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Yang D, Zhang X, Luo X, Zhang F, Sun S, Shaocheng L, Zhao X, Zhou J. Abnormal Local Brain Activity and Cognitive Impairments in Young Non-Disabled Patients With Intracerebral Hemorrhage: A Resting-State Functional MRI Study. J Magn Reson Imaging 2024; 60:941-951. [PMID: 38146647 DOI: 10.1002/jmri.29166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND Resting-state functional MRI (rs-fMRI) has identified static changes of local brain activity among patients with intracerebral hemorrhage (ICH). However, the dynamic and concordance-related characteristics of brain activity remain unclear. PURPOSE To investigate static, dynamic, and concordance-related features of the regional brain activity of young non-disabled ICH patients. STUDY TYPE Prospective. SUBJECTS Thirty-three ICH patients (modified Rankin Scale score ≤2, 21% female, 46.36 ± 6.53) and 33 matched healthy controls (HCs) (21% female, 47.64 ± 6.16). FIELD STRENGTH/SEQUENCE 3-T, rs-fMRI using gradient echo-planar imaging, T1-weighted imaging. ASSESSMENT Neuropsychological and rs-fMRI data were acquired from all participants. Amplitude of low-frequency fluctuations (ALFF), fractional ALFF (fALFF), regional homogeneity (ReHo), voxel-mirrored homotopic connectivity, global signal correlation (GSCorr) and degree centrality (DC), and their dynamic and concordance-related changes with sliding window analysis were calculated based on rs-fMRI data at a whole-brain level. The burden of cerebral small vascular diseases (cSVD) was assessed by cSVD scores. All hemorrhage lesions were delineated on normalized T1 images. STATISTICAL TESTS Multiple regression models, a voxel-level uncorrected P < 0.001, a cluster-level false discovery rate (FDR) corrected q < 0.05, a re-corrected qFDR <0.05 were considered significant. Pearson or Spearman correlation analyses between fMRI data and neurocognitive performance were performed. RESULTS Compared to HCs, ICH patients showed significant abnormal changes of ALFF, dynamic ALFF, fALFF, ReHo, dynamic ReHo, GSCorr, DC, and voxel-wise concordance in multiple brain regions mainly including the bilateral cerebellar hemispheres, ipsilesional thalamus, and bilateral middle cingulum gyrus. The ALFF in the cerebellar posterior lobe and thalamus were significantly associated with attention (r = -0.481) and executive function (rho = -0.521) in ICH patients. DATA CONCLUSION Young non-disabled ICH patients exhibit static, dynamic, and concordance-related alterations of local brain activity, part of which shows associations with cognitive functions. These findings may help comprehensively understand the mechanism of cognitive impairment after ICH. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Dan Yang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xue Zhang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiangqi Luo
- National Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Fengxia Zhang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shengjun Sun
- Department of Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liu Shaocheng
- Department of Neurology, Beijing Mentougou District Hospital, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Zhou
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Hwang DY, Kim KS, Muehlschlegel S, Wartenberg KE, Rajajee V, Alexander SA, Busl KM, Creutzfeldt CJ, Fontaine GV, Hocker SE, Madzar D, Mahanes D, Mainali S, Sakowitz OW, Varelas PN, Weimar C, Westermaier T, Meixensberger J. Guidelines for Neuroprognostication in Critically Ill Adults with Intracerebral Hemorrhage. Neurocrit Care 2024; 40:395-414. [PMID: 37923968 PMCID: PMC10959839 DOI: 10.1007/s12028-023-01854-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 09/01/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND The objective of this document is to provide recommendations on the formal reliability of major clinical predictors often associated with intracerebral hemorrhage (ICH) neuroprognostication. METHODS A narrative systematic review was completed using the Grading of Recommendations Assessment, Development, and Evaluation methodology and the Population, Intervention, Comparator, Outcome, Timing, Setting questions. Predictors, which included both individual clinical variables and prediction models, were selected based on clinical relevance and attention in the literature. Following construction of the evidence profile and summary of findings, recommendations were based on Grading of Recommendations Assessment, Development, and Evaluation criteria. Good practice statements addressed essential principles of neuroprognostication that could not be framed in the Population, Intervention, Comparator, Outcome, Timing, Setting format. RESULTS Six candidate clinical variables and two clinical grading scales (the original ICH score and maximally treated ICH score) were selected for recommendation creation. A total of 347 articles out of 10,751 articles screened met our eligibility criteria. Consensus statements of good practice included deferring neuroprognostication-aside from the most clinically devastated patients-for at least the first 48-72 h of intensive care unit admission; understanding what outcomes would have been most valued by the patient; and counseling of patients and surrogates whose ultimate neurological recovery may occur over a variable period of time. Although many clinical variables and grading scales are associated with ICH poor outcome, no clinical variable alone or sole clinical grading scale was suggested by the panel as currently being reliable by itself for use in counseling patients with ICH and their surrogates, regarding functional outcome at 3 months and beyond or 30-day mortality. CONCLUSIONS These guidelines provide recommendations on the formal reliability of predictors of poor outcome in the context of counseling patients with ICH and surrogates and suggest broad principles of neuroprognostication. Clinicians formulating their judgments of prognosis for patients with ICH should avoid anchoring bias based solely on any one clinical variable or published clinical grading scale.
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Affiliation(s)
- David Y Hwang
- Division of Neurocritical Care, Department of Neurology, University of North Carolina School of Medicine, 170 Manning Drive, CB# 7025, Chapel Hill, NC, 27599-7025, USA.
| | - Keri S Kim
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA
| | - Susanne Muehlschlegel
- Division of Neurosciences Critical Care, Departments of Neurology and Anesthesiology/Critical Care Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | | | | | | | - Katharina M Busl
- Departments of Neurology and Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Gabriel V Fontaine
- Departments of Pharmacy and Neurosciences, Intermountain Health, Salt Lake City, UT, USA
| | - Sara E Hocker
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Dominik Madzar
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Dea Mahanes
- Departments of Neurology and Neurosurgery, UVA Health, Charlottesville, VA, USA
| | - Shraddha Mainali
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | - Oliver W Sakowitz
- Department of Neurosurgery, Neurosurgery Center Ludwigsburg-Heilbronn, Ludwigsburg, Germany
| | | | - Christian Weimar
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
- BDH-Klinik Elzach, Elzach, Germany
| | - Thomas Westermaier
- Department of Neurosurgery, Helios Amper-Kliniken Dachau, University of Wuerzburg, Würzburg, Germany
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Chen C, Xie Y, Pu M, Deng L, Li Z, Yang T, Yin H, Zhang Z, Lv X, Liu X, Cheng J, Li Q. Age-related differences in risk factors, clinical characteristics, and outcomes for intracerebral hemorrhage. Front Aging Neurosci 2023; 15:1264124. [PMID: 38020784 PMCID: PMC10655109 DOI: 10.3389/fnagi.2023.1264124] [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: 07/20/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Background and purpose Intracerebral hemorrhage (ICH) is a severe form of stroke that remains understudied in the young adults. We aimed to investigate the clinical presentation, and risk factors associated with ICH in this age group and compare them to older patients. Methods Our study included ICH patients admitted between March 2016 and December 2021 in the First Affiliated Hospital of Chongqing Medical University from our ongoing prospective cohort database. Demographic characteristics, etiology, risk factors, and clinical outcomes were compared between elderly and young patients. Furthermore, logistic regression analysis was employed to explore risk factors associated with the functional outcome at 3-months. Results We selected 1,003 patients (mean age, 59.9 ±13.8 years old), 746 (74.4%) patients were aged >50 years. The logistic regression analysis showed young patients have a higher proportion of secondary ICH, higher white blood cell count and higher body mass index (BMI), but less diabetes mellitus. Of all patients, predictors of 3-month functional independence was first-ever ICH and age ≤50 years. The history of nephropathy and stroke, higher baseline NIHSS score, larger hematoma volume, and the presence of hydrocephalus were associated with poor outcomes. And the white blood cell count could significantly influence the prognosis among young ICH patients. Three-month functional outcome based on modified Rankin scale score was better in young patients than the elderly (OR, 1.232; 95% CI, 1.095-1.388; p < 0.001). Conclusions The highest incidence of ICH occurs in the age groups of 50-59 and 60-69. ICH in young adults had higher white blood cell and BMI compared to the elderly, and differs in etiological distribution. The young patients also had similar short-term mortality but more favorable functional outcomes than the elderly. Furthermore, NIHSS score and larger hematoma volumes were associated with poor outcome in all patients.
