1
|
De Rosa L, Manara R, Vodret F, Kulyk C, Montano F, Pieroni A, Viaro F, Zedde ML, Napoletano R, Ermani M, Baracchini C. The "SALPARE study" of spontaneous intracerebral hemorrhage: part 1. Neurol Res Pract 2023; 5:5. [PMID: 36726162 PMCID: PMC9893659 DOI: 10.1186/s42466-023-00231-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 01/10/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (ICH) is a devastating type of stroke with a huge impact on patients and families. Expanded use of oral anticoagulants and ageing population might contribute to an epidemiological change. In view of these trends, we planned a study to obtain a contemporary picture and identify early prognostic factors to improve secondary prevention. METHODS This multicenter prospective cohort study included consecutive adult patients with non-traumatic ICH admitted to three academic Italian hospitals (Salerno, Padova, Reggio Emilia) over a 2-year period. Demographic characteristics, vascular risk profile, clinical data and main radiological characteristics were correlated to 90-day clinical outcome. RESULTS Out of 682 patients [mean age: 73 ± 14 years; 316 (46.3%) females] enrolled in this study, 40% died [86/180 (47.8%) in Salerno, 120/320 (37.5%) in Padova, 67/182 (36.8%) in Reggio Emilia; p < 0.05)] and 36% were severely disabled at 90 days. Several factors were associated with a higher risk of poor functional outcome such as antithrombotic drug use, hyperglycemia, previous cerebrovascular accident, low platelet count, and pontine/massive/intraventricular hemorrhage. However, at multivariate analysis only pre-ICH mRS score (OR 30.84), GCS score at presentation (OR 11.88), initial hematoma volume (OR 29.71), and NIHSS score at presentation (OR 25.89) were independent predictors of death and poor functional outcome. CONCLUSION Despite the heterogeneity among centers, this study on ICH has identified four simple prognostic factors that can independently predict patients outcome, stratify their risk, and guide their management.
Collapse
Affiliation(s)
- Ludovica De Rosa
- grid.411474.30000 0004 1760 2630Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy
| | - Renzo Manara
- grid.411474.30000 0004 1760 2630Neuroradiology Unit, Padua University Hospital, Padua, Italy
| | - Francesca Vodret
- grid.411474.30000 0004 1760 2630Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy
| | - Caterina Kulyk
- grid.9970.70000 0001 1941 5140Stroke Unit and Neurosonology Laboratory, Department of Neurology, Johannes Kepler University Linz, Linz, Austria
| | - Florian Montano
- grid.11780.3f0000 0004 1937 0335Neuroradiology, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Alessio Pieroni
- grid.411474.30000 0004 1760 2630Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy
| | - Federica Viaro
- grid.411474.30000 0004 1760 2630Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy
| | - Maria Luisa Zedde
- Neurology Unit, Stroke Unit, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Rosa Napoletano
- UOC Neurologia AOU S. Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
| | - Mario Ermani
- grid.411474.30000 0004 1760 2630Service of Medical Statistics, Department of Neurology, Padua University Hospital, Padua, Italy
| | - Claudio Baracchini
- grid.411474.30000 0004 1760 2630Stroke Unit and Neurosonology Laboratory, Padua University Hospital, Padua, Italy
| |
Collapse
|
2
|
Singh B, Lavezo J, Gavito-Higueroa J, Ahmed F, Narasimhan S, Brar S, Cruz-Flores S, Kraus J. Updated Outlook of Cerebral Amyloid Angiopathy and Inflammatory Subtypes: Pathophysiology, Clinical Manifestations, Diagnosis and Management. J Alzheimers Dis Rep 2022; 6:627-639. [DOI: 10.3233/adr-220055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/17/2022] [Indexed: 11/15/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA) is a common untreatable cause of lobar hemorrhages and cognitive decline in the older population. Subset of patients present with its inflammatory subtype with rapid decline in cognitive functions and neurological deficits. Most commonly the underlying pathophysiology of this disease is deposition of insoluble amyloid protein into blood vessel walls which results in vessel fragility leading to local neurotoxicity which may eventually leads to lobar hemorrhages and cognitive decline. The term “Amyloid Spell” encompasses transient focal neurological deficits which is commonly misdiagnosed as seizures or transient ischemic attack in the emergency department. Radiologic findings in these patients may reveal microbleeds, cortical superficial siderosis, white matter hyperintensities, and cerebral edema which support the clinical diagnosis which could be otherwise challenging. CAA diagnostic criteria require CT (Edinburgh Criteria) or MRI imaging, or neuropathology. The diagnosis can be suspected without imaging or neuropathology but cannot be confirmed. This review article provides a critical outlook on different types of presentations, updated diagnostic criteria and management of CAA patients illustrating underlying mechanisms associated with neuronal injury secondary to amyloid deposition.
Collapse
Affiliation(s)
- Baljinder Singh
- Department of Neurology, Texas Tech University Health Sciences Center, TX, USA
| | - Jonathan Lavezo
- Department of Neurology, Texas Tech University Health Sciences Center, TX, USA
| | | | - Faiza Ahmed
- Department of Neurology, Texas Tech University Health Sciences Center, TX, USA
| | | | - Simrandeep Brar
- Department of Neurology, Texas Tech University Health Sciences Center, TX, USA
| | | | | |
Collapse
|
3
|
Gong Y, Klein Wolterink RGJ, Wang J, Bos GMJ, Germeraad WTV. Chimeric antigen receptor natural killer (CAR-NK) cell design and engineering for cancer therapy. J Hematol Oncol 2021; 14:73. [PMID: 33933160 PMCID: PMC8088725 DOI: 10.1186/s13045-021-01083-5] [Citation(s) in RCA: 160] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/15/2021] [Indexed: 02/06/2023] Open
Abstract
Due to their efficient recognition and lysis of malignant cells, natural killer (NK) cells are considered as specialized immune cells that can be genetically modified to obtain capable effector cells for adoptive cellular treatment of cancer patients. However, biological and technical hurdles related to gene delivery into NK cells have dramatically restrained progress. Recent technological advancements, including improved cell expansion techniques, chimeric antigen receptors (CAR), CRISPR/Cas9 gene editing and enhanced viral transduction and electroporation, have endowed comprehensive generation and characterization of genetically modified NK cells. These promising developments assist scientists and physicians to design better applications of NK cells in clinical therapy. Notably, redirecting NK cells using CARs holds important promise for cancer immunotherapy. Various preclinical and a limited number of clinical studies using CAR-NK cells show promising results: efficient elimination of target cells without side effects, such as cytokine release syndrome and neurotoxicity which are seen in CAR-T therapies. In this review, we focus on the details of CAR-NK technology, including the design of efficient and safe CAR constructs and associated NK cell engineering techniques: the vehicles to deliver the CAR-containing transgene, detection methods for CARs, as well as NK cell sources and NK cell expansion. We summarize the current CAR-NK cell literature and include valuable lessons learned from the CAR-T cell field. This review also provides an outlook on how these approaches may transform current clinical products and protocols for cancer treatment.
