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Wang Y, Chen P, Liang Y, Deng Y, Zhou W. Association between admission serum potassium concentration and the island sign on cranial CT in HICH patients: a cross-sectional study. Front Neurol 2024; 15:1337168. [PMID: 38895694 PMCID: PMC11184062 DOI: 10.3389/fneur.2024.1337168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Objective This study aimed to explore the correlation between serum potassium (K+) concentration upon admission and the presence of the Island Sign (IS) in cranial CT scans of patients diagnosed with Hypertensive Intracerebral Hemorrhage (HICH), including the potential presence of a non-linear relationship. Methods This investigation constituted a single-center cross-sectional study. We systematically gathered comprehensive general clinical characteristics, biological indicators, and imaging data from a cohort of 330 patients diagnosed with HICH. These patients received treatment within the neurosurgery department of Chongqing Emergency Medical Center during the period spanning from July 1, 2018, to July 7, 2023. Our primary objective was to scrutinize the potential connection between serum K+ concentration upon admission and the presence of the IS observed in cranial CT scans. To meticulously address this inquiry, we employed logistic regression modeling, thereby meticulously evaluating the correlation aforementioned. Moreover, in order to delve deeper into the intricacies of the relationship, we extended our analysis by employing a smoothed curve-fitting model to meticulously authenticate the potential non-linear interrelation between these two critical variables. Results In this investigation, a total of 330 patients diagnosed with HICH were ultimately enrolled, exhibiting an average age of 58.4 ± 13.1 years, comprising 238 (72.1%) males and 92 (27.9%) females. Among these participants, 118 individuals (35.7%) presented with the IS upon admission cranial CT scans, while 212 patients (64.3%) did not exhibit this characteristic. Upon comprehensive multifactorial adjustments, a non-linear association was uncovered between serum K+ concentration and the presence of IS. Notably, an inflection point was identified at approximately 3.54 mmol/L for serum K+ concentration. Prior to the patient's serum K+ concentration reaching around 3.54 mmol/L upon admission, a discernible trend was observed-every 0.1 mmol/L increment in serum K+ concentration was associated with an 8% decrease in the incidence of IS (OR: 0.914, 95% CI: 0.849-0.983, p = 0.015). Conclusion The findings of this study underscore a negative association between reduced serum K+ concentration upon admission and the occurrence of the IS on cranial CT scans among patients diagnosed with hypertensive cerebral hemorrhage. Furthermore, this negative correlation appears to manifest within the realm of a non-linear relationship. This study elucidates the potential significance of serum K+ concentration levels among patients with HICH, highlighting the role they play. Moreover, the maintenance of a physiological equilibrium in serum K+ concentrations emerges as a conceivable protective factor for individuals within the stroke population.
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Affiliation(s)
| | | | | | | | - Weiduo Zhou
- Department of Neurosurgery, Chongqing Emergency Medical Center, Chongqing University Central Hospital, School of Medicine, Chongqing University, Chongqing, China
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De Rosa L, Manara R, Vodret F, Kulyk C, Montano F, Pieroni A, Viaro F, Zedde ML, Napoletano R, Ermani M, Baracchini C. The "SALPARE study" of spontaneous intracerebral hemorrhage: part 1. Neurol Res Pract 2023; 5:5. [PMID: 36726162 PMCID: PMC9893659 DOI: 10.1186/s42466-023-00231-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 01/10/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (ICH) is a devastating type of stroke with a huge impact on patients and families. Expanded use of oral anticoagulants and ageing population might contribute to an epidemiological change. In view of these trends, we planned a study to obtain a contemporary picture and identify early prognostic factors to improve secondary prevention. METHODS This multicenter prospective cohort study included consecutive adult patients with non-traumatic ICH admitted to three academic Italian hospitals (Salerno, Padova, Reggio Emilia) over a 2-year period. Demographic characteristics, vascular risk profile, clinical data and main radiological characteristics were correlated to 90-day clinical outcome. RESULTS Out of 682 patients [mean age: 73 ± 14 years; 316 (46.3%) females] enrolled in this study, 40% died [86/180 (47.8%) in Salerno, 120/320 (37.5%) in Padova, 67/182 (36.8%) in Reggio Emilia; p < 0.05)] and 36% were severely disabled at 90 days. Several factors were associated with a higher risk of poor functional outcome such as antithrombotic drug use, hyperglycemia, previous cerebrovascular accident, low platelet count, and pontine/massive/intraventricular hemorrhage. However, at multivariate analysis only pre-ICH mRS score (OR 30.84), GCS score at presentation (OR 11.88), initial hematoma volume (OR 29.71), and NIHSS score at presentation (OR 25.89) were independent predictors of death and poor functional outcome. CONCLUSION Despite the heterogeneity among centers, this study on ICH has identified four simple prognostic factors that can independently predict patients outcome, stratify their risk, and guide their management.