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Affiliation(s)
- Chu Chen
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanfang Xie
- Department of Neurology, Second Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Mingjun Pu
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lan Deng
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zuoqiao Li
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tiannan Yang
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Yin
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhehao Zhang
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinni Lv
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xueyun Liu
- Department of Neurology, Second Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Jing Cheng
- Department of Neurology, Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Li
- Department of Neurology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Yang Y, Huang S, Jia Y, Song G, Ye X, Lu K, Li G, Wang F, Zhu S. A 6-month prognostic nomogram incorporating hemoglobin level for intracerebral hemorrhage in younger adults. BMC Neurol 2023; 23:6. [PMID: 36609246 PMCID: PMC9817395 DOI: 10.1186/s12883-022-03039-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Intracerebral hemorrhage (ICH) is the second most common subtype of stroke, with high mortality and morbidity. At present, there are no effective 6-month prognostic markers, particularly for younger patients. The aim of this research was to construct a new valuable prognostic nomogram model incorporating haemoglobin levels for adult patients with ICH. METHODS Patients aged between 18 and 50 presenting with intracerebral haemorrhage at the Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology between January 1st 2012 and December 31st 2018 were included in this retrospective study. Independent factors of prognosis were identified by univariate and multivariate logistic regression analyses, and a new nomogram model was constructed and validated. The clinical value of the nomogram model was subsequently explored utilizing decision curve analysis and clinical impact curves. RESULTS In total, 565 patients were enrolled in this study, 117 (20.7%) of whom developed an unfavourable prognosis. Infratentorial lesion (adjusted odds ratio [aOR] = 3.708, 95% confidence interval [CI], 1.490-9.227; P = 0.005) was the most significant unfavourable outcome. Age ([aOR] = 1.054; 95% CI, 1.014-1.096; P = 0.008), hematoma volume (aOR = 1.014, 95% CI, 1.002-1.027; P = 0.024), haemoglobin (aOR = 0.981, 95% CI, 0.969-0.993; P = 0.002), blood glucose (aOR = 1.135, 95% CI, 1.037-1.241; P = 0.005) and NIHSS (aOR = 1.105, 95% CI, 1.069-1.141; P < 0.001) were independent risk factors. Based on these 6 factors, the nomogram can be employed to predict early functional prognosis with high accuracy (AUC 0.791). Decision curve analysis and clinical impact curves showed an increased net benefit for utilizing the nomogram. CONCLUSION The haemoglobin level at admission may be an easily overlooked factor in clinical work. This new nomogram model could be a promising and convenient tool to predict the early functional prognosis of adults with ICH. More prospective multicentre studies are needed to validate these findings.
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Affiliation(s)
- Yuyan Yang
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
| | - Shanshan Huang
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
| | - Yuchao Jia
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
| | - Guini Song
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
| | - Xiaodong Ye
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
| | - Kai Lu
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
| | - Guo Li
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
| | - Furong Wang
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
| | - Suiqiang Zhu
- grid.33199.310000 0004 0368 7223Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No 1095 Jiefang Avenue, Qiaok’ou District, Wuhan, 430030 Hubei China
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Wu YY, Chen PY, Wu CC, Chen HJ, Liang CL, Lee YC, Lin CW, Hung CM, Lin IF, Wang HK. Long-term mortality rates of young stroke in Taiwan: A decade-long epidemiology population-based study. Eur Stroke J 2022; 7:447-455. [PMID: 36478751 PMCID: PMC9720855 DOI: 10.1177/23969873221115268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/04/2022] [Indexed: 09/08/2023] Open
Abstract
INTRODUCTION Stroke remains a leading cause of death worldwide. Stroke in young adults is an important issue, gaining extra attention in recent years. This study aims to investigate the mortality after stroke in young adults in Taiwan. PATIENTS AND METHODS This is a registry- and population-based study in Taiwan of patients aged 20-50 years with first-ever stroke between 1999 and 2012, with follow-up until January 1, 2022. Patients and mortalities were identified through Taiwan National Health Insurance database. RESULTS The study population included 65,097 patients with stroke (mean age, 42.6 ± 6.6 years; 30.5% woman). There were 23,481 (36.1%) intracranial hemorrhage, 37,522 (57.6%) ischemic stroke, and 4094 (6.3%) stroke not otherwise specified. At the end of follow-up, a total of 18,248 deaths (28.0%) occurred during a median follow-up of 9.8 years (interquartile range, 6.4-13.7 years). CONCLUSION Taiwan young adults who were 30-day survivors of first-ever stroke have significantly higher long-term mortality rates when compared to other population-based studies.
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Affiliation(s)
- Yu-ying Wu
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of Neurosurgery, E-Da
Hospital, Kaohsiung
| | - Po-Yuan Chen
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of Neurosurgery, E-Da
Hospital, Kaohsiung
| | - Cheng-Chun Wu
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
| | - Han-Jung Chen
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of Neurosurgery, E-Da
Hospital, Kaohsiung
| | - Cheng-Loong Liang
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of Neurosurgery, E-Da
Hospital, Kaohsiung
| | - Yi-Che Lee
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of Nephrology, E-Da
Hospital, Kaohsiung
| | - Chi-Wei Lin
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of Family Medicine, E-Da
Hospital, Kaohsiung
| | - Chao-Ming Hung
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of General Surgery, E-Da
cancer Hospital, Kaohsiung
| | - I-Fan Lin
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of Infectious Disease, E-Da
Hospital, Kaohsiung
| | - Hao-Kuang Wang
- School of Medicine, College of
Medicine, I-Shou University, Kaohsiung
- Department of Neurosurgery, E-Da
Hospital, Kaohsiung
- Department of Neurosurgery, E-Da Cancer
Hospital, Kaohsiung
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Guo X, Zhong R, Han Y, Zhang H, Zhang X, Lin W. Incidence and relevant factors for seizures after spontaneous intracerebral hemorrhage: A systematic review and meta-analysis. Seizure 2022; 101:30-38. [DOI: 10.1016/j.seizure.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 12/01/2022] Open
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Park C, Charalambous LT, Yang Z, Adil SM, Hodges SE, Lee HJ, Verbick LZ, McCabe AR, Lad SP. Inpatient mortality and healthcare resource utilization of nontraumatic intracerebral hemorrhage complications in the US. J Neurosurg 2021; 135:1081-1090. [PMID: 33482635 DOI: 10.3171/2020.8.jns201839] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Nontraumatic, primary intracerebral hemorrhage (ICH) accounts for 2 million strokes worldwide annually and has a 1-year survival rate of 50%. Recent studies examining functional outcomes from ICH evacuation have been performed, but limited work has been done quantifying the incidence of subsequent complications and their healthcare economic impact. The purpose of this study was to quantify the incidence and healthcare resource utilization (HCRU) for major complications that can arise from ICH. METHODS The IBM MarketScan Research databases were used to retrospectively identify patients with ICH from 2010 to 2015. Complications examined included cerebral edema, hydrocephalus, venous thromboembolic events (VTEs), pneumonia, urinary tract infections (UTIs), and seizures. For each complication, inpatient mortality and HCRU were assessed. RESULTS Of 25,322 adult patients included, 10,619 (42%) developed complications during the initial admission of ICH: 22% had cerebral edema, 11% hydrocephalus, 10% pneumonia, 6% UTIs, 5% seizures, and 5% VTEs. The inpatient mortality rates at 7 and 30 days for each complication of ICH ranked from highest to lowest were hydrocephalus (24% and 32%), cerebral edema (15% and 20%), pneumonia (8% and 18%), seizure (7% and 13%), VTE (4% and 11%), and UTI (4% and 8%). Hydrocephalus had the highest total cost (median $92,776, IQR $39,308-$180,716) at 7 days post-ICH diagnosis and the highest cumulative total cost (median $170,839, IQR $91,462-$330,673) at 1 year post-ICH diagnosis. CONCLUSIONS This study characterizes one of the largest cohorts of patients with nontraumatic ICH in the US. More than 42% of the patients with ICH developed complications during initial admission, which resulted in high inpatient mortality and considerable HCRU.