Collapse
Affiliation(s)
- Ying Gong
- Division of Hematology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Roel G J Klein Wolterink
- Division of Hematology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Jianxiang Wang
- State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, China.,National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 288 Nanjing Road, Tianjin, 300020, China
| | - Gerard M J Bos
- Division of Hematology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.,CiMaas BV, Maastricht, The Netherlands
| | - Wilfred T V Germeraad
- Division of Hematology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands. .,GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands. .,CiMaas BV, Maastricht, The Netherlands.
| |
Collapse
|
4
|
The prevalence, mortality rate and functional outcome of intracerebral hemorrhage according to age sex and ethnic group in the state of Qatar. Clin Neurol Neurosurg 2020; 199:106255. [PMID: 33161215 DOI: 10.1016/j.clineuro.2020.106255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the prevalence of intracerebral hemorrhage (ICH) using stroke database from the main tertiary hospital in Qatar (Hamad General Hospital) over the period of Dec 2013 to Oct 2017. METHODS The prevalence of ICH was calculated based on age groups and ethnicity (Qatari nationals, non-Qatari Arab, South east Indian (SI) and Far East Asians (FE)). Thirty-day case fatality rate, poor clinical outcome at discharge (modified Rankin scale (mRS):3-6) and poor long-term outcome (mRS at 90 days: 3-6) were calculated per each age group sex and ethnicity. RESULT There were 653/4039 (16 %) with ICH. The median age was 53 (IQ range: 45-64) with a male/female ratio: 557/96 (85.3/14.7 %). The 30-day mortality rate was 14.7 % (96/653), poor outcome at discharge (mRS 3-6): 66.8 % (436/653) and poor long-term outcome (mRS 90 days:3-6) 50.1 % (199/397). The prevalence of ICH in Qatar was 24.9 per 100 000. The highest mortality rate was seen in the elderly (≥ 70 years old) (16/67 (23.9 %)) and young group (48/291 (16.5 %)). The most common ethnic group among our ICH population are the following: FE (40.59 per 100 000), Qatari (25.26 per 100 000) and SI ethnic group (24.97 per 100 000). In multiple logistic regression analysis only, old age (≥ 70 years old) was associated with 30 days mortality (adj OR: 2.51, 95 % CI: 1.14-5.54, P = 0.023). Similar regression analysis was also observed that age ≥ 70 years old (adj. OR: 4.18, 95 % CI: 1.27-13.77, P = 0.019), sex (male) (adj. OR: 0.21, 95 % CI: 0.08-0.56, P = 0.002), and ethnicity (SI vs Qatari: adj. OR: 4.08, 95 % CI: 1.28-12.92, P = 0.017); (FE vs Qatari: adj. OR: 2.22, 95 % CI: 0.65-7.67, P = 0.203) are statistically associated with poor outcome. CONCLUSION The prevalence of ICH was high in the elderly and in the FE, Qatari, and SI ethnic group. Further studies are needed to better understand the differences in ICH prognosis in multiethnic groups.
Collapse
|
5
|
Liu J, Wang D, Yuan R, Xiong Y, Liu M. Prognosis of 908 patients with intracerebral hemorrhage in Chengdu, Southwest of China. Int J Neurosci 2016; 127:586-591. [PMID: 27451828 DOI: 10.1080/00207454.2016.1216414] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Intracerebral hemorrhage (ICH) is the deadliest, most disable and least treatable form of acute cerebral accident. Prognostic risk factors of ICH are not yet fully identified. This study investigated the possible clinical factors leading to poor outcomes in patients with ICH, which can be used to guide clinical treatment and predict prognosis. METHODS We prospectively enrolled patients with ICH who were admitted within 7 d of stroke onset from January 2012 to April 2014. The prognostic factors of patients with ICH were analyzed in univariate analyses and logistic regression analyses. RESULTS A total of 908 consecutive patients with ICH (mean age, 57.87 ± 13.92 years) were finally included, of which 616 patients (67.8%) were male. 59.5%, 54.5% and 52.2% patients with ICH had poor outcomes (death/disability) at 3, 6 and 12 months, respectively. Stroke severity and stroke-related complications during hospitalization were independently associated with poor outcomes both at 3 and 12 months. In addition, hyperglycemia, hematocrit and blood urea nitrogen on admission were independently associated with poor outcomes at three months. CONCLUSION This study found that severity of ICH and stroke-related complications were independent predictors of poor outcomes at three months and one year after ICH. Thereby, it highlights the importance of understanding the role of clinical features in ICH prognostic evaluation.
Collapse
Affiliation(s)
- Junfeng Liu
- a Stroke Clinical Research Unit, Department of Neurology, West China Hospital , Sichuan University , Chengdu , P.R. China
| | - Deren Wang
- a Stroke Clinical Research Unit, Department of Neurology, West China Hospital , Sichuan University , Chengdu , P.R. China
| | - Ruozhen Yuan
- a Stroke Clinical Research Unit, Department of Neurology, West China Hospital , Sichuan University , Chengdu , P.R. China
| | - Yao Xiong
- a Stroke Clinical Research Unit, Department of Neurology, West China Hospital , Sichuan University , Chengdu , P.R. China
| | - Ming Liu
- a Stroke Clinical Research Unit, Department of Neurology, West China Hospital , Sichuan University , Chengdu , P.R. China
| |
Collapse
|
6
|
Moussa WMM, Khedr W. Decompressive craniectomy and expansive duraplasty with evacuation of hypertensive intracerebral hematoma, a randomized controlled trial. Neurosurg Rev 2016; 40:115-127. [PMID: 27235128 DOI: 10.1007/s10143-016-0743-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/22/2016] [Accepted: 05/05/2016] [Indexed: 12/25/2022]
Abstract
Hypertensive intracerebral hemorrhage (ICH) has high morbidity and mortality rates. Decompressive craniectomy (DC) is generally used for the treatment of cases associated with refractory increased intracranial pressure (ICP). In this study, we investigated the beneficial effects of adding DC and expansive duraplasty (ED) to hematoma evacuation in patients who underwent surgery for large hypertensive ICH. A prospective randomized controlled clinical trial where 40 patients diagnosed having large hypertensive ICH was randomly allocated to either group A or B, each comprised 20 patients. Group A patients, the treatment group, were submitted to hematoma evacuation together with DC and ED, whereas group B patients, the control group, were submitted only to hematoma evacuation. Twenty-three (57.5 %) of the patients were males, with an overall age range of 34-79 years (mean 59.3 years). Preoperative Glasgow Coma Scale (GCS) scores in group A ranged from 4 to 13 (mean 7.1), while in group B it ranged from 4 to 12 (mean 6.8). Postoperative hydrocephalus occurred in 3 (15 %) patients in group A and in 4 (20 %) patients in group B, whereas meningitis occurred in one patient (5 %) in group A. The mortality rate was 2 (10 %) patients in group A as compared to 5 (25 %) patients in group B (p = 0.407). High admission GCS (p = 0.0032), younger age (p = 0.0023), smaller hematoma volume (p = 0.044), subcortical hematoma location (p = 0.041), absent or minimal preoperative (p = 0.0068), and postoperative (p = 0.0031) midline shift as well as absent intraventricular extension of the hematoma (p = 0.036) contributed significantly to a better outcome. Selected patients' subgroups who benefited from adding DC and ED to ICH evacuation were age category of 30 to less than 50 (p = 0.0015) and from 50 to less than 70 (p = 0.00619) as well as immediate preoperative GCS from 6 to 8 (p = 0.000436) and from 9 to 12 (p = 0.00774). At 6 months' follow-up, 14 (70 %) patients of group A had favorable outcome as compared to 4 (20 %) patients of group B (p = 0.0015). Adding DC with ED to evacuation of a large hypertensive hemispheric ICH might improve the outcome in selected group of patients.
Collapse
Affiliation(s)
- Wael Mohamed Mohamed Moussa
- Department of Neurosurgery, Faculty of Medicine, Alexandria University, Champolion Street, Khartoum Square, Azareeta, Alexandria, Egypt.
| | - Wael Khedr
- Department of Neurosurgery, Faculty of Medicine, Alexandria University, Champolion Street, Khartoum Square, Azareeta, Alexandria, Egypt
| |
Collapse
|
7
|
Fung C, Murek M, Klinger-Gratz PP, Fiechter M, Z’Graggen WJ, Gautschi OP, El-Koussy M, Gralla J, Schaller K, Zbinden M, Arnold M, Fischer U, Mattle HP, Raabe A, Beck J. Effect of Decompressive Craniectomy on Perihematomal Edema in Patients with Intracerebral Hemorrhage. PLoS One 2016; 11:e0149169. [PMID: 26872068 PMCID: PMC4752325 DOI: 10.1371/journal.pone.0149169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/07/2016] [Indexed: 12/01/2022] Open
Abstract
Background Perihematomal edema contributes to secondary brain injury in the course of intracerebral hemorrhage. The effect of decompressive surgery on perihematomal edema after intracerebral hemorrhage is unknown. This study analyzed the course of PHE in patients who were or were not treated with decompressive craniectomy. Methods More than 100 computed tomography images from our published cohort of 25 patients were evaluated retrospectively at two university hospitals in Switzerland. Computed tomography scans covered the time from admission until day 100. Eleven patients were treated by decompressive craniectomy and 14 were treated conservatively. Absolute edema and hematoma volumes were assessed using 3-dimensional volumetric measurements. Relative edema volumes were calculated based on maximal hematoma volume. Results Absolute perihematomal edema increased from 42.9 ml to 125.6 ml (192.8%) after 21 days in the decompressive craniectomy group, versus 50.4 ml to 67.2 ml (33.3%) in the control group (Δ at day 21 = 58.4 ml, p = 0.031). Peak edema developed on days 25 and 35 in patients with decompressive craniectomy and controls respectively, and it took about 60 days for the edema to decline to baseline in both groups. Eight patients (73%) in the decompressive craniectomy group and 6 patients (43%) in the control group had a good outcome (modified Rankin Scale score 0 to 4) at 6 months (P = 0.23). Conclusions Decompressive craniectomy is associated with a significant increase in perihematomal edema compared to patients who have been treated conservatively. Perihematomal edema itself lasts about 60 days if it is not treated, but decompressive craniectomy ameliorates the mass effect exerted by the intracerebral hemorrhage plus the perihematomal edema, as reflected by the reduced midline shift.