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Affiliation(s)
- Ludovica De Rosa
- grid.411474.30000 0004 1760 2630Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy
| | - Renzo Manara
- grid.411474.30000 0004 1760 2630Neuroradiology Unit, Padua University Hospital, Padua, Italy
| | - Francesca Vodret
- grid.411474.30000 0004 1760 2630Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy
| | - Caterina Kulyk
- grid.9970.70000 0001 1941 5140Stroke Unit and Neurosonology Laboratory, Department of Neurology, Johannes Kepler University Linz, Linz, Austria
| | - Florian Montano
- grid.11780.3f0000 0004 1937 0335Neuroradiology, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Alessio Pieroni
- grid.411474.30000 0004 1760 2630Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy
| | - Federica Viaro
- grid.411474.30000 0004 1760 2630Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy
| | - Maria Luisa Zedde
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rosa Napoletano
- UOC Neurologia AOU S. Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Mario Ermani
- grid.411474.30000 0004 1760 2630Service of Medical Statistics, Department of Neurology, Padua University Hospital, Padua, Italy
| | - Claudio Baracchini
- grid.411474.30000 0004 1760 2630Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy
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Blood Pressure and Spot Sign in Spontaneous Supratentorial Subcortical Intracerebral Hemorrhage. Neurocrit Care 2022; 37:246-254. [PMID: 35445934 PMCID: PMC9283165 DOI: 10.1007/s12028-022-01485-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/07/2022] [Indexed: 10/27/2022]
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage is a potentially devastating cause of brain injury, often occurring secondary to hypertension. Contrast extravasation on computed tomography angiography (CTA), known as the spot sign, has been shown to predict hematoma expansion and worse outcomes. Although hypertension has been associated with an increased rate of the spot sign being present, the relationship between spot sign and blood pressure has not been fully explored. METHODS We retrospectively analyzed data from 134 patients (40 women and 94 men, mean age 62.3 ± 15.73 years) presenting to a tertiary academic medical center with spontaneous supratentorial subcortical intracerebral hemorrhage from 1/1/2018 to 1/4/2021. RESULTS A spot sign was demonstrated in images of 18 patients (13.43%) and correlated with a higher intracerebral hemorrhage score (2.61 ± 1.42 vs. 1.31 ± 1.25, p = 0.002), larger hematoma volume (53.49cm3 ± 32.08 vs. 23.45cm3 ± 25.65, p = 0.001), lower Glasgow Coma Scale on arrival (9.06 ± 4.56 vs. 11.74 ± 3.65, p = 0.027), increased risk of hematoma expansion (16.67% vs. 5.26%, p = 0.042), and need for surgical intervention (66.67% vs. 15.52%, p < 0.001). We did not see a correlation with age, sex, or underlying comorbidities. The presence of spot sign correlated with higher modified Rankin scores at discharge (4.94 ± 1.00 vs. 3.92 ± 1.64, p < 0.001). We saw significantly higher systolic blood pressure at the time of CTA in patients with a spot sign (184 mm Hg ± 43.11 vs. 153 mm Hg ± 36.99, p = 0.009) and the highest recorded blood pressure (p = 0.019), although not blood pressure on arrival (p = 0.081). Performing CTA early in the process of blood pressure lowering was associated with a spot sign (p < 0.001). CONCLUSIONS The presence of spot sign correlates with larger hematomas, worse outcomes, and increased surgical intervention. There is a significant association between spot sign and systolic blood pressure at the time of CTA, with the highest systolic blood pressure being recorded prior to CTA. Although the role of intensive blood pressure management in spontaneous intracerebral hemorrhage remains a subject of debate, patients with a spot sign may be a subgroup that could benefit from this.