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Affiliation(s)
| | | | - Zidanyue Yang
- 2Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina; and
| | | | | | - Hui-Jie Lee
- 2Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina; and
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Chen CY, Lin PT, Wang YH, Syu RW, Hsu SL, Chang LH, Tsai JY, Huang HC, Liu TC, Lin CJ, Tang CW, Hsu LC, Chung CP, Liu HY, Chi NF, Lee IH. Etiology and risk factors of intracranial hemorrhage and ischemic stroke in young adults. J Chin Med Assoc 2021; 84:930-936. [PMID: 34380990 DOI: 10.1097/jcma.0000000000000598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Young stroke incidence has increased worldwide with lifestyle changes. Etiology and risk factors for both ischemic and hemorrhagic stroke in young Asians remain underexplored. METHODS We retrospectively reviewed consecutive acute stroke patients aged 16-45 years admitted to the Taipei Veterans General Hospital between 2009 and 2019 to analyze etiologic subtypes, risk factors, and serial modified Rankin Scale scores for 1 year and compare the age groups of 16-30 and 31-45 years. RESULTS Among 670 young Taiwanese patients (mean age at onset 37.5 ± 7.0 years; male 65.1%), there were 366 nontraumatic spontaneous hemorrhagic stroke (including 259 intracerebral hemorrhage [ICH] and 107 subarachnoid hemorrhage, SAH), 292 ischemic stroke and 12 cerebral venous thromboses. Notably, ICH was more prevalent in patients aged 16-30 than in those aged 31-45 (54.8% vs 36.8%). Specifically, structural vasculopathy (e.g., arteriovenous malformation, cavernoma) was the most common etiologic subtype in patients aged 16-30 (p < 0.001), whereas hypertensive ICH was the most common subtype in patients aged 31-45 (p < 0.001). On the other hand, the top ischemic subtype for both age groups was other determined diseases (e.g., arterial dissection, autoimmune diseases, moyamoya disease, etc.) rather than large artery atherosclerosis. Hyperlipidemia, diabetes, and cigarette smoking were more common risk factors for infarction than ICH. Familial stroke patients whose first- or second-degree relatives had a stroke by age 80 (n = 104, 15.5%) had more infarctions than those without a familial stroke history. In multivariate analyses, initial stroke severity, and infarction type were important predictors of favorable outcomes after 3 months. At the 1-year follow-up, patients with ICH and SAH had worse functional outcomes and survival rates than those with infarction. CONCLUSION An aggressive approach to elucidate the etiology of stroke is indicated because structural vasculopathy-induced ICH and other determined infarction are distinctively prevalent in young adults, particularly those aged 16-30.
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Affiliation(s)
- Chun-Yu Chen
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, Taipei Veterans General Hospital Yuli Branch, Hualian, Taiwan, ROC
| | - Po-Tso Lin
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yun-Huei Wang
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ruei-Wun Syu
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Medical Department, Taipei Veterans General Hospital Hsinchu branch, Hsinchu, Taiwan, ROC
| | - Shao-Lun Hsu
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Li-Hsin Chang
- Institute of Brain Science, Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Jui-Yao Tsai
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hui-Chi Huang
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzu-Ching Liu
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chun-Jen Lin
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chih-Wei Tang
- Department of Neurology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Li-Chi Hsu
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chih-Ping Chung
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hung-Yu Liu
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Nai-Fang Chi
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - I-Hui Lee
- Division of Cerebrovascular Diseases, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Brain Science, Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Wen H, Chen Y. The predictive value of platelet to lymphocyte ratio and D-dimer to fibrinogen ratio combined with WELLS score on lower extremity deep vein thrombosis in young patients with cerebral hemorrhage. Neurol Sci 2021; 42:3715-3721. [PMID: 33443669 DOI: 10.1007/s10072-020-05007-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/16/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To study the predictive effect on YCH patients complicated with LEDVT by PLR and DFR combined with WELLS score. MATERIALS AND METHODS A total of 109 patients with YCH were selected as the research subjects. Patients with combined LEDVT were in the thrombosis group (33 cases), and without LEDVT in the non-thrombosis group (76 cases). Wells score was used to evaluate the vascular of the lower extremities. The PLR and DFR were calculated. The diagnostic value of PLR and DFR combined with the Wells score was evaluated by the AUC, sensitivity, specificity, and other indicators in the ROC. RESULTS The values of PLR, DFR, and Wells score in the thrombus group were 149.20 ± 52.17, 118.46 ± 8.37, and 2.67 ± 0.48, and that of the non-thrombotic group were 95.27 ± 29.48, 75.28 ± 10.16, and 0.72 ± 0.34, respectively. The differences were statistically significant. ROC results showed good diagnosis power of PLR (sensitivity 86.35%, specificity 75.18%, AUC 0.702.), DFR (sensitivity 88.57%, specificity 79.21%, AUC 0.786.), and the Wells score (sensitivity 90.17%, specificity 81.06%, AUC 0.889.). The combined application of the Wells score, PLR, and DFR for the occurrence of LEDVT had a sensitivity of 97.65%, a specificity of 92.43%, a missed diagnosis rate of 2.35%, and a misdiagnosis rate of 7.57%. The area under the ROC curve was 0.951, which was higher than using these variables independently. CONCLUSIONS PLR and DFR combined with Wells score have high specificity for predicting LEDVT in YCH patients with low missed diagnosis and low misdiagnosis rates. They are worthy of popularization and application.
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Affiliation(s)
- Huijun Wen
- Department of Neurology, Baoji Municipal Central Hospital, 8 Jiangtan Road, Baoji, 721008, Shaanxi, People's Republic of China
| | - Yingcong Chen
- Department of Neurology, Baoji Municipal Central Hospital, 8 Jiangtan Road, Baoji, 721008, Shaanxi, People's Republic of China.
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10
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Lahti AM, Nätynki M, Huhtakangas J, Bode M, Juvela S, Ohtonen P, Tetri S. Long-term survival after primary intracerebral hemorrhage: A population-based case-control study spanning a quarter of a century. Eur J Neurol 2021; 28:3663-3669. [PMID: 34155734 DOI: 10.1111/ene.14988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to determine the differences in life expectancy and causes of death after primary intracerebral hemorrhage (ICH) relative to general population controls. METHODS In a population-based setting, 963 patients from Northern Ostrobothnia who had their first-ever ICH between 1993 and 2008 were compared with a cohort of 2884 sex- and age-matched controls in terms of dates and causes of death as extracted from the Causes of Death Register kept by Statistics Finland and valid up to the end of 2017. RESULTS Of our 963 patients, 781 died during the follow-up time (mortality 81.1%). Cerebrovascular disease was the most common cause of death for these patients, 37.3% compared with 8.2% amongst the controls. The most common reasons for cerebrovascular mortality in the ICH patients were late sequelae of ICH in 12.8% (controls 0%) and new bleeding in 10.6% (controls 1.0%). The long-term survivors had a smaller ICH volume (median 12 ml) than those patients who died within 3 months (median 39 ml). The mortality rate of ICH patients during a follow-up between 12 and 24 years was still higher than that of their controls (hazard ratio 2.08, 95% confidence interval 1.58-2.74, p < 0.001). CONCLUSIONS Very long-term ICH survivors have a constant excess mortality relative to controls even 10 years after the index event. A significantly larger proportion of patients died of cerebrovascular causes and fewer because of cancer relative to the controls.