Collapse
Affiliation(s)
- Christian Fung
- Department of Neurosurgery, University Hospital Bern, Bern, Switzerland
- Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland
| | - Michael Murek
- Department of Neurosurgery, University Hospital Bern, Bern, Switzerland
| | - Pascal P. Klinger-Gratz
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Michael Fiechter
- Department of Neurosurgery, University Hospital Bern, Bern, Switzerland
| | | | - Oliver P. Gautschi
- Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland
| | - Marwan El-Koussy
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Jan Gralla
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Karl Schaller
- Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland
| | - Martin Zbinden
- Institute for Diagnostic and Interventional Neuroradiology, University Hospital Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, University Hospital Bern, Bern, Switzerland
| | | | - Andreas Raabe
- Department of Neurosurgery, University Hospital Bern, Bern, Switzerland
| | - Jürgen Beck
- Department of Neurosurgery, University Hospital Bern, Bern, Switzerland
- * E-mail:
| |
Collapse
|
8
|
Kumar A, Kumar P, Misra S, Sagar R, Kathuria P, Vibha D, Vivekanandhan S, Garg A, Kaul B, Raghvan S, Gorthi SP, Dabla S, Aggarwal CS, Prasad K. Biomarkers to enhance accuracy and precision of prediction of short-term and long-term outcome after spontaneous intracerebral haemorrhage: a study protocol for a prospective cohort study. BMC Neurol 2015; 15:136. [PMID: 26264492 PMCID: PMC4533964 DOI: 10.1186/s12883-015-0384-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 07/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Several studies reported prognostic value of biomarker in intracerebral hemorrhagic (ICH) but they are either preliminary observation or inadequately powered to analyse independent contribution of biomarkers over and above clinical and neuroimaging data. OBJECTIVE To examine whether the biomarker can significantly add to the predictive accuracy of prognosis of ICH. METHOD/DESIGN In a multi-centric prospective cohort study, 1020 patients with ICH within 72 hours of onset are being recruited. After obtaining written informed consent from patients/proxy, venous blood sample (10 ml) is being collected and analysed for C-reactive protein (CRP) level, S100B, Glial fibrillary acidic protein (GFAP), Troponin, change in leukocyte count and Copeptin levels. The patients are telephonically followed using stroke scales (Barthel Index and modified Rankin Scale) at 3, 6, 12 months and 2 years after the recruitment. DISCUSSION This protocol will aim at predicting the short term or long term prognosis with the use of clinical, neuroimaging and biomarkers in order to help clinician to stratify patients for early referral or intervention.
Collapse
Affiliation(s)
- A Kumar
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - P Kumar
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - S Misra
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - R Sagar
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - P Kathuria
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - D Vibha
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - S Vivekanandhan
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - A Garg
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - B Kaul
- Department of Neurology, Safdarjung, Hospital, New Delhi, India
| | - S Raghvan
- Department of Neurology, Safdarjung, Hospital, New Delhi, India
| | - S P Gorthi
- Department of Neurology, Research and Referral Army Hospital, New Delhi, India
| | - S Dabla
- Pt. B.D. Sharma, PGIMS, Rohtak, India
| | | | - Kameshwar Prasad
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India.
| |
Collapse
|
9
|
Ye Z, Huang X, Han Z, Shao B, Cheng J, Wang Z, Zhang Z, Xiao M. Three-year prognosis of first-ever primary pontine hemorrhage in a hospital-based registry. J Clin Neurosci 2015; 22:1133-8. [DOI: 10.1016/j.jocn.2014.12.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/21/2014] [Indexed: 10/23/2022]
|
10
|
Losiniecki A, Zuccarello M. Minimally invasive treatment options for spontaneous intracerebral hemorrhage. CRITICAL CARE OF THE STROKE PATIENT 2014:329-334. [DOI: 10.1017/cbo9780511659096.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
11
|
Takeuchi S, Wada K, Nagatani K, Otani N, Mori K. Decompressive hemicraniectomy for spontaneous intracerebral hemorrhage. Neurosurg Focus 2013; 34:E5. [PMID: 23634924 DOI: 10.3171/2013.2.focus12424] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intracerebral hemorrhage (ICH) is devastating, with high mortality rates, but its optimum management has not been fully established. Decompressive hemicraniectomy is a surgical procedure used to relieve the malignant elevation of intracranial pressure. The application of decompressive hemicraniectomy in patients with hemispheric ICH has been much less common, although several studies have shown the usefulness of this procedure for large hemispheric ICH. In this review, the present knowledge of the safety and efficacy of this procedure are evaluated. The authors conclude that decompressive hemicraniectomy with hematoma evacuation for large ICH might be a safe and effective procedure in patients with severely disturbed consciousness and large hematoma volume.
Collapse
Affiliation(s)
- Satoru Takeuchi
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
| | | | | | | | | |
Collapse
|
12
|
Gotoh S, Hata J, Ninomiya T, Hirakawa Y, Nagata M, Mukai N, Fukuhara M, Ikeda F, Shikata K, Kamouchi M, Kitazono T, Kiyohara Y. Trends in the incidence and survival of intracerebral hemorrhage by its location in a Japanese community. Circ J 2013; 78:403-9. [PMID: 24270733 DOI: 10.1253/circj.cj-13-0811] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND No previous population-based studies have examined secular trends in the incidence of intracerebral hemorrhage (ICH) by its location. METHODS AND RESULTS We established 3 cohorts consisting of residents of Hisayama, Japan, aged ≥40 years without a history of stroke or myocardial infarction in 1961 (the first cohort, n=1,618), in 1974 (the second cohort, n=2,038), and in 1988 (the third cohort, n=2,637). Each cohort was followed for 13 years. The age- and sex-adjusted incidence of ICH significantly declined from the first to the second cohort and showed no further change in the third cohort. With regard to the ICH location, the incidence of putaminal hemorrhage decreased steadily, mainly in subjects aged 60-69 years, whereas the incidence of thalamic hemorrhage increased, especially in those aged ≥70 years. Both hypertension and alcohol intake were strong risk factors for ICH in the first cohort, but their influence declined with time. Blood pressure levels in hypertensive subjects decreased significantly, and the proportion of current drinkers decreased slightly over the study period. CONCLUSIONS Our findings suggest that the ICH incidence steeply declined from the 1960s to the 1970s in Japan as a result of the reduced influence of hypertension and alcohol intake, but that this decline has leveled off since then, probably because of the increased incidence of thalamic hemorrhage in the elderly in recent years.
