 1.12-2.53). Small vessel disease was significantly less common in older people OR .64 (95% CI, .50-.81). Regarding large vessel disease, no statistically significant difference between the two groups was shown OR 1.05 (95% CI, .77-1.43). CONCLUSION In people ≥80 years, cardioembolic stroke is more common, and small vessel disease less common compared to people <80 years. Overall, the results have to be interpreted with caution due to few studies. Large studies using validated classification systems are needed.
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Affiliation(s)
- Johan Sanner
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Neurology and Rehabilitation, Central Hospital Karlstad, Karlstad, Sweden
| | - Jakob O Ström
- Department of Neurology, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Mia von Euler
- Department of Neurology, Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Bente Thommessen
- Division of Medicine, Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Brynjar Fure
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Internal Medicine, Central Hospital, Karlstad, Sweden
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Seiffge DJ, Polymeris AA, Law ZK, Krishnan K, Zietz A, Thilemann S, Werring D, Al-Shahi Salman R, Dineen RA, Engelter ST, Bath PM, Sprigg N, Lyrer P, Peters N. Cerebral Amyloid Angiopathy and the Risk of Hematoma Expansion. Ann Neurol 2022; 92:921-930. [PMID: 36054211 PMCID: PMC9804369 DOI: 10.1002/ana.26481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We assessed whether hematoma expansion (HE) and favorable outcome differ according to type of intracerebral hemorrhage (ICH). METHODS Among participants with ICH enrolled in the TICH-2 (Tranexamic Acid for Hyperacute Primary Intracerebral Haemorrhage) trial, we assessed baseline scans for hematoma location and presence of cerebral amyloid angiopathy (CAA) using computed tomography (CT, simplified Edinburgh criteria) and magnetic resonance imaging (MRI; Boston criteria) and categorized ICH as lobar CAA, lobar non-CAA, and nonlobar. The main outcomes were HE and favorable functional outcome. We constructed multivariate regression models and assessed treatment effects using interaction terms. RESULTS A total of 2,298 out of 2,325 participants were included with available CT (98.8%; median age = 71 years, interquartile range = 60-80 years; 1,014 female). Additional MRI was available in 219 patients (9.5%). Overall, 1,637 participants (71.2%) had nonlobar ICH; the remaining 661 participants (28.8%) had lobar ICH, of whom 202 patients had lobar CAA-ICH (8.8%, 173 participants according to Edinburgh and 29 participants according to Boston criteria) and 459 did not (lobar non-CAA, 20.0%). For HE, we found a significant interaction of lobar CAA ICH with time from onset to randomization (increasing risk with time, pinteraction < 0.001) and baseline ICH volume (constant risk regardless of volume, pinteraction < 0.001) but no association between type of ICH and risk of HE or favorable outcome. Tranexamic acid significantly reduced the risk of HE (adjusted odds ratio = 0.7, 95% confidence interval = 0.6-1.0, p = 0.020) without statistically significant interaction with type of ICH (pinteraction = 0.058). Tranexamic acid was not associated with favorable outcome. INTERPRETATION Risk of HE in patients with lobar CAA-ICH was not independently increased but seems to have different dynamics compared to other types of ICH. The time window for treatment of CAA-ICH to prevent HE may be longer. ANN NEUROL 2022;92:921-930.
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Affiliation(s)
- David J Seiffge
- Department of Neurology, Inselspital University Hospital and University of Bern, Bern, Switzerland
| | - Alexandros A Polymeris
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Zhe Kang Law
- Stroke Trials Unit, University of Nottingham, Nottingham, UK.,Department of Medicine, National University of Malaysia, Bangi, Malaysia
| | - Kailash Krishnan
- Stroke Trials Unit, University of Nottingham, Nottingham, UK.,Stroke, Nottingham University Hospitals National Health Service Trust, Nottingham, UK
| | - Annaelle Zietz
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Sebastian Thilemann
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - David Werring
- Stroke Research Centre, University College London Queen Square Institute of Neurology, London, UK
| | | | - Robert A Dineen
- Radiological Sciences, University of Nottingham, Nottingham, UK.,National Institute for Health Research Nottingham Biomedical Research Centre, Nottingham, UK
| | - Stefan T Engelter
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.,Neurology and Neurorehabilitation, University Hospital for Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland
| | - Philip M Bath
- Stroke Trials Unit, University of Nottingham, Nottingham, UK.,Stroke, Nottingham University Hospitals National Health Service Trust, Nottingham, UK
| | - Nikola Sprigg
- Stroke Trials Unit, University of Nottingham, Nottingham, UK.,Stroke, Nottingham University Hospitals National Health Service Trust, Nottingham, UK
| | - Philippe Lyrer
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Nils Peters
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland.,Neurology and Neurorehabilitation, University Hospital for Geriatric Medicine Felix Platter, University of Basel, Basel, Switzerland.,Stroke Center, Hirslanden Clinic, Zürich, Switzerland