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Falcone J, Chen JW. Early Minimally Invasive Parafascicular Surgery for Evacuation of Spontaneous Intracerebral Hemorrhage in the Setting of Computed Tomography Angiography Spot Sign: A Case Series. Oper Neurosurg (Hagerstown) 2022; 22:123-130. [PMID: 35030111 DOI: 10.1227/ons.0000000000000078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/03/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (sICH) is associated with high morbidity and mortality, and the role of surgery is uncertain. Spot sign on computed tomography angiography (CTA) has previously been seen as a contraindication for minimally invasive techniques. OBJECTIVE To demonstrate the use of minimally invasive parafascicular surgery (MIPS) for early evacuation of sICH in patients with spot sign on CTA. METHODS Retrospective review of patients presenting to a US tertiary academic medical center from 2018 to 2020 with sICH and CTA spot sign who were treated with MIPS within 6 h of arrival. RESULTS Seven patients (6 men and 1 woman, mean age 54.4 yr) were included in this study. There was a significant decrease between preoperative and postoperative intracerebral hemorrhage volumes (75.03 ± 39.00 cm3 vs 19.48 ± 17.81 cm3, P = .005) and intracerebral hemorrhage score (3.1 ± 0.9 vs 1.9 ± 0.9, P = .020). The mean time from arrival to surgery was 3.72 h (±1.22 h). The mean percentage of hematoma evacuation was 73.78% (±21.11%). The in-hospital mortality was 14.29%, and the mean modified Rankin score at discharge was 4.6 (±1.3). No complications related to the surgery were encountered in any of the cases, with no abnormal intraoperative bleeding and no pathology demonstrating occult vascular lesion. CONCLUSION Early intervention with MIPS appears to be a safe and effective means of hematoma evacuation despite the presence of CTA spot sign, and this finding should not delay early intervention when indicated. Intraoperative hemostasis may be facilitated by the direct visualization provided by a tubular retractor system.
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Affiliation(s)
- Joseph Falcone
- Department of Neurosurgery, University of California Irvine, Orange, California, USA
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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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Shen J, Shao X, Ge R, Di G, Jiang X. Risk Factors for Postoperative Rebleeding and Short-Term Prognosis of Spontaneous Cerebellar Hemorrhage. Risk Manag Healthc Policy 2021; 14:2045-2053. [PMID: 34040467 PMCID: PMC8140942 DOI: 10.2147/rmhp.s309286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Postoperative rebleeding (PRB) is one of the most severe complications after hematoma evacuation of spontaneous intracerebral hemorrhage (ICH). PRB has been proven to be an independent risk factor for poor prognosis. Previous studies have shown that spot sign and blend sign are independent risk factors for PRB of spontaneous ICH. However, the risk factors for PRB of spontaneous cerebellar hemorrhage (SCH) have not been elucidated. The aim of the present study was to investigate the possible risk factors for PRB and short-term prognosis of patients with SCH. Patients and Methods This study identified 62 patients with SCH who underwent hematoma evacuation in our department. Risk factors for PRB and short-term prognosis were identified by a univariable logistic regression model, and predictors with a P value of less than 0.05 were included in the multivariable logistic regression model to identify independent predictors. A receiver operating characteristic (ROC) curve was created to test the sensitivity and specificity of independent risk factors. Results Hematoma volume was the only independent predictor of PRB (OR=15.14, 95% CI=1.08–213.1, P=0.044). The sensitivity and specificity of hematoma volume to PRB were 63.6% and 89.7%, respectively, and the cutoff value of hematoma volume was >29.3 mL. GCS score ≤8 (OR=5.131, 95% CI=1.030–25.554, P=0.046) and PRB (OR=13.17, 95% CI=1.316–131.798, P=0.028) were independent risk factors for poor prognosis of patients with SCH. The sensitivity and specificity of the GCS score to poor prognosis were 66.7% and 86.2%, respectively. The sensitivity and specificity of the PRB to poor prognosis were 36.4% and 96.6%, respectively. Conclusion Hematoma volume is likely to be a strong predictor of PRB among patients with SCH. GCS scores ≤8 on arrival and PRB were significant predictors of short-term poor outcome.