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Affiliation(s)
- Anna-Maija Lahti
- Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.,Medical Research Center Oulu Brain Health, Oulu University Hospital, Oulu, Finland
| | - Mirva Nätynki
- Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.,Medical Research Center Oulu Brain Health, Oulu University Hospital, Oulu, Finland
| | - Juha Huhtakangas
- Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.,Medical Research Center Oulu Brain Health, Oulu University Hospital, Oulu, Finland
| | - Michaela Bode
- Department of Radiology, Medical Imaging, Physics and Technology Research Unit, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Seppo Juvela
- Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Pasi Ohtonen
- Medical Research Center Oulu Brain Health, Oulu University Hospital, Oulu, Finland.,Division of Operative Care, Oulu University Hospital, Oulu, Finland.,Surgery, Anaesthesia and Intensive Care Research Unit, University of Oulu, Oulu, Finland
| | - Sami Tetri
- Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland.,Medical Research Center Oulu Brain Health, Oulu University Hospital, Oulu, Finland
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11
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Verhoeven JI, Pasi M, Casolla B, Hénon H, de Leeuw FE, Leys D, Klijn CJM, Cordonnier C. Long-term mortality in young patients with spontaneous intracerebral haemorrhage: Predictors and causes of death. Eur Stroke J 2021; 6:185-193. [PMID: 34414294 PMCID: PMC8370081 DOI: 10.1177/23969873211017723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/08/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Intracerebral haemorrhage (ICH) in young adults is rare but has devastating consequences. We investigated long-term mortality rates, causes of death and predictors of long-term mortality in young spontaneous ICH survivors. PATIENTS AND METHODS We included consecutive patients aged 18-55 years from the Prognosis of Intracerebral Haemorrhage cohort (PITCH), a prospective observational cohort of patients admitted to Lille University Hospital (2004-2009), who survived at least 30 days after spontaneous ICH. We studied long-term mortality with Kaplan-Meier analyses, collected causes of death, performed uni-/multivariable Cox-regression analyses for the association of baseline characteristics with long-term mortality. RESULTS Of 560 patients enrolled in the PITCH, 75 patients (75% men) met our inclusion criteria (median age 50 years, interquartile range [IQR] 44-53 years). During a median follow-up of 8.2 years (IQR 5.0-10.1), 26 patients died (35%), with a standardized mortality ratio of 13.0 (95% confidence interval [95% CI] 8.5-18.0) compared to peers from the general population. Causes of death were vascular in 7 (27%) patients, non-vascular in 13 (50%) and unknown in 6 (23%). Global cerebral atrophy (hazard ratio [HR] 3.0, 95% CI 1.1-8.6), modified Rankin Score >2 before ICH (HR 3.4, 95% CI 1.0-11.0), and excessive alcohol consumption (HR 3.3, 95% CI 1.1-10.2) were independently associated with long-term mortality. DISCUSSION We found a 13-fold higher mortality risk for young ICH survivors compared to the general French population. Predictors of long-term mortality were pre-existing conditions, not ICH-characteristics. CONCLUSION Young ICH survivors remain at increased mortality risk of vascular and non-vascular death for years after ICH.
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Affiliation(s)
- Jamie I Verhoeven
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Marco Pasi
- Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, University of Lille, Lille, France
| | - Barbara Casolla
- Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, University of Lille, Lille, France
| | - Hilde Hénon
- Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, University of Lille, Lille, France
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Didier Leys
- Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, University of Lille, Lille, France
| | - Catharina JM Klijn
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen, the Netherlands
| | - Charlotte Cordonnier
- Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience and Cognition, University of Lille, Lille, France
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12
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A Dynamic Joint Angle Measurement Device for an Active Hand Rehabilitation System. JOURNAL OF HEALTHCARE ENGINEERING 2021. [DOI: 10.1155/2021/6688345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Traditional methods of measuring a joint angle are neither repeatable nor accurate and cannot instantly display, record, and upload the data onto a cloud drive. These mechanisms require development if they are to be used to evaluate rehabilitation programs. This pilot study aim is to create a simple dynamic joint angle measurement system and develop a hand rehabilitation application for stroke users using small and sensitive 3-axis accelerometers. Using Bluetooth communication technology, an electrogoniometer is developed to measure the free range of motion of lower limb joints and automatically send and save all data on to a cloud drive. The reliability of the proposed device is evaluated by comparison with a commercial electrogoniometer. Five healthy youth subjects and five health elderly subjects are involved in the evaluation process for this pilot study. The accuracy and repeatability of the proposed device are tested using Bland–Altman plots and linear correlation analysis. Measurements that were made by the proposed device and a commercial electrogoniometer are shown to be comparable and repeatable, as confirmed by Bland–Atman plots. There is also a very high degree of linear correlation (R2 > 0.99 for all joint angle measurements) between the lower limb joint angles that are measured using both devices. In conclusion, a portable, highly accurate and repeatable device was designed to be used for clinical assessment and for rehabilitation application that gives increased motivation to the user.
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13
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Enriquez CAG, Omar AT, Medrano JMM, Diestro JDB, Ochoco GETD, Spears J, Khu KJO, Pineda-Franks MC. Non-Traumatic Intracerebral Hematoma in the Young: Findings from a Tertiary Hospital in the Philippines. J Stroke Cerebrovasc Dis 2020; 29:105242. [PMID: 33066927 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105242] [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: 06/02/2020] [Revised: 08/01/2020] [Accepted: 08/06/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is geographic variability in the clinical profile and outcomes of non-traumatic intracerebral hematoma (ICH) in the young, and data for the Philippines is lacking. We aimed to describe this in a cohort from the Philippines, and identify predictors of mortality. METHODS We performed a retrospective study of all patients aged 19-49 years with radiographic evidence of non-traumatic ICH admitted in our institution over five years. Data on demographics, risk factors, imaging, etiologies, surgical management, in-hospital mortality, and discharge functional outcomes were collected. Multivariate logistic regression analysis was done to determine factors predictive of mortality. RESULTS A total of 185 patients were included, which had a mean age of 40.98 years and a male predilection (71.9%). The most common hematoma location was subcortical, but it was lobar for the subgroup of patients aged 19-29 years. Overall, the most common etiology was hypertension (73.0%), especially in patients aged 40-49. Conversely, the incidence of vascular lesions and thrombocytopenia was higher in patients aged 19-29. Surgery was done in 7.0% of patients. The rates of mortality and favorable functional outcome at discharge were 8.7% and 35.1%, respectively. Younger age (p = 0.004), higher NIHSS score on admission (p=0.01), higher capillary blood glucose on admission (p=0.02), and intraventricular extension of hematoma (p = 0.01) predicted mortality. CONCLUSIONS In the Philippines, the most common etiology of ICH in young patients was hypertension, while aneurysms and AVM's were the most common etiology in the subgroup aged 19 - 29 years. Independent predictors of mortality were identified.
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Affiliation(s)
- Clare Angeli G Enriquez
- Department of Neurosciences, University of the Philippines Manila - Philippine General Hospital, Manila
| | - Abdelsimar T Omar
- Department of Neurosciences, University of the Philippines Manila - Philippine General Hospital, Manila.
| | - Jose Miguel M Medrano
- Department of Neurosciences, University of the Philippines Manila - Philippine General Hospital, Manila
| | - Jose Danilo B Diestro
- Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | | | - Julian Spears
- Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen Joy O Khu
- Department of Neurosciences, University of the Philippines Manila - Philippine General Hospital, Manila
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14
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van Nieuwenhuizen KM, Vaartjes I, Verhoeven JI, Rinkel GJ, Kappelle LJ, Schreuder FH, Klijn CJ. Long-term prognosis after intracerebral haemorrhage. Eur Stroke J 2020; 5:336-344. [PMID: 33598551 PMCID: PMC7856590 DOI: 10.1177/2396987320953394] [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: 02/12/2020] [Accepted: 07/29/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction The aim of this study was to determine the risk of recurrent intracerebral haemorrhage (ICH), ischaemic stroke, all stroke, any vascular event and all-cause mortality in 30-day survivors of ICH, according to age and sex. Patients and methods We linked national hospital discharge, population and cause of death registers to obtain a cohort of Dutch 30-day survivors of ICH from 1998 to 2010. We calculated cumulative incidences of recurrent ICH, ischaemic stroke, all stroke and composite vascular outcome, adjusted for competing risk of death and all-cause mortality. Additionally, we compared survival with the general population. Results We included 19,444 ICH-survivors (52% male; median age 72 years, interquartile range 61–79; 78,654 patient-years of follow-up). First-year cumulative incidence of recurrent ICH ranged from 1.5% (95% confidence interval 0.9–2.3; men 35–54 years) to 2.4% (2.0–2.9; women 75–94 years). Depending on age and sex, 10-year risk of recurrent ICH ranged from 3.7% (2.6–5.1; men 35–54 years) to 8.1% (6.9–9.4; women 55–74 years); ischaemic stroke 2.6% to 7.0%, of all stroke 9.9% to 26.2% and of any vascular event 15.0% to 40.4%. Ten-year mortality ranged from 16.7% (35–54 years) to 90.0% (75–94 years). Relative survival was lower in all age-groups of both sexes, ranging from 0.83 (0.80–0.87) in 35- to 54-year-old men to 0.28 (0.24–0.32) in 75- to 94-year-old women. Discussion ICH-survivors are at high risk of recurrent ICH, of ischaemic stroke and other vascular events, and have a sustained reduced survival rate compared to the general population. Conclusion The high risk of recurrent ICH, other vascular events and prolonged reduced survival-rates warrant clinical trials to determine optimal secondary prevention treatment after ICH.