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Wang Q, Tu Y, Huang Y, Chen L, Lin Y, Zhan L, He J. High fibrinogen to albumin ratio is associated with hematoma enlargement in spontaneous intracerebral hemorrhage. J Clin Neurosci 2022; 106:37-42. [DOI: 10.1016/j.jocn.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/18/2022] [Accepted: 09/12/2022] [Indexed: 11/15/2022]
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5
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Kuohn LR, Witsch J, Steiner T, Sheth KN, Kamel H, Navi BB, Merkler AE, Murthy SB, Mayer SA. Early Deterioration, Hematoma Expansion, and Outcomes in Deep Versus Lobar Intracerebral Hemorrhage: The FAST Trial. Stroke 2022; 53:2441-2448. [PMID: 35360929 DOI: 10.1161/strokeaha.121.037974] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with intracerebral hemorrhage (ICH), it is unclear whether early neurological deterioration, hematoma expansion (HE), and outcome vary by supratentorial ICH location (deep versus lobar). Herein, we assessed these relationships in a clinical trial cohort that underwent brain imaging early after symptom onset. We hypothesized that HE would occur more frequently, and outcome would be worse in patients with deep ICH. METHODS We performed a post hoc analysis of the FAST (Factor-VII-for-Acute-Hemorrhagic-Stroke-Treatment) trial including all patients with supratentorial hemorrhage. Enrolled patients underwent brain imaging within 3 hours of symptom onset and 24 hours after randomization. Multivariable regression was used to test the association between ICH location and 3 outcomes: HE (increase of ≥33% or 6mL), early neurological deterioration (decrease in Glasgow Coma Scale score ≥2 points or increase in National Institutes of Health Stroke Scale ≥4 points within 24 hours of admission), and 90-day outcome (modified Rankin Scale). RESULTS Of 841 FAST trial patients, we included 728 (mean age 64 years, 38% women) with supratentorial hemorrhages (deep n=623, lobar n=105). HE (44 versus 27%, P=0.001) and early neurological deterioration (31 versus 17%, P=0.001) were more common in lobar hemorrhages. Deep hemorrhages were smaller than lobar hemorrhages at baseline (12 versus 35mL, P<0.001) and 24 hours (14 versus 38mL, P<0.001). Unadjusted 90-day outcome was worse in lobar compared with deep ICH (median modified Rankin Scale score 5 versus 4, P=0.03). However, when adjusting for variables included in the ICH score including ICH volume, deep location was associated with worse and lobar location with better outcome (odds ratio lobar location, 0.58 [95% CI, 0.38-0.89]; P=0.01). CONCLUSIONS In this secondary analysis of randomized trial patients, lobar ICH location was associated with larger ICH volume, more HE and early neurological deterioration, and worse outcome than deep ICH. After adjustment for prognostic variables, however, deep ICH was associated with worse outcome, likely due to their proximity to eloquent brain structures.
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Affiliation(s)
| | - Jens Witsch
- Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia (J.W.)
| | - Thorsten Steiner
- Department of Neurology, Klinikum Frankfurt Höchst, Frankfurt a. M., Germany (T.S.).,Department of Neurology, Universität Heidelberg, Germany (T.S.)
| | - Kevin N Sheth
- Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale School of Medicine, Yale New Haven Hospital, CT (K.N.S.)
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York (H.K., B.B.N., A.E.M., S.B.M.)
| | - Babak B Navi
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York (H.K., B.B.N., A.E.M., S.B.M.)
| | - Alexander E Merkler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York (H.K., B.B.N., A.E.M., S.B.M.)
| | - Santosh B Murthy
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Department of Neurology, Weill Cornell Medicine, New York (H.K., B.B.N., A.E.M., S.B.M.)
| | - Stephan A Mayer
- Departments of Neurology and Neurosurgery, New York Medical College, Valhalla, NY (S.A.M.)
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Raj AB, Lian LF, Xu F, Li G, Huang SS, Liang QM, Lu K, Zhao JL, Wang FR. Association of Satellite Sign with Postoperative Rebleeding in Patients Undergoing Stereotactic Minimally Invasive Surgery for Hypertensive Intracerebral Haemorrhage. Curr Med Sci 2021; 41:565-571. [PMID: 34250575 DOI: 10.1007/s11596-021-2392-4] [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: 01/24/2020] [Accepted: 08/03/2020] [Indexed: 11/28/2022]
Abstract
There are few studies regarding imaging markers for predicting postoperative rebleeding after stereotactic minimally invasive surgery (MIS) for hypertensive intracerebral haemorrhage (ICH), and little is known about the relationship between satellite sign on computed tomography (CT) scans and postoperative rebleeding after MIS. This study aimed to determine the value of the CT satellite sign in predicting postoperative rebleeding in patients with hypertensive ICH who undergo stereotactic MIS. We retrospectively examined and analysed 105 patients with hypertensive ICH who underwent standard stereotactic MIS for hematoma evacuation within 72 h following admission. Postoperative rebleeding occurred in 14 of 65 (21.5%) patients with the satellite sign on baseline CT, and in 5 of the 40 (12.5%) patients without the satellite sign. This difference was statistically significant. Positive and negative values of the satellite sign for predicting postoperative rebleeding were 21.5% and 87.5%, respectively. Multivariate logistic regression analysis verified that baseline ICH volume and intraventricular rupture were independent predictors of postoperative rebleeding. In conclusion, the satellite sign on baseline CT scans may not predict postoperative rebleeding following stereotactic MIS for hypertensive ICH.