Collapse
Affiliation(s)
- Seiji Gotoh
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Takeuchi S, Takasato Y, Masaoka H, Hayakawa T, Yatsushige H, Shigeta K, Nagatani K, Otani N, Nawashiro H, Shima K. Decompressive craniectomy with hematoma evacuation for large hemispheric hypertensive intracerebral hemorrhage. ACTA NEUROCHIRURGICA. SUPPLEMENT 2013; 118:277-9. [PMID: 23564148 DOI: 10.1007/978-3-7091-1434-6_53] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Hemispheric hypertensive intracerebral hemorrhage (ICH) has a high mortality rate. Decompressive craniectomy (DC) has generally been used for the treatment of severe traumatic brain injury, aneurysmal subarachnoid hemorrhage, and hemispheric cerebral infarction. However, the effect of DC on hemispheric hypertensive ICH is not well understood. To investigate the effects of DC for treating hemispheric hypertensive ICH, we retrospectively reviewed the clinical and radiological findings of 21 patients who underwent DC for hemispheric hypertensive ICH. Eleven of the patients were male and 10 were female, with an age range of 22-75 years (mean, 56.6 years). Their preoperative Glasgow Coma Scale scores ranged from 3 to 13 (mean, 6.9). The hematoma volumes ranged from 33.4 to 98.1 mL (mean, 74.2 mL), and the hematoma locations were the basal ganglia in 10 patients and the subcortex in 11 patients. Intraventricular extensions were observed in 11 patients. With regard to the complications after DC, postoperative hydrocephalus developed in ten patients, and meningitis was observed in three patients. Six patients had favorable outcomes and 15 had poor outcomes. The mortality rate was 10 %. A statistical analysis showed that the GCS score at admission was significantly higher in the favorable outcome group than that in the poor outcome group (P = 0.029). Our results suggest that DC with hematoma evacuation might be a useful surgical procedure for selected patients with large hemispheric hypertensive ICH.
Collapse
Affiliation(s)
- Satoru Takeuchi
- Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
D'Amore C, Paciaroni M, Silvestrelli G, Agnelli G, Santucci P, Lanari A, Alberti A, Venti M, Acciarresi M, Caso V. Severity of acute intracerebral haemorrhage, elderly age and atrial fibrillation: independent predictors of poor outcome at three months. Eur J Intern Med 2013; 24:310-3. [PMID: 23291004 DOI: 10.1016/j.ejim.2012.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 12/09/2012] [Accepted: 12/10/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Prognostic risk factors of haemorrhagic stroke are not yet fully identified. This study investigated clinical factors leading to poor outcome at three months in patients with intracerebral haemorrhage (ICH) in order to better understand the role of clinical features in prognostic evaluation. SUBJECTS AND METHODS This was a prospective cohort study on patients having ICH admitted to two Italian hospitals (the Stroke Units at "Ospedale Santa Maria della Misericordia", Perugia and "Ospedale C. Poma", Mantua) between January 1, 2006 and June 30, 2010. RESULTS A total of 470 consecutive ICH patients (mean age 73.89±13.02 years) were included and of these, 241 (51.1%) were males. At three months, 293 (62.3%) patients had poor outcome including 133 (27.6%) deaths. The resulting significant predictors of poor outcome from univariate analysis included: age, NIH Stroke Scale Score (NIHSSS) at admission, hyperglycaemia and the presence of atrial fibrillation (AF). These variables were confirmed in logistic regression analyses as being independent predictors of disability: age (OR 1.04 95% CI, 1.02-1.07, p=0.0001), AF (OR 3.18 95% CI, 1.12-9.05 p=0.03) and NIHSSS (OR 1.38 95% CI, 1.28-1.48, p=0.0001), while elderly age (OR 1.10 95% CI, 1.06-1.14, p≤0.0001) and high NIHSSS (OR 1.25 95% CI, 1.19-1.31, p≤0.0001) resulted being independent predictors of mortality. CONCLUSIONS This study found that severity of ICH, elderly age and AF were independent predictors of poor outcome in ICH patients at three months. Thereby, this highlights the importance of understanding the roles of clinical features in ICH prognostic evaluation.
Collapse
Affiliation(s)
- Cataldo D'Amore
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Ospedale Santa Maria della Misericordia, Sant' Andrea delle Fratte, 06156, Perugia, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Rodríguez-Yáñez M, Castellanos M, Freijo M, López Fernández J, Martí-Fàbregas J, Nombela F, Simal P, Castillo J, Díez-Tejedor E, Fuentes B, Alonso de Leciñana M, Álvarez-Sabin J, Arenillas J, Calleja S, Casado I, Dávalos A, Díaz-Otero F, Egido J, Gállego J, García Pastor A, Gil-Núñez A, Gilo F, Irimia P, Lago A, Maestre J, Masjuan J, Martínez-Sánchez P, Martínez-Vila E, Molina C, Morales A, Purroy F, Ribó M, Roquer J, Rubio F, Segura T, Serena J, Tejada J, Vivancos J. Clinical practice guidelines in intracerebral haemorrhage. NEUROLOGÍA (ENGLISH EDITION) 2013. [DOI: 10.1016/j.nrleng.2011.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
|
16
|
Heuts SG, Bruce SS, Zacharia BE, Hickman ZL, Kellner CP, Sussman ES, McDowell MM, Bruce RA, Connolly ES. Decompressive hemicraniectomy without clot evacuation in dominant-sided intracerebral hemorrhage with ICP crisis. Neurosurg Focus 2013; 34:E4. [DOI: 10.3171/2013.2.focus1326] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Large intracerebral hemorrhage (ICH), compounded by perihematomal edema, can produce severe elevations of intracranial pressure (ICP). Decompressive hemicraniectomy (DHC) with or without clot evacuation has been considered a part of the armamentarium of treatment options for these patients. The authors sought to assess the preliminary utility of DHC without evacuation for ICH in patients with supratentorial, dominant-sided lesions.
Methods
From September 2009 to May 2012, patients with ICH who were admitted to the neurological ICU at Columbia University Medical Center were prospectively enrolled in that institution's ICH Outcomes Project (ICHOP). Five patients with spontaneous supratentorial dominant-sided ICH underwent DHC without clot evacuation for recalcitrant elevated ICP. Data pertaining to the patients' characteristics and outcomes of treatment were prospectively collected.
Results
The patients' median age was 43 years (range 30–55 years) and the ICH etiology was hypertension in 4 of 5 patients, and systemic lupus erythematosus vasculitis in 1 patient. On admission, the median Glasgow Coma Scale (GCS) score was 7 (range 5–9). The median ICH volume was 53 cm3 (range 28–79 cm3), and the median midline shift was 7.6 mm (range 3.0–11.3 mm). One day after surgery, the median decrease in midline shift was 2.7 mm (range 1.5–4.6 mm), and the median change in GCS score was +1 (range −3 to +5). At discharge, all patients were still alive, and the median GCS score was 10 (range 9–11), the median modified Rankin Scale (mRS) score was 5 (range 5–5), and the median NIHSS (National Institutes of Health Stroke Scale) score was 22 (range 17–27). Six months after hemorrhage, 1 patient had died, 2 were functionally dependent (mRS Score 4–5), and 2 were functionally independent (mRS Score 0–3). Outcomes for the patients treated with DHC were good compared with 1) outcomes for all patients with spontaneous supratentorial ICH admitted during the same period (n = 144) and 2) outcomes for matched patients (dominant ICH, GCS Score 5–9, ICH volume 28–79 cm3, age < 60 years) whose cases were managed nonoperatively (n = 5).
Conclusions
Decompressive hemicraniectomy without clot evacuation appears feasible in patients with large ICH and deserves further investigation, preferably in a randomized controlled setting.