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Affiliation(s)
- Koen M van Nieuwenhuizen
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jamie I Verhoeven
- Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gabriel Je Rinkel
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Floris Hbm Schreuder
- Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Catharina Jm Klijn
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Neurology, Donders Institute of Brain, Cognition and Behaviour, Center for Neuroscience, Radboud University Medical Center, Nijmegen, the Netherlands
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15
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Kim BD, Kurian C, Stein LK, Tuhrim S, Dhamoon MS. Index Admission Characteristics and All-Cause Readmissions Analysis in Younger and Older Adults with Intracerebral Hemorrhage. Cerebrovasc Dis 2020; 49:375-381. [PMID: 32829328 DOI: 10.1159/000509839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 06/29/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Intracerebral hemorrhage (ICH) comprises 15-20% of all strokes with debilitating consequences. Data regarding characteristics and outcomes of primary ICH in the young are lacking, given its rarity, making comparisons between younger and older cohorts difficult to perform. Nationally representative administrative databases enable analysis of such rare events. OBJECTIVE To determine the baseline characteristics, all-cause readmission rates, and reasons for primary ICH in younger and older adults using a nationally representative database. METHODS A retrospective cohort analysis was performed using the Nationwide Readmissions Database 2013. Validated ICD-9-CM codes identified index ICH admissions, comorbidities, demographics, behavioral risk factors, procedures, and Elixhauser and Charlson Comorbidity indices. We compared "younger" (age ≤ 45 years) and "older" (age > 45) index ICH admissions by weighted 30-day all-cause readmission rates, primary diagnosis code for 30-day readmissions, most common comorbidities during the index hospitalization, and Kaplan-Meier cumulative risk of readmission up to 1 year. RESULTS Older admissions had higher comorbidity scores and mortality, but both groups had similar total comorbidities. Younger admissions exhibited longer length of stay with more procedures performed. Vascular anomalies (aneurysm 7.2 vs. 4.6% and arteriovenous malformation 5.9 vs. 0.8%) and behavioral risk factors (smoking 26.5 vs. 23.0%, alcohol abuse 6.7 vs. 4.6%, and substance use 13.5 vs. 2.9%) were more prevalent in younger admissions, while older patients had more cardiovascular comorbidities. All-cause 30-day readmission rates (13.1 vs. 13.0%) and 1-year cumulative risk of readmission (log-rank p value 0.7209) were similar. Readmissions in the younger cohort were primarily for neurological conditions, and those in the older cohort were for systemic conditions. CONCLUSIONS Adults <45 years with ICH had similar total comorbidities as older adults but more procedures, longer hospital stay, and more behavioral risk factors. Readmission rates were similar though reasons differed; younger patients were more for neurological reasons than for other systemic causes.
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Affiliation(s)
- Brian Dongha Kim
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christeena Kurian
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laura K Stein
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stanley Tuhrim
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mandip S Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA,
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16
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Mello TG, Rosado-de-Castro PH, Campos RMP, Vasques JF, Rangel-Junior WS, Mattos RSDARD, Puig-Pijuan T, Foerster BU, Gutfilen B, Souza SAL, Boltze J, Paiva FF, Mendez-Otero R, Pimentel-Coelho PM. Intravenous Human Umbilical Cord-Derived Mesenchymal Stromal Cell Administration in Models of Moderate and Severe Intracerebral Hemorrhage. Stem Cells Dev 2020; 29:586-598. [PMID: 32160799 DOI: 10.1089/scd.2019.0176] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Intracerebral hemorrhage (ICH) is as a life-threatening condition that can occur in young adults, often causing long-term disability. Recent preclinical data suggest mesenchymal stromal cell (MSC)-based therapies as promising options to minimize brain damage after ICH. However, therapeutic evidence and mechanistic insights are still limited, particularly when compared with other disorders such as ischemic stroke. Herein, we employed a model of collagenase-induced ICH in young adult rats to investigate the potential therapeutic effects of an intravenous injection of human umbilical cord Wharton's jelly-derived MSCs (hUC-MSCs). Two doses of collagenase were used to cause moderate or severe hemorrhages. Magnetic resonance imaging showed that animals treated with hUC-MSCs after moderate ICH had smaller residual hematoma volumes than vehicle-treated rats, whereas the cell therapy failed to decrease the hematoma volume in animals with a severe ICH. Functional assessments (rotarod and elevated body swing tests) were performed for up to 21 days after ICH. Enduring neurological impairments were seen only in animals subjected to severe ICH, but the cell therapy did not induce statistically significant improvements in the functional recovery. The biodistribution of Technetium-99m-labeled hUC-MSCs was also evaluated, showing that most cells were found in organs such as the spleen and lungs 24 h after transplantation. Nevertheless, it was possible to detect a weak signal in the brain, which was higher in the ipsilateral hemisphere of rats subjected to a severe ICH. These data indicate that hUC-MSCs have moderately beneficial effects in cases of less severe brain hemorrhages in rats by decreasing the residual hematoma volume, and that optimization of the therapy is still necessary.
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Affiliation(s)
- Tanira Giara Mello
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto de Engenharia Nuclear, Comissão Nacional de Energia Nuclear, Rio de Janeiro, Brazil.,Instituto Nacional de Ciência e Tecnologia em Medicina Regenerativa, Rio de Janeiro, Brazil
| | - Paulo Henrique Rosado-de-Castro
- Instituto Nacional de Ciência e Tecnologia em Medicina Regenerativa, Rio de Janeiro, Brazil.,Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Juliana Ferreira Vasques
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto Nacional de Ciência e Tecnologia em Medicina Regenerativa, Rio de Janeiro, Brazil
| | | | | | - Teresa Puig-Pijuan
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto Nacional de Ciência e Tecnologia em Medicina Regenerativa, Rio de Janeiro, Brazil
| | - Bernd Uwe Foerster
- Instituto de Física de São Carlos, Universidade de São Paulo, São Carlos, Brazil
| | - Bianca Gutfilen
- Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sergio Augusto Lopes Souza
- Departamento de Radiologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Johannes Boltze
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
| | | | - Rosalia Mendez-Otero
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto Nacional de Ciência e Tecnologia em Medicina Regenerativa, Rio de Janeiro, Brazil
| | - Pedro Moreno Pimentel-Coelho
- Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto Nacional de Ciência e Tecnologia em Medicina Regenerativa, Rio de Janeiro, Brazil
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17
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Doumbe J, Abdouramani K, Gams DM, Ayeah CM, Kenmegne C, Mapoure YN. Spontaneous Intracerebral Hemorrhage: Epidemiology, Clinical Profile and Short-Term Outcome in a Tertiary Hospital in Sub-Saharan Africa. ACTA ACUST UNITED AC 2020. [DOI: 10.4236/wjns.2020.103016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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18
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Bernardo F, Rebordão L, Machado S, Salgado V, Pinto AN. In-Hospital and Long-Term Prognosis after Spontaneous Intracerebral Hemorrhage among Young Adults Aged 18-65 Years. J Stroke Cerebrovasc Dis 2019; 28:104350. [PMID: 31492627 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/21/2019] [Accepted: 08/11/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (ICH) accounts for 10%-15% of all strokes and has an estimated annual incidence of 5/100,000 in young adults. Limited data on prognosis after ICH in young adults are available. We aimed to identify prognostic predictors after ICH among adults aged 18-65 years. METHODS We retrospectively selected all patients with ICH from a prospective single-center registry of adults with first stroke before 65 years between 1997 and 2002. We recorded in-hospital mortality as well as mortality and recurrent stroke after discharge until December 1, 2018. For in-hospital analysis, we compared patients that died in-hospital versus patients discharged alive. For long-term analysis, we compared patients that died in follow-up versus patients still alive. Independent prognostic predictors were identified using multivariate analyses. RESULTS Among 161 patients included, 24 (14.9%) died in-hospital. Among in-hospital survivors, 5-year survival was 92.0%, 10-year survival 78.1%, and 15-year survival 62.0%. After median follow-up of 17 years, 47.4% of patients died, 18 patients had ischemic stroke, and 6 recurrent ICH. Regarding in-hospital prognosis, coma at admission (OR .02 [.00-.11]) was independent predictor for mortality whereas alcoholic habits (OR 12.32 [1.82-83.30]) was independent predictor for survival. An increasing age (OR 1.08 [1.03-1.12]), higher blood glucose levels (OR 1.01 [1.00-1.01]), and hypertension (OR 2.21 [1.22-4.00]) were independent predictors of long-term mortality after ICH. CONCLUSIONS Alcoholic habits may influence in-hospital survival after ICH in young adults. Long-term mortality in young adults seems to be lower than in elderly and was predicted by higher blood glucose levels and hypertension.