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Affiliation(s)
- Ajith Bernardin Raj
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Li-Fei Lian
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Feng Xu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Guo Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shan-Shan Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Qi-Ming Liang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Kai Lu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jian-Ling Zhao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fu-Rong Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Li K, Ding X, Wang Q, Fan G, Guo W, Li C, Li M, Li Z. Low-Cost, Accurate, Effective Treatment of Hypertensive Cerebral Hemorrhage With Three-Dimensional Printing Technology. Front Neurol 2021; 12:608403. [PMID: 33716921 PMCID: PMC7947911 DOI: 10.3389/fneur.2021.608403] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/19/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Hypertensive intracerebral hemorrhage (HICH) is an acute, severe neurosurgical disease. Puncture drainage of the hematoma has gradually been accepted as a surgical treatment for HICH because of its minimally invasive nature. The precision of the puncture is extremely high because of particular physiological functions. This study was performed to explore the effect of a navigation mold created by three-dimensional printing (3DP) technology in the surgical treatment of HICH. Material and methods: We conducted a retrospective analysis of all consecutive patients with ICH treated with minimally invasive surgery using 3DP navigation or craniotomy to remove the hematoma through a small bone window at the Binzhou Medical University Hospital from June 2017 to March 2019. In total, 61 patients were treated with minimally invasive surgery using 3DP navigation (3DP group), and 67 patients were treated with craniotomy to remove the hematoma through a small bone window (craniotomy group). A comparative study of the two groups was conducted to assess the preoperative and postoperative conditions. Results: The duration of the surgery was significantly longer in the craniotomy group than in the 3DP group (3.27 ± 1.14 h vs. 1.52 ± 0.23 h). Postoperative complication rates were significantly lower in the 3DP group than in the craniotomy group (18.0 vs. 34.3%). Moreover, the rate of patients with a Glasgow Outcome Scale score ≥4 points was not statistically significantly different in the two groups. Conclusion: Minimally invasive surgery assisted by 3DP navigation to treat patients with HICH appears to be safe and effective. The 3DP technique may improve the individualization and accuracy of the surgery.
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Affiliation(s)
- Ke Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Xiangqian Ding
- Department of Neurosurgery, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qingbo Wang
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Gangxian Fan
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Wei Guo
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Chenglong Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Meng Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Zefu Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
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Zhang S, Wang Z, Zheng A, Yuan R, Shu Y, Zhang S, Lei P, Wu B, Liu M. Blood Pressure and Outcomes in Patients With Different Etiologies of Intracerebral Hemorrhage: A Multicenter Cohort Study. J Am Heart Assoc 2020; 9:e016766. [PMID: 32924756 PMCID: PMC7792400 DOI: 10.1161/jaha.120.016766] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/30/2020] [Indexed: 02/05/2023]
Abstract
Background We aimed to investigate the association between blood pressure (BP) and outcomes in intracerebral hemorrhage (ICH) subtypes with different etiologies. Methods and Results A total of 5656 in-hospital patients with spontaneous ICH were included between January 2012 and December 2016 in a prospective multicenter cohort study. Etiological subtypes of ICH were assigned using SMASH-U (structural lesion, medication, amyloid angiopathy, systemic/other disease, hypertension, undetermined) classification. Elevated systolic BP was defined as ≥140 mm Hg. Hypertension was defined as elevated BP for >1 month before the onset of ICH. The primary outcomes were measured as 1-month survival rate and 3-month mortality. A total of 5380 patients with ICH were analyzed, of whom 4052 (75.3%) had elevated systolic BP on admission and 3015 (56.0%) had hypertension. In multinomial analysis of patients who passed away by 3 months, systolic BP on admission was significantly different in cerebral amyloid angiopathy (P<0.001), structural lesion (P<0.001), and undetermined subtypes (P=0.003), compared with the hypertensive angiopathy subtype. Elevated systolic BP was dose-responsively associated with higher 3-month mortality in hypertensive angiopathy (Ptrend=0.013) and undetermined (Ptrend=0.005) subtypes. In cerebral amyloid angiopathy, hypertension history had significant inverse association with 3-month mortality (adjusted odds ratio, 0.37, 95% CI, 0.20-0.65; P<0.001). Similarly, adjusted Cox regression indicated decreased risk of 1-month survival rate in the presence of hypertension in patients with cerebral amyloid angiopathy (adjusted hazard ratio, 0.47; 95% CI, 0.24-0.92; P=0.027). Conclusions This study suggests that the association between BP and ICH outcomes might specifically depend on its subtypes, and cerebral amyloid angiopathy might be pathologically distinctive from the others. Future studies of individualized BP-lowering strategy are needed to validate our findings.