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Affiliation(s)
- Jun Shen
- Department of Neurosurgery, The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College, Wuhu City, Anhui, 241001, People's Republic of China
| | - Xuefei Shao
- Department of Neurosurgery, The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College, Wuhu City, Anhui, 241001, People's Republic of China
| | - Ruixiang Ge
- Department of Neurosurgery, The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College, Wuhu City, Anhui, 241001, People's Republic of China
| | - Guangfu Di
- Department of Neurosurgery, The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College, Wuhu City, Anhui, 241001, People's Republic of China
| | - Xiaochun Jiang
- Department of Neurosurgery, The First Affiliated Hospital (YiJiShan Hospital) of Wannan Medical College, Wuhu City, Anhui, 241001, People's Republic of China
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Hannah TC, Kellner R, Kellner CP. Minimally Invasive Intracerebral Hemorrhage Evacuation Techniques: A Review. Diagnostics (Basel) 2021; 11:diagnostics11030576. [PMID: 33806790 PMCID: PMC8005063 DOI: 10.3390/diagnostics11030576] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 12/30/2022] Open
Abstract
Intracerebral hemorrhage (ICH) continues to have high morbidity and mortality. Improving ICH outcomes likely requires rapid removal of blood from the parenchyma and restraining edema formation while also limiting further neuronal damage due to the surgical intervention. Minimally invasive surgery (MIS) approaches promise to provide these benefits and have become alluring options for management of ICH. This review describes six MIS techniques for ICH evacuation including craniopuncture, stereotactic aspiration with thrombolysis, endoport-mediated evacuation, endoscope-assisted evacuation, adjunctive aspiration devices, and the surgiscope. The efficacy of each modality is discussed based on current literature. The largest clinical trials have yet to demonstrate definitive effects of MIS intervention on mortality and functional outcomes for ICH. Thus, there is a significant need for further innovation for ICH treatment. Multiple ongoing trials promise to better clarify the potential of the newer, non-thrombolytic MIS techniques.