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Affiliation(s)
- Francisco Bernardo
- Department of Neurology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal.
| | - Leonor Rebordão
- Department of Neurology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Sara Machado
- Department of Neurology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Vasco Salgado
- Department of Neurology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Amélia Nogueira Pinto
- Department of Neurology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
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Ekker MS, Verhoeven JI, Vaartjes I, Jolink WMT, Klijn CJM, de Leeuw FE. Association of Stroke Among Adults Aged 18 to 49 Years With Long-term Mortality. JAMA 2019; 321:2113-2123. [PMID: 31121602 PMCID: PMC6547225 DOI: 10.1001/jama.2019.6560] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Stroke remains the second leading cause of death worldwide. Approximately 10% to 15% of all strokes occur in young adults. Information on prognosis and mortality specifically in young adults is limited. OBJECTIVE To determine short- and long-term mortality risk after stroke in young adults, according to age, sex, and stroke subtype; time trends in mortality; and causes of death. DESIGN, SETTING, AND PARTICIPANTS Registry- and population-based study in the Netherlands of 15 527 patients aged 18 to 49 years with first stroke between 1998 and 2010, and follow-up until January 1, 2017. Patients and outcomes were identified through linkage of the national Hospital Discharge Registry, national Cause of Death Registry, and the Dutch Population Register. EXPOSURES First stroke occurring at age 18 to 49 years, documented using International Classification of Diseases, Ninth Revision, and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, codes for ischemic stroke, intracerebral hemorrhage, and stroke not otherwise specified. MAIN OUTCOMES AND MEASURES Primary outcome was all-cause cumulative mortality in 30-day survivors at end of follow-up, stratified by age, sex, and stroke subtype, and compared with all-cause cumulative mortality in the general population. RESULTS The study population included 15 527 patients with stroke (median age, 44 years [interquartile range, 38-47 years]; 53.3% women). At end of follow-up, a total of 3540 cumulative deaths had occurred, including 1776 deaths within 30 days after stroke and 1764 deaths (23.2%) during a median duration of follow-up of 9.3 years (interquartile range, 5.9-13.1 years). The 15-year mortality in 30-day survivors was 17.0% (95% CI, 16.2%-17.9%). The standardized mortality rate compared with the general population was 5.1 (95% CI, 4.7-5.4) for ischemic stroke (observed mortality rate 12.0/1000 person-years [95% CI, 11.2-12.9/1000 person-years]; expected rate, 2.4/1000 person-years; excess rate, 9.6/1000 person-years) and the standardized mortality rate for intracerebral hemorrhage was 8.4 (95% CI, 7.4-9.3; observed rate, 18.7/1000 person-years [95% CI, 16.7-21.0/1000 person-years]; expected rate, 2.2/1000 person-years; excess rate, 16.4/1000 person-years). CONCLUSIONS AND RELEVANCE Among young adults aged 18 to 49 years in the Netherlands who were 30-day survivors of first stroke, mortality risk compared with the general population remained elevated up to 15 years later.
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Affiliation(s)
- Merel Sanne Ekker
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Jamie Inge Verhoeven
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Nijmegen, the Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Wilhelmus Martinus Tim Jolink
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Catharina Johanna Maria Klijn
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Nijmegen, the Netherlands
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank-Erik de Leeuw
- Radboud University Medical Centre, Donders Institute for Brain, Cognition, and Behaviour, Department of Neurology, Nijmegen, the Netherlands
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Is nontraumatic intracerebral hemorrhage different between young and elderly patients? Neurosurg Rev 2019; 43:781-791. [PMID: 31161443 DOI: 10.1007/s10143-019-01120-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/29/2019] [Accepted: 05/21/2019] [Indexed: 01/05/2023]
Abstract
Only a few studies have reported nontraumatic intracerebral hemorrhage in young patients notwithstanding its fatal and devastating characteristics. This study investigated the clinical characteristics and outcome of nontraumatic intracerebral hemorrhage in young patients in comparison to those of the elderly. A retrospective review of consecutive patients admitted at the department of neurosurgery of two tertiary care medical centers presenting with first-ever nontraumatic intracerebral hemorrhage was performed. We identified and compared the demographics, etiologies, risk factors, and laboratory, radiological, and clinical findings between elderly and young patients. Additionally, logistic regression analyses of independent prognostic factors associated with 1-month mortality and favorable functional outcome were performed. Altogether, 247 patients including 69 young patients and 178 elderly patients were enrolled. On multivariate analysis, young patients exhibited significantly more often an infratentorial hematoma location, excessive alcohol consumption, and high body mass index (BMI), but less frequent systemic hypertension. There was no statistical difference between the two groups in 1-month mortality (17.46% and 18.01% for young and elderly patients, respectively), but the favorable functional outcome based on modified Rankin scale score of 0 or 1 was significantly different between the two groups (favorable outcome in 51.79% and 29.93% of patients, respectively). Predictors of 1-month mortality was the presence of herniation in the young group, and lower Glasgow Coma Scale score, renal or heart disease, and leukocytosis (WBC > 10,000) in the elderly group. Lower National Institutes Health Stroke Scale score was associated with favorable functional outcome in both groups. Nontraumatic intracerebral hemorrhage in younger patients appears to be associated with excessive alcohol consumption and high BMI. Younger patients had similar short-term mortality but more favorable functional outcome than the elderly.
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Fahlström A, Tobieson L, Redebrandt HN, Zeberg H, Bartek J, Bartley A, Erkki M, Hessington A, Troberg E, Mirza S, Tsitsopoulos PP, Marklund N. Differences in neurosurgical treatment of intracerebral haemorrhage: a nation-wide observational study of 578 consecutive patients. Acta Neurochir (Wien) 2019; 161:955-965. [PMID: 30877470 PMCID: PMC6484090 DOI: 10.1007/s00701-019-03853-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/13/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Supratentorial intracerebral haemorrhage (ICH) carries an excessive mortality and morbidity. Although surgical ICH treatment can be life-saving, the indications for surgery in larger cohorts of ICH patients are controversial and not well defined. We hypothesised that surgical indications vary substantially among neurosurgical centres in Sweden. OBJECTIVE In this nation-wide retrospective observational study, differences in treatment strategies among all neurosurgical departments in Sweden were evaluated. METHODS Patient records, neuroimaging and clinical outcome focused on 30-day mortality were collected on each operated ICH patient treated at any of the six neurosurgical centres in Sweden from 1 January 2011 to 31 December 2015. RESULTS In total, 578 consecutive surgically treated ICH patients were evaluated. There was a similar incidence of surgical treatment among different neurosurgical catchment areas. Patient selection for surgery was similar among the centres in terms of patient age, pre-operative level of consciousness and co-morbidities, but differed in ICH volume, proportion of deep-seated vs. lobar ICH and pre-operative signs of herniation (p < .05). Post-operative patient management strategies, including the use of ICP-monitoring, CSF-drainage and mechanical ventilation, varied among centres (p < .05). The 30-day mortality ranged between 10 and 28%. CONCLUSIONS Although indications for surgical treatment of ICH in the six Swedish neurosurgical centres were homogenous with regard to age and pre-operative level of consciousness, important differences in ICH volume, proportion of deep-seated haemorrhages and pre-operative signs of herniation were observed, and there was a substantial variability in post-operative management. The present results reflect the need for refined evidence-based guidelines for surgical management of ICH.