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Affiliation(s)
- Shuting Zhang
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceP.R. China
| | - Zhihao Wang
- West China School of MedicineSichuan UniversityChengduSichuan ProvinceP.R. China
| | - Aiping Zheng
- West China School of MedicineSichuan UniversityChengduSichuan ProvinceP.R. China
| | - Ruozhen Yuan
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceP.R. China
| | - Yang Shu
- State Key Laboratory of BiotherapyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceP.R. China
| | - Shihong Zhang
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceP.R. China
| | - Peng Lei
- State Key Laboratory of BiotherapyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceP.R. China
| | - Bo Wu
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceP.R. China
| | - Ming Liu
- Department of NeurologyWest China Hospital of Sichuan UniversityChengduSichuan ProvinceP.R. China
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Helal HHAE, Bahnasy WS, Ghali AA, Rabie MO. Early hematoma expansion in primary intracerebral hemorrhage: incidence and predictors. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0108-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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10
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Roh D, Chang T, Zammit C, Wagener G, Reynolds AS, Yoh N, Elkind MS, Doyle K, Boehme A, Eisenberger A, Francis RO, Park S, Agarwal S, Connolly ES, Claassen J, Hod E. Functional Coagulation Differences Between Lobar and Deep Intracerebral Hemorrhage Detected by Rotational Thromboelastometry: A Pilot Study. Neurocrit Care 2019; 31:81-87. [PMID: 30693412 PMCID: PMC6609477 DOI: 10.1007/s12028-019-00672-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Lobar intracerebral hemorrhage (ICH) is known to have better clinical outcomes and preliminary evidence of less hematoma expansion compared to deep ICH. No functional coagulation differences between lobar and deep ICH have been identified using traditional plasma-based coagulation tests. We investigated for coagulation differences between lobar and deep ICH using whole-blood coagulation testing (Rotational Thromboelastometry: [ROTEM]). METHODS Clinical, radiographic, and laboratory data were prospectively collected for primary ICH patients enrolled in a single-center ICH study. Patients with preceding anticoagulant use or admission coagulopathy on traditional laboratory testing were excluded. Lobar and deep ICH patients receiving admission ROTEM were analyzed. Linear regression was used to assess the association of ICH location with coagulation test results after adjusting for potential confounders. RESULTS There were 12 lobar and 19 deep ICH patients meeting inclusion criteria. Lobar ICH patients were significantly older and predominantly female. Lobar ICH had faster intrinsic pathway coagulation times (139.8 vs 203.2 s; 95% CI - 179.91 to - 45.96; p = 0.002) on ROTEM testing compared to deep ICH after adjusting for age, sex, and hematoma volume. This revealed functional coagulation differences, specifically quicker clot formation in lobar compared to deep ICH. No differences were noted using traditional coagulation testing (prothrombin time/partial thromboplastin time/platelet count). CONCLUSIONS Our pilot data may suggest that there are functional coagulation differences between lobar and deep ICH identified using ROTEM. Whole-blood coagulation testing may be useful in assessing coagulopathy in ICH patients and in determining reversal treatment paradigms, though further work is needed.
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Affiliation(s)
- David Roh
- Columbia University, Vagelos College of Physicians and Surgeons, NY
| | | | | | - Gebhard Wagener
- Columbia University, Vagelos College of Physicians and Surgeons, NY
| | | | - Nina Yoh
- Columbia University, Vagelos College of Physicians and Surgeons, NY
| | | | - Kevin Doyle
- Columbia University, Vagelos College of Physicians and Surgeons, NY
| | - Amelia Boehme
- Columbia University, Vagelos College of Physicians and Surgeons, NY
| | | | | | - Soojin Park
- Columbia University, Vagelos College of Physicians and Surgeons, NY
| | - Sachin Agarwal
- Columbia University, Vagelos College of Physicians and Surgeons, NY
| | | | - Jan Claassen
- Columbia University, Vagelos College of Physicians and Surgeons, NY
| | - Eldad Hod
- Columbia University, Vagelos College of Physicians and Surgeons, NY
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11
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Roh D, Sun CH, Murthy S, Elkind MSV, Bruce SS, Melmed K, Ironside N, Boehme A, Doyle K, Woo D, Kamel H, Park S, Agarwal S, Connolly ES, Claassen J. Hematoma Expansion Differences in Lobar and Deep Primary Intracerebral Hemorrhage. Neurocrit Care 2019; 31:40-45. [PMID: 30756318 PMCID: PMC6609462 DOI: 10.1007/s12028-018-00668-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hematoma expansion (HE) after intracerebral hemorrhage (ICH) is associated with worse outcome. Lobar ICHs are known to have better outcomes compared to deep ICH; however, it is unclear whether there are HE differences between these locations. We sought to investigate the hypothesis that lobar ICH has less HE compared to deep ICH. METHODS Primary ICH patients admitted between 2009 and 2016 were included in a prospective single-center ICH cohort study. Patients with preceding anticoagulant use, coagulopathy on admission labs, or presenting after 24 h from symptom onset were excluded. Lobar and deep ICH patients with baseline and follow-up computed tomography (CT) (within 24 h of admission CT) were evaluated. HE was defined primarily as relative growth > 33% given expected baseline hematoma volume differences between locations. Other commonly utilized definitions of HE: > 6 mL, and > 33% or > 6 mL, were additionally assessed. Multivariable logistic regression was used to assess the association of ICH location with HE while adjusting for previously identified covariates of HE. RESULTS There were 59 lobar and 143 deep ICH patients analyzed. Lobar