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Yang W, Zhang S, Shen Y, Wei X, Zhao L, Xie X, Deng L, Li X, Lv X, Lv F, Dowlatshahi D, Li Q, Xie P. Noncontrast Computed Tomography Markers as Predictors of Revised Hematoma Expansion in Acute Intracerebral Hemorrhage. J Am Heart Assoc 2021; 10:e018248. [PMID: 33506695 PMCID: PMC7955436 DOI: 10.1161/jaha.120.018248] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/16/2020] [Indexed: 01/12/2023]
Abstract
Background Noncontrast computed tomography (NCCT) markers are the emerging predictors of hematoma expansion in intracerebral hemorrhage. However, the relationship between NCCT markers and the dynamic change of hematoma in parenchymal tissues and the ventricular system remains unclear. Methods and Results We included 314 consecutive patients with intracerebral hemorrhage admitted to our hospital from July 2011 to May 2017. The intracerebral hemorrhage volumes and intraventricular hemorrhage (IVH) volumes were measured using a semiautomated, computer-assisted technique. Revised hematoma expansion (RHE) was defined by incorporating the original definition of hematoma expansion into IVH growth. Receiver operating characteristic curve analysis was used to compare the performance of the NCCT markers in predicting the IVH growth and RHE. Of 314 patients in our study, 61 (19.4%) had IVH growth and 93 (23.9%) had RHE. After adjustment for potential confounding variables, blend sign, black hole sign, island sign, and expansion-prone hematoma could independently predict IVH growth and RHE in the multivariate logistic regression analysis. Expansion-prone hematoma had a higher predictive performance of RHE than any single marker. The diagnostic accuracy of RHE in predicting poor prognosis was significantly higher than that of hematoma expansion. Conclusions The NCCT markers are independently associated with IVH growth and RHE. Furthermore, the expansion-prone hematoma has a higher predictive accuracy for prediction of RHE and poor outcome than any single NCCT marker. These findings may assist in risk stratification of NCCT signs for predicting active bleeding.
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Affiliation(s)
- Wen‐Song Yang
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Shu‐Qiang Zhang
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Yi‐Qing Shen
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xiao Wei
- Department of Traditional Chinese MedicineChongqing Medical and Pharmaceutical CollegeChongqingChina
| | - Li‐Bo Zhao
- Department of NeurologyYongchuan Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of Cerebrovascular Disease ResearchYongchuan Hospital of Chongqing Medical UniversityChongqingChina
| | - Xiong‐Fei Xie
- Department of RadiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Lan Deng
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xin‐Hui Li
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xin‐Ni Lv
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Fa‐Jin Lv
- Department of RadiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Dar Dowlatshahi
- Department of Medicine (Neurology)Ottawa Hospital Research InstituteUniversity of OttawaOntarioCanada
| | - Qi Li
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of Cerebrovascular Disease ResearchYongchuan Hospital of Chongqing Medical UniversityChongqingChina
| | - Peng Xie
- Department of NeurologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional DiseasesThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Chongqing Key Laboratory of Cerebrovascular Disease ResearchYongchuan Hospital of Chongqing Medical UniversityChongqingChina
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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: 62] [Impact Index Per Article: 15.5] [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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Wei Y, Zhu G, Gao Y, Chang J, Zhang H, Liu N, Tian C, Jiang P, Gao Y. Island Sign Predicts Hematoma Expansion and Poor Outcome After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis. Front Neurol 2020; 11:429. [PMID: 32582001 PMCID: PMC7287172 DOI: 10.3389/fneur.2020.00429] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/22/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Early hematoma expansion (HE) occurs in patients with intracerebral hemorrhage (ICH) within the first few hours from ICH onset. Hematoma expansion has been considered as an independent predictor of poor clinical outcome and mortality after ICH. Island sign (IS) on the non-contrast computed tomography (NCCT) appears to increase the rate of detection of HE. However, there is insufficient evidence to declare that IS is an independent predictor for ICH patients prognosis and classification. Objectives: To investigate whether IS on NCCT could predict HE and functional outcome following ICH. Methods: Major databases were systematically searched, including PubMed, EMBASE, Cochrane library, and the Chinese database (CNKI, VIP, and Wanfang databases). Studies about the associations between IS and HE or IS and clinical outcome were included. The pooled result used the odds ratio (OR) with a 95% confidence interval (CI) as effect size. Heterogeneity and publication bias were assessed. Subgroup analysis and meta-regression were applied to detect potential factors of heterogeneity. Results: Eleven studies with 4,310 patients were included in the final analysis. The average incidence rate of IS and HE were 21.58 and 33%, respectively. The ideal timing for assessing HE was also not uniform or standardized. We separately performed two meta-analyses. First, 10 studies were included to estimate the association between IS and HE. The pooled OR was statistically significant (OR = 7.61, 95% CI = 3.10–18.67, P < 0.001). Second, four studies were included in the meta-analysis, and the pooled result showed that IS had a significantly positive relationship with poor outcome (OR = 3.83, 95% CI = 2.51–5.85, P < 0.001). Conclusions: This meta-analysis showed that NCCT IS is of great importance and value for evaluation of HE and poor outcome in patients with ICH. Future studies should focus on developing consensus guidelines, and more studies with large sample size and longitudinal design are needed to validate the conclusions.