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Affiliation(s)
- Andreas Fahlström
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden.
| | - Lovisa Tobieson
- Department of Neurosurgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Henrietta Nittby Redebrandt
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Hugo Zeberg
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jiri Bartek
- Department of Medicine and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Andreas Bartley
- Department of Clinical Neuroscience, Neurosurgery, University of Gothenburg, Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Erkki
- Department of Clinical Neuroscience, Neurosurgery, Umeå University, Umeå University Hospital, Umeå, Sweden
| | - Amel Hessington
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Ebba Troberg
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Sadia Mirza
- Department of Medicine and Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Parmenion P Tsitsopoulos
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Niklas Marklund
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
- Department of Neurosurgery and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Clinical Sciences Lund, Neurosurgery, Lund University, Skane University Hospital, Lund, Sweden
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Targeting GPER1 to suppress autophagy as a male-specific therapeutic strategy for iron-induced striatal injury. Sci Rep 2019; 9:6661. [PMID: 31040364 PMCID: PMC6491488 DOI: 10.1038/s41598-019-43244-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/05/2018] [Indexed: 12/21/2022] Open
Abstract
The functional outcome of intracerebral hemorrhage (ICH) in young male patients are poor than in premenopausal women. After ICH, ferrous iron accumulation causes a higher level of oxidative injury associated with autophagic cell death in striatum of male mice than in females. In rodent model of ferrous citrate (FC)-infusion that simulates iron accumulation after ICH, female endogenous estradiol (E2) suppresses autophagy via estrogen receptor α (ERα) and contributes to less injury severity. Moreover, E2 implantation diminished the FC-induced autophagic cell death and injury in males, whose ERα in the striatum is less than females. Since, no sex difference of ERβ was observed in striatum, we delineated whether ERα and G-protein-coupled estrogen receptor 1 (GPER1) mediate the suppressions of FC-induced autophagy and oxidative injury by E2 in a sex-dimorphic manner. The results showed that the ratio of constitutive GPER1 to ERα in striatum is higher in males than in females. The GPER1 and ERα predominantly mediated suppressive effects of E2 on FC-induced autophagy in males and antioxidant effect of E2 in females, respectively. This finding opens the prospect of a male-specific therapeutic strategy targeting GPER1 for autophagy suppression in patients suffering from iron overload after hemorrhage.
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Management of intracranial haemorrhage, unruptured aneurysms and arteriovenous malformations during and after pregnancy. Curr Opin Neurol 2019; 32:36-42. [DOI: 10.1097/wco.0000000000000643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Pinho J, Costa AS, Araújo JM, Amorim JM, Ferreira C. Intracerebral hemorrhage outcome: A comprehensive update. J Neurol Sci 2019; 398:54-66. [PMID: 30682522 DOI: 10.1016/j.jns.2019.01.013] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 12/22/2018] [Accepted: 01/11/2019] [Indexed: 12/15/2022]
Abstract
Non-traumatic intracerebral hemorrhage (ICH) is associated with a significant global burden of disease, and despite being proportionally less frequent than ischemic stroke, in 2010 it was associated with greater worldwide disability-adjusted life years lost. The focus of outcome assessment after ICH has been mortality in most studies, because of the high early case fatality which reaches 40% in some population-based studies. The most robust and consistent predictors of early mortality include age, severity of neurological impairment, hemorrhage volume and antithrombotic therapy at the time of the event. Long-term outcome assessment is multifaceted and includes not only mortality and functional outcome, but also patient self-assessment of the health-related quality of life, occurrence of cognitive impairment, psychiatric disorders, epileptic seizures, recurrent ICH and subsequent thromboembolic events. Several scores which predict mortality and functional outcome after ICH have been validated and are useful in the daily clinical practice, however they must be used in combination with the clinical judgment for individualized patients. Management of patients with ICH both in the acute and chronic phases, requires health care professionals to have a comprehensive and updated perspective on outcome, which informs decisions that are needed to be taken together with the patient and next of kin.
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Affiliation(s)
- João Pinho
- Neurology Department, Hospital de Braga, Portugal.
| | - Ana Sofia Costa
- Department of Neurology, RWTH Aachen University Hospital, Germany; JARA-BRAIN Institute Molecular Neuroscience and Neuroimaging, Forschungszentrum Jülich GmbH and RWTH Aachen University, Germany
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Lee L, Lo YT, See AAQ, Hsieh PJ, James ML, King NKK. Long-term recovery profile of patients with severe disability or in vegetative states following severe primary intracerebral hemorrhage. J Crit Care 2018; 48:269-275. [PMID: 30248648 DOI: 10.1016/j.jcrc.2018.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 09/09/2018] [Accepted: 09/10/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE We conducted a single-center retrospective review to investigate the long-term recovery of patients who were severely disabled or vegetative secondary to primary intracerebral hemorrhage upon discharge from hospital from January 2009 to November 2013. METHODS Patients were categorized into two groups based on their Glasgow outcome scale (GOS) scores at discharge, namely vegetative state (GOS 2; n = 91) and severely disabled (GOS 3; n = 278). Long-term outcomes at three years post discharge were defined as death, stable, deterioration and improvement from discharge to follow-up. RESULTS Lower mortality (29% versus 69%) and higher neurological improvement rates at three years (33% versus 10%) were observed in the SD compared to VS group (both p = .0001). Age was a significant predictor of survival in the VS group (p = .03) and the SD group (p = .012). Age was also the only predictor of neurological improvement in the SD group (p = .01). CONCLUSIONS Neurological status at discharge from hospital was not truly indicative of long-term prognosis for patients who were severely disabled or vegetative. Patients in both groups can potentially improve in the long term and may benefit from prolonged rehabilitation programmes to maximize their recovery potential.
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Affiliation(s)
- Lester Lee
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Department of Neurosurgery, Singapore General Hospital, Singapore
| | - Yu Tung Lo
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Department of Neurosurgery, Singapore General Hospital, Singapore
| | - Angela An Qi See
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Department of Neurosurgery, Singapore General Hospital, Singapore
| | - Po-Jang Hsieh
- Neuroscience and Behavioral Disorders Program, Duke-NUS Medical School, Singapore
| | - Michael Lucas James
- Departments of Anesthesiology and Neurology, Duke University, Durham, NC, United States
| | - Nicolas Kon Kam King
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Duke-NUS Medical School, Singapore; Department of Neurosurgery, Singapore General Hospital, Singapore.
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Hessington A, Tsitsopoulos PP, Fahlström A, Marklund N. Favorable clinical outcome following surgical evacuation of deep-seated and lobar supratentorial intracerebral hemorrhage: a retrospective single-center analysis of 123 cases. Acta Neurochir (Wien) 2018; 160:1737-1747. [PMID: 30051159 PMCID: PMC6105225 DOI: 10.1007/s00701-018-3622-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 07/17/2018] [Indexed: 12/04/2022]
Abstract
Background In spontaneous supratentorial intracerebral hemorrhage (ICH), the role of surgical treatment remains controversial, particularly in deep-seated ICHs. We hypothesized that early mortality and long-term functional outcome differ between patients with surgically treated lobar and deep-seated ICH. Method Patients who underwent craniotomy for ICH evacuation from 2009 to 2015 were retrospectively evaluated and categorized into two subgroups: lobar and deep-seated ICH. The modified Rankin Scale (mRS) was used to evaluate long-term functional outcome. Result Of the 123 patients operated for ICH, 49.6% (n = 61) had lobar and 50.4% (n = 62) deep-seated ICH. At long-term follow-up (mean 4.2 years), 25 patients (20.3%) were dead, while 51.0% of survivors had a favorable outcome (mRS score ≤ 3). Overall mortality was 13.0% at 30 days and 17.9% at 6 months post-ictus, not influenced by ICH location. Mortality was higher in patients ≥ 65 years old (p = 0.020). The deep-seated group had higher incidence and extent of intraventricular extension, younger age (52.6 ± 9.0 years vs. 58.5 ± 9.8 years; p < 0.05), more frequently pupillary abnormalities, and longer neurocritical care stay (p < 0.05). The proportion of patients with good outcome was 48.0% in deep-seated vs. 54.1% in lobar ICH (p = 0.552). In lobar ICH, independent predictors of long-term outcome were age, hemorrhage volume, preoperative level of consciousness, and pupillary reaction. In deep-seated ICHs, only high age correlated significantly with poor outcome. Conclusions At long-term follow-up, most ICH survivors had a favorable clinical outcome. Neither mortality nor long-term functional outcome differed between patients operated for lobar or deep-seated ICH. A combination of surgery and neurocritical care can result in favorable clinical outcome, regardless of ICH location.