ICH patients had significantly larger baseline hematoma volumes, lower admission systolic blood pressure, and longer times to admission CT compared to deep ICH. Multivariable logistic regression revealed an association of lobar ICH with lower odds of HE (> 33%) [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.11-0.93; p = 0.04] compared to deep ICH after adjusting for baseline ICH volume, blood pressure, and time to CT. Secondary analysis did not identify an association of lobar ICH with HE defined as > 6 mL (adjusted OR 1.44; 95% CI 0.59-3.50; p = 0.41) or > 33% or > 6 mL (adjusted OR 0.71; 95% CI 0.29-1.70; p = 0.44). CONCLUSION We identified less HE in lobar compared to deep ICH. The use of absolute growth thresholds in defining HE may be limited when assessing groups with largely different baseline hematoma sizes. Further study is required to replicate our findings and investigate mechanisms for HE differences between lobar and deep ICH locations.
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Affiliation(s)
- David Roh
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
| | - Chung-Huan Sun
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | - Mitchell S V Elkind
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Samuel S Bruce
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Kara Melmed
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Natasha Ironside
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Amelia Boehme
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Kevin Doyle
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Daniel Woo
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Soojin Park
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Sachin Agarwal
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - E Sander Connolly
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jan Claassen
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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12
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Computed Tomographic Black Hole Sign Predicts Postoperative Rehemorrhage in Patients with Spontaneous Intracranial Hemorrhage Following Stereotactic Minimally Invasive Surgery. World Neurosurg 2018; 120:e153-e160. [PMID: 30092481 DOI: 10.1016/j.wneu.2018.07.256] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/28/2018] [Accepted: 07/30/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Determining the value of the computed tomographic black hole sign in predicting postoperative rehemorrhage in patients with intracranial hemorrhage (ICH) underwent minimally invasive surgery (MIS). METHODS Two hundred ninety-five patients with spontaneous ICH underwent stereotactic MIS within 24 hours after admission. Ninety-eight patients (33%) demonstrated a black hole sign on initial computed tomography (CT). Postoperative rehemorrhage occurred in 68 patients (named the rehemorrhage group, including patients with and without black hole sign) and the other 227 patients (non-rehemorrhage group) did not show rehemorrhage. Multivariable logistic regression analyses were performed to assess the values of the black hole sign. RESULTS Postoperative rehemorrhage occurred in 57 of the 98 (58.2%) patients with the black hole sign, and in 11 of the 197 (5.58%) patients without the black hole sign. In the rehemorrhage group, 39 patients (57.4%) were found to have the black hole sign. However, only 59 patients (25.99%) from the non-rehemorrhage group showed the black hole sign. The sensitivity, specificity, and positive and negative predictive values of the black hole sign for predicting postoperative rehemorrhage were 57.4%, 74%, 39.8%, and 85.3%, respectively. The odd ratio for the black hole sign, the hematoma irregularity, and the CT value for predicting the postoperative rehemorrhage were 10.501, 9.631, and 4.750, respectively. CONCLUSIONS The black hole sign on initial CT could predict the postoperative rehemorrhage following the minimally invasive procedures.
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13
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Guha R, Boehme A, Demel SL, Li JJ, Cai X, James ML, Koch S, Langefeld CD, Moomaw CJ, Osborne J, Sekar P, Sheth KN, Woodrich E, Worrall BB, Woo D, Chaturvedi S. Aggressiveness of care following intracerebral hemorrhage in women and men. Neurology 2017; 89:349-354. [PMID: 28659419 DOI: 10.1212/wnl.0000000000004143] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 03/23/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To compare comorbidities and use of surgery and palliative care between men and women with intracerebral hemorrhage (ICH). METHODS The Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study is a prospective, multicenter, case-control study of ICH risk factors and outcomes. We compared comorbidities, treatments, and use of do-not-resuscitate (DNR) orders in men vs women. Multivariate analysis was used to assess the likelihood of ICH surgery and palliative care after adjustment for variables that were p < 0.1 in univariate analyses and backward elimination to retain those that were significant (p < 0.05). RESULTS Women were older on average (65.0 vs 59.9, p < 0.0001), and higher proportions of women had previous stroke (24.1% vs 19.3%, p = 0.002), had dementia (6.1% vs 3.4%, p = 0.0007), lived alone (23.1% vs 18.0%, p = 0.0005), and took anticoagulants (12.8% vs 10.1% p = 0.02), compared with men. Men had higher rates of alcohol and cocaine use. After adjusting for age, hematoma volume, and ICH location, there was no difference in rates of surgical treatment by sex (odds ratio [OR] 0.93 for men vs women, 95% confidence interval [CI] 0.68-1.28, p = 0.67), and there was no difference in DNR/comfort care decisions after adjustment for ICH score, prior stroke, and dementia (OR 0.96, CI 0.77-1.22, p = 0.76). CONCLUSIONS After ICH, women do not receive less aggressive care than men after controlling for the substantial comorbidity differences. Future studies on sex bias should include the presence of comorbidities, prestroke disability, and other factors that may influence management.