Collapse
|
17
|
Ventriculomegaly after decompressive craniectomy with hematoma evacuation for large hemispheric hypertensive intracerebral hemorrhage. Clin Neurol Neurosurg 2013; 115:317-22. [DOI: 10.1016/j.clineuro.2012.05.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 05/19/2012] [Accepted: 05/27/2012] [Indexed: 11/24/2022]
|
18
|
Wang W, Yang Z, Liu L, Dornbos D, Wang C, Song X, Gong X, Wang A, Zhao X. Relationship between transcranial Doppler variables in acute stage and outcome of intracerebral hemorrhage. Neurol Res 2012; 33:487-93. [PMID: 21669117 DOI: 10.1179/016164111x13007856084089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To investigate the characteristics of transcranial Doppler variables in the acute stage of intracerebral hemorrhage (ICH) and its relationship with 14-day death and outcomes at 90 day after onset. METHODS Ninety first-time supratentorial nontraumatic ICH patients were prospectively included. Computed tomography and transcranial Doppler examinations were performed on the first, third, seventh, and fourteenth day after onset. Transcranial Doppler variables were obtained from bilateral middle cerebral arteries. The relationship between ICH outcome and the following variables were analyzed: systolic (V(s)), diastolic (V(d)), mean (V(m)) velocities, and pulsatiliy index (PI) from affected and unaffected hemispheres. RESULTS Fourteen (15.6%) patients died within 14 days after onset of ICH. The stepwise logistic regression analyses proved presence of intraventricular hemorrhage (OR: 11.91; 95%CI: 1.62-87.42) and PI from unaffected hemisphere (OR: 1.64; 95%CI: 1.19-2.25) to be independent predictors of 14-day death. Forty-eight of the 90 ICH patients performed the transcranial Doppler monitoring at all four time points. V(m) from both hemispheres decreased gradually within 14 days after onset. Among the 48 patients, 22 patients were dependent (modified Rankin Scale ≥ 3) at 90 days after onset. Compared with patients who were independent at 90 days, V(d) (F = 4.98, P = 0.03) and V(m) (F = 7.30, P<0.01) from unaffected hemisphere were significantly lower, while the PI was significantly higher in patients who were dependent (F = 9.84, P<0.01). CONCLUSIONS Presence of intraventricular hemorrhage and PI from unaffected hemisphere proved to be independent predictors of 14-day death. Sustained persistent decreases in V(d) and V(m) and increases in PI from the unaffected hemisphere during the acute stage may be related with dependency at 90 days.
Collapse
Affiliation(s)
- Wenjuan Wang
- Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Garcia PY, Roussel M, Bugnicourt JM, Lamy C, Canaple S, Peltier J, Loas G, Deramond H, Godefroy O. Cognitive impairment and dementia after intracerebral hemorrhage: a cross-sectional study of a hospital-based series. J Stroke Cerebrovasc Dis 2012; 22:80-6. [PMID: 22421024 DOI: 10.1016/j.jstrokecerebrovasdis.2011.06.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 06/12/2011] [Accepted: 06/16/2011] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Frequencies of cognitive impairment and dementia have not been assessed in spontaneous intracerebral hemorrhage (ICH). The objective of this study was to determine the frequencies and patterns of cognitive impairment and dementia in a cross-sectional study of consecutive patients hospitalized in a single university medical center. METHODS Of 183 consecutive patients hospitalized between 2002 and 2006, 80 survivors were contacted and 78 were included (mean time since stroke 40 months). Thirty patients were scored with the Informant Questionnaire on Cognitive Decline in the Elderly and Instrumental Activities of Daily Living in a telephone interview, and 48 underwent a comprehensive clinical and neuropsychological assessment. RESULTS Dementia was observed in 18 of 78 patients (23%; 95% confidence interval [CI] 13-32%) and cognitive impairment without dementia was seen in 37 of 48 patients (77%; 95% CI 65-89%). The cognitive disorders mainly concerned episodic memory (52%), psychomotor speed (44%), and executive function (37%), followed by language and visuoconstructive abilities. In a logistic regression analysis, Rankin score >1 at discharge and hemorrhage volume were the initial factors to be selected as a predictor of long-term dementia. CONCLUSIONS This single-center, cross-sectional study revealed that the prevalence of dementia and cognitive impairment without dementia after ICH are high and are similar to those observed in cerebral infarct. Further longitudinal, prospective studies are required to assess accurately the prevalence, mechanisms and predictors of post-ICH dementia.
Collapse
|
20
|
Tao T, Wang T, Zhang JH, Qin X. Characteristics of pulse pressure parameters in acute intracerebral hemorrhage patients. ACTA NEUROCHIRURGICA. SUPPLEMENT 2011; 111:349-52. [PMID: 21725780 DOI: 10.1007/978-3-7091-0693-8_58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
We explored the features of changes in pulse pressure (PP) in patients with intracerebral hemorrhage (ICH). Two hundred one patients with ICH were admitted to our hospital from January 2008 to August 2009. Meanwhile, another 201 people matching in age and gender with these patients were assigned as controls. Blood Pressures (BP) were collected within the first 24 h after admission. PP was calculated from the BP readings. The mean of PPs was compared via T-test. The distributed frequency of the PP level was analyzed using the chi-square test. PPs in the ICH group were higher than those of the controls (P<0.001). Chi-square test showed a significant difference in distribution ratios of PP (P<0.01) between the ICH and control group. The largest PP range in the ICH group was from 80 to 99 mmHg, which accounted for 33.3%; PP of the control group was from 40 to 49 mmHg (30.3%). The PP level in the 40-89-year-old case group was higher than that in the 40-89-year-old control group. PP increased with age. Our investigation indicates that higher PP is correlated with acute ICH and that PP is important in predicting the risk of ICH.
Collapse
Affiliation(s)
- Tao Tao
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | | | | | | |
Collapse
|
21
|
Abstract
Intracerebral hemorrhage (ICH) imparts a higher mortality and morbidity than ischemic stroke. The therapeutic interventions that are currently available focus mainly on supportive care and secondary prevention. There is a paucity of evidence to support any one acute intervention that improves functional outcome. This chapter highlights current treatment targets for ICH based on the pathophysiology of the disease.
Collapse
Affiliation(s)
- Navdeep Sangha
- Department of Neurology, University of Texas Medical School-UT Health, 6431 Fannin, MSB 7.118, Houston, TX 77030 USA
| | - Nicole R. Gonzales
- Department of Neurology, University of Texas Medical School-UT Health, 6431 Fannin, MSB 7.118, Houston, TX 77030 USA
| |
Collapse
|
22
|
Clinical practice guidelines in intracerebral haemorrhage. Neurologia 2011; 28:236-49. [PMID: 21570742 DOI: 10.1016/j.nrl.2011.03.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 03/06/2011] [Indexed: 01/15/2023] Open
Abstract
Intracerebral haemorrhage accounts for 10%-15% of all strokes; however it has a poor prognosis with higher rates of morbidity and mortality. Neurological deterioration is often observed during the first hours after onset and determines poor prognosis. Intracerebral haemorrhage, therefore, is a neurological emergency which must be diagnosed and treated properly as soon as possible. In this guide we review the diagnostic procedures and factors that influence the prognosis of patients with intracerebral haemorrhage and we establish recommendations for the therapeutic strategy, systematic diagnosis, acute treatment and secondary prevention for this condition.
Collapse
|
23
|
|
24
|
van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 2010; 9:167-76. [PMID: 20056489 DOI: 10.1016/s1474-4422(09)70340-0] [Citation(s) in RCA: 1767] [Impact Index Per Article: 126.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Since the early 1980s, imaging techniques have enabled population-based studies of intracerebral haemorrhage. We aimed to assess the incidence, case fatality, and functional outcome of intracerebral haemorrhage in relation to age, sex, ethnic origin, and time period in studies published since 1980. METHODS From PubMed and Embase searches with predefined inclusion criteria, we identified population-based studies published between January, 1980, and November, 2008. We calculated incidence and case fatality. Incidences for multiple studies were pooled in a random-effects binomial meta-analysis. Time trends of case fatality were assessed with weighted linear-regression analysis. FINDINGS 36 eligible studies described 44 time periods (mid-year range 1983-2006). These studies included 8145 patients with intracerebral haemorrhage. Incidence did not decrease between 1980 and 2008. Overall incidence was 24.6 per 100 000 person-years (95% CI 19.7-30.7). Incidence was not significantly lower in women than in men (overall incidence ratio 0.85, 95% CI 0.61-1.18). Using the age group 45-54 years as reference, incidence ratios increased from 0.10 (95% CI 0.06-0.14) for people aged less than 45 years to 9.6 (6.6-13.9) for people older than 85 years. Median case fatality at 1 month was 40.4% (range 13.1-61.0) and did not decrease over time, and was lower in Japan (16.7%, 95% CI 15.0-18.5) than elsewhere (42.3%, 40.9-43.6). Six studies reported functional outcome, with independency rates of between 12% and 39%. Incidence of intracerebral haemorrhage per 100 000 person-years was 24.2 (95% CI 20.9-28.0) in white people, 22.9 (14.8-35.6) in black people, 19.6 (15.7-24.5) in Hispanic people, and 51.8 (38.8-69.3) in Asian people. INTERPRETATION Incidence of intracerebral haemorrhage increases with age and has not decreased between 1980 and 2006. Case fatality is lower in Japan than elsewhere, increases with age, and has not decreased over time. More data on functional outcome are needed. FUNDING Netherlands Heart Foundation.