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Liebkind R, Gordin D, Strbian D, Meretoja A, Thorn LM, Hägg-Holmberg S, Forsblom C, Tatlisumak T, Groop PH, Putaala J. Diabetes and intracerebral hemorrhage: baseline characteristics and mortality. Eur J Neurol 2018; 25:825-832. [PMID: 29443444 DOI: 10.1111/ene.13603] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 02/06/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Acknowledging the conflicting evidence for diabetes as a predictor of short- and long-term mortality following an intracerebral hemorrhage (ICH), we compared baseline characteristics and 30-day and long-term mortality between patients with and without diabetes after an ICH, paying special attention to differences between type 1 (T1D) and type 2 (T2D) diabetes. METHODS Patients with a first-ever ICH were followed for a median of 2.3 years. Adjusting for demographics, comorbidities and documented ICH characteristics increasing mortality after ICH, logistic regression analysis assessed factors associated with case fatality and 1-year survival among the 30-day survivors. Diabetes was compared with patients without diabetes in separate models as (i) any diabetes and (ii) T1D or T2D. RESULTS Of our 969 patients, 813 (83.9%) had no diabetes, 41 (4.2%) had T1D and 115 (11.9%) had T2D. Compared with patients without diabetes, those with diabetes were younger, more often men and more frequently had hypertension, coronary heart disease and chronic kidney disease, with similar ICH characteristics. Patients with T1D were younger, more often had chronic kidney disease and brainstem ICH, and less often had atrial fibrillation and lobar ICH, than did patients with T2D. Diabetes had no impact on case fatality. Any diabetes (odds ratio, 2.57; 1.19-5.52), T1D (odds ratio, 7.04; 1.14-43.48) and T2D (odds ratio, 2.32; 1.04-5.17) were independently associated with 1-year mortality. CONCLUSIONS Patients with ICH with diabetes exhibited a distinct pattern of comorbidities and disease characteristics with specific differences between T1D and T2D. Despite their younger age, T1D seems to carry a substantially higher likelihood of long-term mortality after an ICH than does T2D.
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Affiliation(s)
- R Liebkind
- Department of Neurology and Neurosciences, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - D Gordin
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - D Strbian
- Department of Neurology and Neurosciences, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - A Meretoja
- Department of Neurology and Neurosciences, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - L M Thorn
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - S Hägg-Holmberg
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - C Forsblom
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - T Tatlisumak
- Department of Neurology and Neurosciences, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Department of Clinical Neurosciences, Sahlgrenska Academy at the University of Gothenburg and Department of Neurology, Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - P-H Groop
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - J Putaala
- Department of Neurology and Neurosciences, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Tatlisumak T, Cucchiara B, Kuroda S, Kasner SE, Putaala J. Nontraumatic intracerebral haemorrhage in young adults. Nat Rev Neurol 2018. [PMID: 29521335 DOI: 10.1038/nrneurol.2018.17] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Nontraumatic intracerebral haemorrhage (ICH) is a common subtype of stroke with a poor prognosis, high mortality and long-term morbidity. The incidence of ICH increases with age. ICH has not been widely investigated in young adults (herein defined as aged ∼18-50 years) despite an annual incidence of ∼5 per 100,000 individuals. Furthermore, ICH characteristics differ between young and elderly patients. Risk factors for ICH are surprisingly common in young adults, in whom ICH is often caused by structural lesions or hypertension, and only rarely by anticoagulation therapy and cerebral amyloid angiopathy (which are common predisposing factors in elderly patients). High short-term mortality (17% at 3 months) and long-term mortality (>25% at 10 years) persist even in contemporary series from high-income countries, and long-term disability is very common. Thus, an aggressive approach to identifying treatable underlying conditions and preventing ICH recurrence is indicated in young patients, although treatment strategies have generally not been investigated specifically in this age group. This narrative Review summarizes existing knowledge on the epidemiology, risk factors, causes, diagnosis, treatment and outcomes of ICH in young adults. We provide comparisons with the population of elderly patients with ICH and discuss challenges for future research.
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Affiliation(s)
- Turgut Tatlisumak
- Department of Clinical Neuroscience and Neurology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Brett Cucchiara
- Comprehensive Stroke Center, Department of Neurology, University of Pennsylvania and University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama Prefecture, Japan
| | - Scott E Kasner
- Comprehensive Stroke Center, Department of Neurology, University of Pennsylvania and University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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Abstract
OPINION STATEMENT Optimal diagnosis and management of stroke in young adults benefit from a multidisciplinary team, including a vascular neurology specialist. In addition to the "standard" vascular risk factors including smoking, hypertension, diabetes, and hyperlipidemia, one needs to consider alternative etiologies including substance abuse, carotid/vertebral artery dissections, and rare genetic conditions among others. Once a young patient is determined to have had a stroke, the next question a clinician should ask is why did this patient have a stroke? A "heart to head" diagnostic approach is recommended. A thorough history is performed, including a detailed family history with specific annotations on each family member. A thorough physical examination is necessary including a careful evaluation of the patient's general appearance, noting any joint laxity, and/or abnormalities of the skin, eyes, and heart. Findings across multiple organ systems in the patient and/or their family may indicate a genetic etiology. After an initial head CT rules out hemorrhagic stroke, additional testing should include a brain MRI, neck and cerebral vascular imaging (e.g., CTA for head and neck), transthoracic echocardiogram with a bubble study, telemetry monitoring, basic risk factor blood work (e.g., lipid panel, hemoglobin A1c, TSH, ESR, CRP, RPR, HIV, and toxicology screen), and, when appropriate, sickle screen and pregnancy test. There should be a low threshold to obtain blood cultures or a lumbar puncture. The acute treatment of ischemic stroke in young adult patients does not differ from treatment of older adults, using intravenous alteplase within 4.5 h, assuming no contraindications. In suspected proximal large artery occlusive disease, interventional clot extraction procedures should be employed in patients deemed eligible. Long-term secondary prevention strategies aimed to reduce recurrent stroke risk by targeting and modifying vascular risk factors should be instituted. The mainstay of preventative therapy is aspirin for most etiologies; however, for atrial fibrillation, anticoagulation is recommended. Statin therapy is another pharmacologic intervention recommended in most stroke patients. Other measures employed are blood pressure reduction, smoking cessation, optimal glucose control in diabetic patients, the initiation of a healthy diet and regular exercise, and lastly, substance abuse counseling in appropriate patients.
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Affiliation(s)
- Christopher A Stack
- Department of Neurology, University of Maryland Medical Center, 16 South Eutaw Street Suite 300, Baltimore, MD, 21201, USA
| | - John W Cole
- Department of Neurology, Baltimore VA Medical Center, University of Maryland School of Medicine, 12th Floor, Bressler Building, Room 12-006, 655 West Baltimore Street, Baltimore, MD, 21201-1559, USA.
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Huang YH, Liao CC, Yang KY. Demographics and Short-Term Outcomes of Spontaneous Subarachnoid Hemorrhage in Young Adults. World Neurosurg 2017; 102:414-419. [DOI: 10.1016/j.wneu.2017.03.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 10/19/2022]
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Affiliation(s)
- A H V Schapira
- Clinical Neurosciences, UCL Institute of Neurology, London, UK
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Abstract
PURPOSE OF REVIEW A series of recent studies have changed the practice of pediatric neuroanesthesia, improving outcomes and making children's quality of life better. RECENT FINDINGS Potential long-term neurologic effects in infants and young children undergoing surgery and anesthesia have been recognized for over a decade. Several recent, well performed studies suggest that hypotension may also be a major contributor to postoperative neurologic impairment in children. Craniosynostosis surgery has also been the subject of extensive study, both related to decreasing blood loss and to optimizing postoperative outcomes. SUMMARY Although neurosurgical anesthesia research in the pediatric population can be ethically and logistically complex, resolving questions such as the optimal blood pressure during surgery and best management of infants undergoing repair of craniosynostosis will improve patient outcomes.
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Hu L, Dong MX, Zhao H, Xu GH, Qin XY. Fibulin-5: a novel biomarker for evaluating severity and predicting prognosis in patients with acute intracerebral haemorrhage. Eur J Neurol 2016; 23:1195-201. [PMID: 27106135 DOI: 10.1111/ene.13013] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/01/2016] [Indexed: 12/20/2022]
Affiliation(s)
- L. Hu
- Department of Neurology; the First Affiliated Hospital of Chongqing Medical University; Chongqing China
- Department of Neurology; the Fifth People's Hospital of Chongqing; Chongqing China
| | - M.-X. Dong
- Department of Neurology; the First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - H. Zhao
- Department of Neurology; the First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - G.-H. Xu
- Department of Neurology; the First Affiliated Hospital of Chongqing Medical University; Chongqing China
| | - X.-Y. Qin
- Department of Neurology; the First Affiliated Hospital of Chongqing Medical University; Chongqing China
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