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Affiliation(s)
- Rahul Guha
- From the University of Virginia (R.G. and B.B.W.), Charlottesville; Columbia University (A.B.), New York, NY; University of Cincinnati (S.L.D., C.J.M., J.O., P.S., D.W.), OH; Georgetown University (J.J.L.), Washington, DC; Tufts Medical Center (X.C.), Boston, MA; Duke University (M.L.J.), Durham, NC; University of Miami (S.K., S.C.), FL; Wake Forest School of Medicine (C.D.L.), Winston-Salem, NC; Yale University School of Medicine (K.N.S.), New Haven, CT; and Banner University Medical Center Tucson (E.W.), AZ
| | - Amelia Boehme
- From the University of Virginia (R.G. and B.B.W.), Charlottesville; Columbia University (A.B.), New York, NY; University of Cincinnati (S.L.D., C.J.M., J.O., P.S., D.W.), OH; Georgetown University (J.J.L.), Washington, DC; Tufts Medical Center (X.C.), Boston, MA; Duke University (M.L.J.), Durham, NC; University of Miami (S.K., S.C.), FL; Wake Forest School of Medicine (C.D.L.), Winston-Salem, NC; Yale University School of Medicine (K.N.S.), New Haven, CT; and Banner University Medical Center Tucson (E.W.), AZ
| | - Stacie L Demel
- From the University of Virginia (R.G. and B.B.W.), Charlottesville; Columbia University (A.B.), New York, NY; University of Cincinnati (S.L.D., C.J.M., J.O., P.S., D.W.), OH; Georgetown University (J.J.L.), Washington, DC; Tufts Medical Center (X.C.), Boston, MA; Duke University (M.L.J.), Durham, NC; University of Miami (S.K., S.C.), FL; Wake Forest School of Medicine (C.D.L.), Winston-Salem, NC; Yale University School of Medicine (K.N.S.), New Haven, CT; and Banner University Medical Center Tucson (E.W.), AZ
| | - Janet J Li
- From the University of Virginia (R.G. and B.B.W.), Charlottesville; Columbia University (A.B.), New York, NY; University of Cincinnati (S.L.D., C.J.M., J.O., P.S., D.W.), OH; Georgetown University (J.J.L.), Washington, DC; Tufts Medical Center (X.C.), Boston, MA; Duke University (M.L.J.), Durham, NC; University of Miami (S.K., S.C.), FL; Wake Forest School of Medicine (C.D.L.), Winston-Salem, NC; Yale University School of Medicine (K.N.S.), New Haven, CT; and Banner University Medical Center Tucson (E.W.), AZ
| | - Xuemei Cai
- From the University of Virginia (R.G. and B.B.W.), Charlottesville; Columbia University (A.B.), New York, NY; University of Cincinnati (S.L.D., C.J.M., J.O., P.S., D.W.), OH; Georgetown University (J.J.L.), Washington, DC; Tufts Medical Center (X.C.), Boston, MA; Duke University (M.L.J.), Durham, NC; University of Miami (S.K., S.C.), FL; Wake Forest School of Medicine (C.D.L.), Winston-Salem, NC; Yale University School of Medicine (K.N.S.), New Haven, CT; and Banner University Medical Center Tucson (E.W.), AZ
| | - Michael L James
- From the University of Virginia (R.G. and B.B.W.), Charlottesville; Columbia University (A.B.), New York, NY; University of Cincinnati (S.L.D., C.J.M., J.O., P.S., D.W.), OH; Georgetown University (J.J.L.), Washington, DC; Tufts Medical Center (X.C.), Boston, MA; Duke University (M.L.J.), Durham, NC; University of Miami (S.K., S.C.), FL; Wake Forest School of Medicine (C.D.L.), Winston-Salem, NC; Yale University School of Medicine (K.N.S.), New Haven, CT; and Banner University Medical Center Tucson (E.W.), AZ
| | - Sebastian Koch
- From the University of Virginia (R.G. and B.B.W.), Charlottesville; Columbia University (A.B.), New York, NY; University of Cincinnati (S.L.D., C.J.M., J.O., P.S., D.W.), OH; Georgetown University (J.J.L.), Washington, DC; Tufts Medical Center (X.C.), Boston, MA; Duke University (M.L.J.), Durham, NC; University of Miami (S.K., S.C.), FL; Wake Forest School of Medicine (C.D.L.), Winston-Salem, NC; Yale University School of Medicine (K.N.S.), New Haven, CT; and Banner University Medical Center Tucson (E.W.), AZ
| | - Carl D Langefeld
- From the University of Virginia (R.G. and B.B.W.), Charlottesville; Columbia University (A.B.), New York, NY; University of Cincinnati (S.L.D., C.J.M., J.O., P.S., D.W.), OH; Georgetown University (J.J.L.), Washington, DC; Tufts Medical Center (X.C.), Boston, MA; Duke University (M.L.J.), Durham, NC; University of Miami (S.K., S.C.), FL; Wake Forest School of Medicine (C.D.L.), Winston-Salem, NC; Yale University School of Medicine (K.N.S.), New Haven, CT; and Banner University Medical Center Tucson (E.W.), AZ