Collapse
Affiliation(s)
- Charlotte Jj van Asch
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, Netherlands.
| | | | | | | | | | | |
Collapse
|
25
|
Vascular Diseases. Neurosurgery 2010. [DOI: 10.1007/978-3-540-79565-0_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
26
|
Elger B, Hornberger W, Schwarz M, Seega J, Zahn W. Ancrod reduces intracerebral hemorrhage quantified in vivo by magnetic resonance imaging in rats. J Stroke Cerebrovasc Dis 2009; 7:10-6. [PMID: 17895051 DOI: 10.1016/s1052-3057(98)80016-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/1997] [Accepted: 09/25/1997] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Promising results of experimental and clinical stroke studies suggest that ancrod may provide an efficient therapy of brain ischemia. Because ancrod has been shown to produce rapid defibrinogenation, we investigated the effects of this agent in a rat model of intracranial bleeding using noninvasive magnetic resonance imaging (MRI). METHODS Intracranial bleeding was induced in anesthetised rats by microinfusion of collagenase into the right striatum. Ancrod was intravenously infused for a period of 30 minutes starting 30 minutes after intrastriatal collagenase infusion. The dosages of ancrod were 0.33 IU . kg(-1) . min(-1) in one group and 1 IU . kg(-1) . min(-1) in another (total dosages were 10 and 30 IU . kg(-1), respectively). Control animals received equal amounts of vehicle solution (0.9% NaCl) only. The volume of intracerebral hemorrhage (ICH) was quantified in vivo by T1-weighted spin-echo MRI in eight consecutive coronal brain planes 24 hours after collagenase infusion. RESULTS Plasma fibrinogen was dose-dependently diminished immediately after infusion of ancrod at dosages of 0.33 or 1 IU . kg(-1) . min(-1). Total volume of ICH was significantly (P<.05) reduced by 50% from 48 (35/57) mm(3) in vehicle-treated controls (n=17) to 24 (20/37) mm(3) in rats (n=15) infused with the lower ancrod dosage (median, 25th/75th centiles). Rats (n=15) treated with the higher dosage of ancrod had 34 (27/39) mm(3) volume of ICH, which is 29% lower compared with vehicle-treated controls (P=.05). CONCLUSIONS Adverse side effects such as aggravation of intracerebral bleeding did not occur in ancrod-infused rats despite pronounced lowering of the plasma fibrinogen level during ongoing bleeding. In contrast, significant reductions in the volumes of ICH were observed suggesting favorable influence of ancrod in the event of intracranial bleeding in rats.
Collapse
Affiliation(s)
- B Elger
- Research and Development, Knoll AG, Ludwigshafen, Germany
| | | | | | | | | |
Collapse
|
27
|
Kim KH. Predictors of 30-day mortality and 90-day functional recovery after primary intracerebral hemorrhage : hospital based multivariate analysis in 585 patients. J Korean Neurosurg Soc 2009; 45:341-9. [PMID: 19609417 DOI: 10.3340/jkns.2009.45.6.341] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 05/31/2009] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The purpose of this study was to identify independent predictors of mortality and functional recovery in patients with primary intracerebral hemorrhage (PICH) and to improve functional outcome in these patients. METHODS Data were collected retrospectively on 585 patients with supratentorial PICH admitted to the Stroke Unit at our hospital between 1st January 2004 and the 31st July 2008. Using multivariate logistic regression analysis, the associations between all selected variables and 30-day mortality and 90-day functional recoveries after PICH was evaluated. RESULTS Ninety-day functional recovery was achieved in 29.1% of the 585 patients and 30-day mortality in 15.9%. Age (OR=7.384, p=0.000), limb weakness (OR=6.927, p=0.000), and hematoma volume (OR=5.293, p=0.000) were found to be powerful predictors of 90-day functional recovery. Furthermore, initial consciousness (OR=3.013, p=0.014) hematoma location (lobar, OR=2.653, p=0.003), ventricular extension of blood (OR=2.077, p=0.013), leukocytosis (OR=2.048, p=0.008), alcohol intake (drinker, OR=1.927, p=0.023), and increased serum aminotransferase (OR=1.892, p=0.035) were found to be independent predictors of 90-day functional recovery after PICH. On the other hand, a pupillary abnormality (OR=4.532, p=0.000) and initial unconsciousness (OR=3.362, p=0.000) were found to be independent predictors of 30-day mortality after PICH. CONCLUSION The predictors of mortality and functional recovery after PICH identified during this analysis may assist during clinical decision-making, when advising patients or family members about the prognosis of PICH and when planning intervention trials.
Collapse
Affiliation(s)
- Kyu-Hong Kim
- Department of Neurosurgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
| |
Collapse
|
28
|
Abstract
BACKGROUND AND PURPOSE Epidemiological studies, mainly based on Western European surveys, have shown that stroke is more common in men than in women. In recent years, sex-specific data on stroke incidence, prevalence, subtypes, severity and case-fatality have become available from other parts of the world. The purpose of this article is to give a worldwide review on sex differences in stroke epidemiology. METHODS We searched PubMed, tables-of-contents, review articles, and reference lists for community-based studies including information on sex differences. In some areas, such as secular trends, ischemic subtypes and stroke severity, noncommunity-based studies were also reviewed. Male/female ratios were calculated. RESULTS We found 98 articles that contained relevant sex-specific information, including 59 incidence studies from 19 countries and 5 continents. The mean age at first-ever stroke was 68.6 years among men, and 72.9 years among women. Male stroke incidence rate was 33% higher and stroke prevalence was 41% higher than the female, with large variations between age bands and between populations. The incidence rates of brain infarction and intracerebral hemorrhage were higher among men, whereas the rate of subarachnoidal hemorrhage was higher among women, although this difference was not statistically significant. Stroke tended to be more severe in women, with a 1-month case fatality of 24.7% compared with 19.7% for men. CONCLUSIONS Worldwide, stroke is more common among men, but women are more severely ill. The mismatch between the sexes is larger than previously described.
Collapse
Affiliation(s)
- Peter Appelros
- Department of Neurology, Orebro University Hospital, Orebro, Sweden.
| | | | | |
Collapse
|
29
|
Sacco S, Marini C, Toni D, Olivieri L, Carolei A. Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry. Stroke 2008; 40:394-9. [PMID: 19038914 DOI: 10.1161/strokeaha.108.523209] [Citation(s) in RCA: 375] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to evaluate the incidence and prognosis of intracerebral hemorrhage. METHODS We analyzed data referring to our prospective population-based registry, including patients with a first-ever stroke followed up to 10 years. RESULTS In a 5-year period, we included 549 patients (247 men and 302 women; mean age+/-SD, 73.6+/-12.5 years) with an intracerebral hemorrhage. The crude annual incidence rate was 36.9 per 100000 (95% CI, 33.8 to 40.0), 32.9 per 100000 when standardized to the 2006 European population, and 15.9 per 100000 when standardized to the world population. The case-fatality rate was 34.6% (95% CI, 30.6 to 38.6) at 7 days; it increased to 50.3% (95% CI, 46.1 to 54.5) at 30 days and to 59.0% (95% CI, 54.9 to 63.1) at 1 year. Diabetes mellitus and posterior fossa hemorrhage were associated with an increased risk of 7- and 30-day mortality, whereas older age was associated with an increased risk of 30-day mortality only. At the Kaplan-Meier analysis, the 10-year survival rate was 24.1% (95% CI, 20.1 to 28.1). CONCLUSIONS Intracerebral hemorrhage is characterized by a severe prognosis, mostly in the short term. Because of the high proportion of fatal events that occurs early after the stroke, it is mandatory to identify and apply specific therapeutic strategies for patients with intracerebral hemorrhage.