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Affiliation(s)
- Yufei Wei
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Guangming Zhu
- Department of Radiology, School of Medicine, Stanford University, Stanford, CA, United States
| | - Yonghong Gao
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Jingling Chang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hua Zhang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Nan Liu
- Department of Neurology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Chao Tian
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Ping Jiang
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ying Gao
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
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Bian L, Mao LG, Sun Y, Shen F, Chen JF, Liu Z, Zhou W. Serum lipoprotein-associated phospholipase A2 as a promising prognostic biomarker in association with 90-day outcome of acute intracerebral hemorrhage. Clin Chim Acta 2019; 495:429-435. [PMID: 31103624 DOI: 10.1016/j.cca.2019.05.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Lipoprotein-associated phospholipase A2 (Lp-PLA2) is reflective of vascular inflammation and plays a role in the pathophysiology of cerebrovascular disease. We determine usefulness of serum Lp-PLA2 as a prognostic biomarker for intracerebral hemorrhage (ICH). METHODS In this prospective, observational study, serum Lp-PLA2 concentrations were detected among 164 patients with acute spontaneous basal ganglia hemorrhage and 164 healthy controls. Using multivariate analysis, we analyzed its association with poor outcome (modified Rankin Scale >2) at poststroke 90 days and hemorrhagic severity indicated by National Institutes of Health Stroke Scale (NIHSS) score and hematoma volume. RESULTS Serum Lp-PLA2 concentrations were remarkably higher in patients than in controls. Lp-PLA2 concentrations were independently correlated with NIHSS score (t = 5.095, P < .001) and hematoma volume (t = 2.850, P = .005). At 90-day follow-up, 85 patients (51.8%) had poor outcome. Under receiver operating characteristic curve, serum Lp-PLA2 showed a significant prognostic discriminatory capability (AUC, 0.813; 95% CI, 0.744-0.869). Serum Lp-PLA2 concentrations ≥304 ng/ml was an independent predictor associated with poor outcome (OR 7.052; 95% CI 1.971-25.228). CONCLUSIONS Rising serum Lp-PLA2 concentrations are closely hemorrhagic severity and clinical outcomes after ICH, substantializing serum Lp-PLA2 as a potential prognostic biomarker of ICH.
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Affiliation(s)
- Lin Bian
- Department of Neurosurgery, HwaMei Hospital, University of Chinese Academy of Sciences, 41 Northwest Street, Ningbo 315010, China
| | - Lian-Gang Mao
- Department of Clinical Laboratory, HwaMei Hospital, University of Chinese Academy of Sciences, 41 Northwest Street, Ningbo 315010, China.
| | - Yi Sun
- Department of Neurosurgery, HwaMei Hospital, University of Chinese Academy of Sciences, 41 Northwest Street, Ningbo 315010, China
| | - Feng Shen
- Department of Neurosurgery, HwaMei Hospital, University of Chinese Academy of Sciences, 41 Northwest Street, Ningbo 315010, China
| | - Jun-Feng Chen
- Department of Neurosurgery, HwaMei Hospital, University of Chinese Academy of Sciences, 41 Northwest Street, Ningbo 315010, China
| | - Zheng Liu
- Department of Neurosurgery, HwaMei Hospital, University of Chinese Academy of Sciences, 41 Northwest Street, Ningbo 315010, China
| | - Wei Zhou
- Department of Neurosurgery, HwaMei Hospital, University of Chinese Academy of Sciences, 41 Northwest Street, Ningbo 315010, China
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