| | - Charles J Moomaw
- From the University of Virginia (R.G. and B.B.W.), Charlottesville; Columbia University (A.B.), New York, NY; University of Cincinnati (S.L.D., C.J.M., J.O., P.S., D.W.), OH; Georgetown University (J.J.L.), Washington, DC; Tufts Medical Center (X.C.), Boston, MA; Duke University (M.L.J.), Durham, NC; University of Miami (S.K., S.C.), FL; Wake Forest School of Medicine (C.D.L.), Winston-Salem, NC; Yale University School of Medicine (K.N.S.), New Haven, CT; and Banner University Medical Center Tucson (E.W.), AZ
| | - Jennifer Osborne
- From the University of Virginia (R.G. and B.B.W.), Charlottesville; Columbia University (A.B.), New York, NY; University of Cincinnati (S.L.D., C.J.M., J.O., P.S., D.W.), OH; Georgetown University (J.J.L.), Washington, DC; Tufts Medical Center (X.C.), Boston, MA; Duke University (M.L.J.), Durham, NC; University of Miami (S.K., S.C.), FL; Wake Forest School of Medicine (C.D.L.), Winston-Salem, NC; Yale University School of Medicine (K.N.S.), New Haven, CT; and Banner University Medical Center Tucson (E.W.), AZ
| | - Padmini Sekar
- From the University of Virginia (R.G. and B.B.W.), Charlottesville; Columbia University (A.B.), New York, NY; University of Cincinnati (S.L.D., C.J.M., J.O., P.S., D.W.), OH; Georgetown University (J.J.L.), Washington, DC; Tufts Medical Center (X.C.), Boston, MA; Duke University (M.L.J.), Durham, NC; University of Miami (S.K., S.C.), FL; Wake Forest School of Medicine (C.D.L.), Winston-Salem, NC; Yale University School of Medicine (K.N.S.), New Haven, CT; and Banner University Medical Center Tucson (E.W.), AZ
| | - Kevin N Sheth
- From the University of Virginia (R.G. and B.B.W.), Charlottesville; Columbia University (A.B.), New York, NY; University of Cincinnati (S.L.D., C.J.M., J.O., P.S., D.W.), OH; Georgetown University (J.J.L.), Washington, DC; Tufts Medical Center (X.C.), Boston, MA; Duke University (M.L.J.), Durham, NC; University of Miami (S.K., S.C.), FL; Wake Forest School of Medicine (C.D.L.), Winston-Salem, NC; Yale University School of Medicine (K.N.S.), New Haven, CT; and Banner University Medical Center Tucson (E.W.), AZ
| | - E Woodrich
- From the University of Virginia (R.G. and B.B.W.), Charlottesville; Columbia University (A.B.), New York, NY; University of Cincinnati (S.L.D., C.J.M., J.O., P.S., D.W.), OH; Georgetown University (J.J.L.), Washington, DC; Tufts Medical Center (X.C.), Boston, MA; Duke University (M.L.J.), Durham, NC; University of Miami (S.K., S.C.), FL; Wake Forest School of Medicine (C.D.L.), Winston-Salem, NC; Yale University School of Medicine (K.N.S.), New Haven, CT; and Banner University Medical Center Tucson (E.W.), AZ
| | - Bradford B Worrall
- From the University of Virginia (R.G. and B.B.W.), Charlottesville; Columbia University (A.B.), New York, NY; University of Cincinnati (S.L.D., C.J.M., J.O., P.S., D.W.), OH; Georgetown University (J.J.L.), Washington, DC; Tufts Medical Center (X.C.), Boston, MA; Duke University (M.L.J.), Durham, NC; University of Miami (S.K., S.C.), FL; Wake Forest School of Medicine (C.D.L.), Winston-Salem, NC; Yale University School of Medicine (K.N.S.), New Haven, CT; and Banner University Medical Center Tucson (E.W.), AZ
| | - Daniel Woo
- From the University of Virginia (R.G. and B.B.W.), Charlottesville; Columbia University (A.B.), New York, NY; University of Cincinnati (S.L.D., C.J.M., J.O., P.S., D.W.), OH; Georgetown University (J.J.L.), Washington, DC; Tufts Medical Center (X.C.), Boston, MA; Duke University (M.L.J.), Durham, NC; University of Miami (S.K., S.C.), FL; Wake Forest School of Medicine (C.D.L.), Winston-Salem, NC; Yale University School of Medicine (K.N.S.), New Haven, CT; and Banner University Medical Center Tucson (E.W.), AZ
| | - Seemant Chaturvedi
- From the University of Virginia (R.G. and B.B.W.), Charlottesville; Columbia University (A.B.), New York, NY; University of Cincinnati (S.L.D., C.J.M., J.O., P.S., D.W.), OH; Georgetown University (J.J.L.), Washington, DC; Tufts Medical Center (X.C.), Boston, MA; Duke University (M.L.J.), Durham, NC; University of Miami (S.K., S.C.), FL; Wake Forest School of Medicine (C.D.L.), Winston-Salem, NC; Yale University School of Medicine (K.N.S.), New Haven, CT; and Banner University Medical Center Tucson (E.W.), AZ.