Collapse
Affiliation(s)
- Simona Sacco
- Department of Neurology, University of L'Aquila, L'Aquila, Italy
| | | | | | | | | |
Collapse
|
30
|
Eckhardt R, Schnabl S, Brainin M. Management von Patienten mit intrazerebralen Blutungen an Österreichischen Stroke Units: Ergebnisse des GÖG-BIQG Österreichischen Stroke Unit Registers 2003–2007. Wien Med Wochenschr 2008; 158:435-45. [DOI: 10.1007/s10354-008-0567-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 05/27/2008] [Indexed: 10/21/2022]
|
31
|
Hänggi D, Steiger HJ. Spontaneous intracerebral haemorrhage in adults: a literature overview. Acta Neurochir (Wien) 2008; 150:371-9; discussion 379. [PMID: 18176774 DOI: 10.1007/s00701-007-1484-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Accepted: 12/04/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND A large number of reports have analysed epidemiology, pathogenesis, symptomatology, diagnostics and options for medical and surgical treatment of intracerebral haemorrhage. Nevertheless, management still remains controversial. The purpose of the present review is to summarise the clinical data and derive a current updated management concept as a result. METHODS The analysis was based on a Medline search to November 2006 for the term "intracerebral haemorrhage" (ICH). The clinical query functions were optimised for aetiology, diagnosis and therapy to limit the results. A total of 103 articles were found eligible for review. FINDINGS Race, age and sex influence the occurrence of ICH. Moreover, hypertension and alcohol consumption are the paramount risk factors. The most frequent pathophysiological mechanism of ICH seems to be a degenerative vessel wall change and, in consequence, rupture of small penetrating arteries and arterioles of 50-200 microm in diameter. The symptomatology depends on the size of ICH, possible rebleeding and the occurrence of hydrocephalus or seizures. The outcome is worse with concomitant occurrence of intraventricular haemorrhage. Treatment with recombinant factor VIIa (rFVIIa) within four hours after the onset of ICH limits the growth of haematoma, reduces mortality and improves functional outcome. Minimally invasive surgery tends to improve functional outcome. CONCLUSION A systematic knowledge of currently available data on epidemiology, pathogenesis and symptomatology, the use of diagnostics and the different conservative and surgical treatment options can lead to a balanced management strategy for patients with ICH.
Collapse
|
32
|
Shah QA, Ezzeddine MA, Qureshi AI. Acute hypertension in intracerebral hemorrhage: pathophysiology and treatment. J Neurol Sci 2007; 261:74-9. [PMID: 17550786 DOI: 10.1016/j.jns.2007.04.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Non-traumatic or spontaneous intracerebral hemorrhage (ICH) is defined as intra-parenchymal bleeding with or without extension into the ventricles and rarely into the subarachoid space. Primary ICH in most cases is associated with chronic hypertension. Acute hypertension is associated with hematoma expansion, and poor neurological outcome. The treatment of hypertension in acute ICH is a topic of controversy. Experiments have shown an area of ischemia around the hematoma, with the reduction of regional cerebral blood flow (CBF) secondary to compression of microvasculature. Not all scientific results agree with the above findings. Recent studies have shown that CBF decreases in the perihematoma region but with concomitant reduction of cerebral metabolism, which would argue against an area of ischemia in the perihematoma region. Based on the above result, there have been several clinical trials looking at clinical outcome and decrease in hematoma expansion rates with reduction of blood pressure acutely after ICH. The parameters for the blood pressure control are still under investigation. The American Heart Association has put forward guidelines for blood pressure control which have been adopted in the centers around the country. We have described the protocol we use at our center for the blood pressure control in patients with acute ICH.
Collapse
Affiliation(s)
- Qaisar A Shah
- Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, Minneapolis, MN 55455, USA.
| | | | | |
Collapse
|
33
|
Abstract
✓Successfully measuring cerebrovascular neurosurgery outcomes requires an appreciation of the current state-of-the-art epidemiological instruments, their specific relevance to surgical treatments and the underlying pathological entity, and ultimately the right set of questions for the next generation of studies. In this paper the authors address these questions with specific attention to measurement targets, individual modeling scales, and types of studies, all within a conceptual framework for specific disease models in their current state of outcomes modeling in cerebrovascular neurosurgery.
Collapse
Affiliation(s)
- Carlos E Sanchez
- Cerebrovascular Surgery Unit, Neurosurgical Service, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | |
Collapse
|
34
|
Pantazis G, Tsitsopoulos P, Mihas C, Katsiva V, Stavrianos V, Zymaris S. Early surgical treatment vs conservative management for spontaneous supratentorial intracerebral hematomas: A prospective randomized study. ACTA ACUST UNITED AC 2006; 66:492-501; discussion 501-2. [PMID: 17084196 DOI: 10.1016/j.surneu.2006.05.054] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Accepted: 05/23/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND Treatment of primary SICH is still controversial. The aim of this study was to investigate the effectiveness of craniotomy and early hematoma evacuation vs nonoperative management in patients with SICH. METHODS A prospective randomized study of craniotomy and early hematoma removal vs best medical management was performed in 108 patients with primary SICH. Surgical or medical treatment was initiated within 8 hours post ictus. Principal eligibility criterium was the presence of neurologic impairment associated with a spontaneous subcortical or putaminal hemorrhage bigger than 30 mL. Outcomes were assessed at 1 year post ictus. RESULTS Analysis of outcome revealed a significantly higher percentage of GOS scores higher than 3 for the surgical patients, compared with those of the conservative group (33% and 9%, respectively; P < .05). By contrast, the mortality rates between operated and conservatively managed patients did not differ significantly. The main prognostic variables were the initial neurologic status, hematoma volume, and location. Stratifications of these parameters and analysis showed that the positive effect of surgery on the quality of survival was statistically not valid for patients with GCS scores lower than 8 or ICH volumes 80 mL or higher at the time of enrollment. CONCLUSIONS The study demonstrates that surgical patients with subcortical or putaminal hematomas showed better functional results than their conservatively treated counterparts. However, early ICH evacuation failed to improve the survival rates, as compared with best medical management.
Collapse
Affiliation(s)
- Georgios Pantazis
- Department of Neurosurgery, Thriassio General Hospital, 19600 Magoula, Athens, Greece.
| | | | | | | | | | | |
Collapse
|
35
|
Ohwaki K, Yano E, Nagashima H, Hirata M, Nakagomi T, Tamura A. Surgery for patients with severe supratentorial intracerebral hemorrhage. Neurocrit Care 2006; 5:15-20. [PMID: 16960289 DOI: 10.1385/ncc:5:1:15] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Little information is available on the efficacy of aggressive treatment such as surgery in improving the outcome of severely affected patients after supratentorial intracerebral hemorrhage (ICH). Our objective was to assess the effect of hematoma removal and ventricular drainage on the mortality of patients with severe primary supratentorial ICH. METHODS We studied 103 consecutive patients who were admitted to the intensive care unit and diagnosed with primary supratentorial ICH. The impacts of clinical factors on 30-day mortality were assessed, including surgery, Glasgow Coma Scale (GCS) score and pupillary abnormality at admission, hematoma volume, and other related factors. RESULTS The 30-day mortality rate was 42%, and the median time between admission and death was 3 days (range: 1 to 27 days). Hematoma removal and ventricular drainage, within the first 24 hours of admission, were performed on 11 and 17 patients, respectively. Two patients who were treated with removal and four with drainage died. A logistic regression model for predicting 30-day mortality was performed. After controlling for GCS score, pupillary abnormality, hydrocephalus, and hematoma volume, hematoma removal was identified as an independent predictor of survival (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.02 to 0.92). Ventricular drainage also tended to decrease mortality rate greatly (OR, 0.31; 95% CI, 0.06 to 1.76). Patients with GCS scores of 3 or 4 were 4.01 times more likely to die (95% CI, 1.13 to 14.26) than those with GCS of at least 5. CONCLUSIONS Hematoma removal may reduce the mortality rate of patients with severe supratentorial ICH.