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Xu M, Lin J, Wang D, Liu M, Hao Z, Lei C. Cardiac troponin and cerebral herniation in acute intracerebral hemorrhage. Brain Behav 2017; 7:e00697. [PMID: 28638706 PMCID: PMC5474704 DOI: 10.1002/brb3.697] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To explore the association, if any, between the relationship between cardiac troponin and cerebral herniation after intracerebral hemorrhage (ICH). METHODS Six hundred and eighty-seven consecutive ICH patients admitted to West China Hospital from May 1, 2014 to September 1, 2015 were retrospectively reviewed. Data on demographics, etiology, laboratory examinations at admission including serum cardiac troponin, computed tomography (CT) scans at admission and follow-up, and clinical outcomes were obtained. Using multiple logistic regression to identify the relationship of troponin and herniation. The association between troponin and hematoma volume was assessed using bivariate correlation and linear regression. RESULTS Among 188 (27.4%) patients who underwent the test of serum cardiac troponin at admission, 16 (8.5%) demonstrated cerebral herniation. The median time from symptom onset to CT at admission and follow-up was 4 and 30.25 hr, respectively. In multivariate analysis, elevated troponin was independently associated with cerebral herniation (adjusted odds ratio [OR] 5.19; 95% confidence interval [CI], 1.08-24.93). And those with elevated troponin had larger hematoma volume at follow-up in bivariate correlation (correlation coefficient, .375, p = .003) and linear regression (β, .370, 95% CI, 0.062-0.320, p = .005), higher National Institutes of Health Stroke Scale score (adjusted OR 2.06; 95% CI, 1.06-4.01, p = .033) and lower Glasgow Coma Scale score (adjusted OR 2.34; 95% CI, 1.17-4.68, p = .016) than those without. CONCLUSIONS Elevated cardiac troponin was associated with an almost five-fold increased risk of cerebral herniation, but not in-hospital mortality. The possibility of cerebral herniation should be considered when ICH patients with large hematoma volume and elevated troponin.
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Affiliation(s)
- Mangmang Xu
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Jing Lin
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Deren Wang
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Ming Liu
- Department of Neurology West China Hospital Sichuan University Chengdu China.,Center of Cerebrovascular Diseases West China Hospital Sichuan University Chengdu China
| | - Zilong Hao
- Department of Neurology West China Hospital Sichuan University Chengdu China
| | - Chunyan Lei
- Department of Neurology First Affiliated Hospital of Kunming Medical University Kunming China
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15
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Correlation of Cerebral Microbleed Distribution to Amyloid Burden in Patients with Primary Intracerebral Hemorrhage. Sci Rep 2017; 7:44715. [PMID: 28303922 PMCID: PMC5356186 DOI: 10.1038/srep44715] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/13/2017] [Indexed: 12/11/2022] Open
Abstract
The underlying pathology of cerebral microbleeds (CMBs) with mixed lobar and deep distribution remains contentious. The aim of this study was to correlate CMBs distribution to β-amyloid burden in patients with primary intracerebral hemorrhage (ICH). Fourty-seven ICH patients underwent magnetic resonance susceptibility-weighted imaging and 11C-Pittsburgh Compound B positron emission tomography. The amyloid burden was expressed as standardized uptake value ratio with reference to cerebellum, and presented as median (interquartile range). Patients were categorized into the lobar, mixed (both lobar and deep regions), and deep types of CMB. Comparing the lobar (17%), mixed (59.6%) and deep (23.4%) CMB types, the global amyloid burden was significantly higher in the mixed type than the deep type (1.10 [1.03–1.25] vs 1.00 [0.97–1.09], p = 0.011), but lower than in the lobar type (1.48 [1.18–1.50], p = 0.048). On multivariable analysis, the ratio of lobar to deep CMB number was positively correlated with global (p = 0.028) and occipital (p = 0.031) amyloid burden. In primary ICH, patients with lobar and mixed CMB types are associated with increased amyloid burden than patients with deep type. The ratio of lobar to deep CMB number is an independent indicator of cerebral β-amyloid deposition.
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