Collapse
Affiliation(s)
- Kazuhiro Ohwaki
- Department of Hygiene and Public Health, Teikyo University School of Medicine, 2-11-1 Kaga Itabashi, Tokyo, Japan.
| | | | | | | | | | | |
Collapse
|
36
|
Pascual AM, López-Mut JV, Benlloch V, Chamarro R, Soler J, Láinez MJA. Perfusion-weighted magnetic resonance imaging in acute intracerebral hemorrhage at baseline and during the 1st and 2nd week: a longitudinal study. Cerebrovasc Dis 2006; 23:6-13. [PMID: 16968980 DOI: 10.1159/000095752] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Accepted: 05/22/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Ischemic penumbra has been suggested as a contributing mechanism to secondary neuronal injury in intracerebral hemorrhage (ICH). Preliminary data suggest the presence of perihematomal hypoperfusion within the first hours after acute ICH. Our objective was to elucidate perfusion changes in the perihematomal region over time using magnetic resonance imaging (MRI). METHODS Two perfusion-weighted MRIs were studied prospectively in 18 ICH patients. All patients had an acute perfusion-weighted MRI within 24 h of the onset of symptoms (time 0); 11 patients had a follow-up study on day 7 (time 1), and 7 patients on days 10-14 (time 2). The region of interest (ROI) was placed over the penumbral area, on high-intensity FLAIR and perfusion overlapping map imaging. Clinical data were assessed at baseline (National Institutes of Health Stroke Scale) and on day 90 (Canadian Scale, modified Rankin Scale). RESULTS The average hematoma volume was 56 (9-140) ml; 10 were located deeply, and 8 were lobar. When we compared the perfusion changes (mean transit time prolongation) in the perihematomal area (lesion ROI) relative to itself over time, we found significant differences only between times 0 and 2 (p = 0.05). There were also significant differences in mean transit time between the lesion ROI and the contralateral mirror ROI in the baseline study (p = 0.001), with a trend to significance for time 1. CONCLUSIONS Our data confirm the presence of hypoperfusion around an acute ICH and demonstrate that this change disappears completely after the first week. These data suggest that further evaluation of this feature of acute ICH is warranted, as its confirmation may lead to modifications in the current therapeutic approach.
Collapse
Affiliation(s)
- Ana M Pascual
- Department of Neurology, Hospital Clínico, Valencia, Spain.
| | | | | | | | | | | |
Collapse
|
37
|
Morioka J, Fujii M, Kato S, Fujisawa H, Akimura T, Suzuki M, Kobayashi S. Surgery for spontaneous intracerebral hemorrhage has greater remedial value than conservative therapy. ACTA ACUST UNITED AC 2006; 65:67-72; discussion 72-3. [PMID: 16378863 DOI: 10.1016/j.surneu.2005.03.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2004] [Accepted: 03/14/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to compare the efficacy of surgery for spontaneous intracerebral hemorrhage with that of medical treatment, based on data from the Japan Stroke Registry Study. METHODS From 1999 to 2001, 1010 patients with spontaneous intracerebral hemorrhage were registered in the Japan Standard Stroke Registry Study from 45 stroke center hospitals in Japan. The National Institutes of Health Stroke Scale (NIHSS), Japan Stroke Scale (JSS), and modified Rankin Scale scores were used to compare severity and improvement in patients given surgical and medical treatment. CONCLUSIONS Surgically treated patients, especially those with cerebellar hemorrhage, had significantly greater improvement in NIHSS or JSS score compared with medically treated patients. Our findings indicated that the patients who underwent surgery appeared to have better outcomes. But, because the study was not randomized, this observation cannot be interpreted as indicating that surgery is advantageous.
Collapse
Affiliation(s)
- Jun Morioka
- Department of Neurosurgery, Yamaguchi University School of Medicine, Yamaguchi 755-8505, Japan.
| | | | | | | | | | | | | |
Collapse
|
38
|
Murthy JMK, Chowdary GVS, Murthy TVRK, Bhasha PSA, Naryanan TJ. Decompressive craniectomy with clot evacuation in large hemispheric hypertensive intracerebral hemorrhage. Neurocrit Care 2005; 2:258-62. [PMID: 16159072 DOI: 10.1385/ncc:2:3:258] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Decompressive hemicraniectomy in large hemispheric infarctions has been reported to lower mortality and improve the unfavorable outcomes. Hematoma volume is a powerful predictor of 30-day mortality in patients with intracerebral hemorrhage (ICH). Hematoma volume adds to intracranial volume and may lead to life-threatening elevation of intracranial pressure. METHODS Records of 12 consecutive patients with hypertensive ICH treated with decompressive hemicraniectomy were reviewed. The data collected included Glasgow Coma Scale (GCS) score at admission and before surgery, ICH volume, ICH score, and a clinical grading scale for ICH that accurately risk-stratifies patients regarding 30-day mortality. Outcome was assessed as immediate mortality and modified Rankin Score (mRS) at the last follow-up. RESULTS Of the 12 patients with decompressive hemicraniectomy, 11 (92%) survived to discharge; of those 11, 6 (54.5%) had good functional outcome, defined as a mRS of 0 to 3 (mean follow-up: 17.13 months; range: 2-39 months). The mean age was 49.8 years (range: 19-76 years). Three of the 7 patients with pupillary abnormalities made a good recovery; of the 11 patients with intraventricular extensions (IVEs), 7 made a good recovery. The clinical finding (which was present in all 3 patients with mRS equal to 5 and which was not present in patients with mRS less than 5) was abnormal occulocephalic reflex. Of the 10 patients with an ICH score of 3, 9 (90%) survived to discharge, 4 (44%) had good functional outcome (mRS: 1-3). Hematoma volume was 60 cm3 or greater in eight patients, four (50%) of whom had good functional outcome (mRS: 0-3). CONCLUSION Decompressive hemicraniectomy with hematoma evacuation is life-saving and improves unfavorable outcomes in a select group of young patients with large right hemispherical ICH.
Collapse
MESH Headings
- Adult
- Aged
- Craniotomy
- Decompression, Surgical
- Follow-Up Studies
- Glasgow Coma Scale
- Hematoma, Subdural, Intracranial/diagnostic imaging
- Hematoma, Subdural, Intracranial/mortality
- Hematoma, Subdural, Intracranial/surgery
- Humans
- Intracranial Hemorrhage, Hypertensive/diagnostic imaging
- Intracranial Hemorrhage, Hypertensive/mortality
- Intracranial Hemorrhage, Hypertensive/surgery
- Middle Aged
- Radiography
- Recovery of Function
- Retrospective Studies
- Survival Rate
- Treatment Outcome
Collapse
Affiliation(s)
- J M K Murthy
- Department of Neurology, The Institute of Neurological Sciences, Hyderabad 500 001, India.
| | | | | | | | | |
Collapse
|
39
|
Fogelholm R, Murros K, Rissanen A, Avikainen S. Long term survival after primary intracerebral haemorrhage: a retrospective population based study. J Neurol Neurosurg Psychiatry 2005; 76:1534-8. [PMID: 16227546 PMCID: PMC1739413 DOI: 10.1136/jnnp.2004.055145] [Citation(s) in RCA: 186] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the long term survival and predictors of death in patients with primary intracerebral haemorrhage (ICH) in Central Finland. METHODS Data were collected retrospectively on all adult patients with first ever ICH in Central Finland county between September 1985 and December 1991. The survival of all patients at the end of December 2002 was investigated. Kaplan-Meier survival curves were constructed and factors associated with both early (< or =28 days) and late deaths determined. Long term survival was compared with the general Finnish population of the same age and sex distribution. The causes of death were compared with those of the population of Central Finland. RESULTS 411 patients with first ever ICH were identified, 199 men (mean age 64.9 years) and 212 women (mean age 69.5); 30 died before hospital admission, and 208 (50.6%) within the first 28 days. In Kaplan-Meier analysis, at 16 years the cumulative survival was 3.2% for men and 9.8% for women. The 28 day survivors had a 4.5-fold increased annual risk of dying during the first year after ICH, and 2.2-fold during years 2 to 6. On admission, significant independent predictors of death within the first four weeks were unconsciousness, lateral shift of cerebral midline structures, mean arterial pressure > or =134 mm Hg, hyperglycaemia, anticoagulant treatment, and ventricular extrasystoles. Predictors of late death for the 28 day survivors were old age, male sex, and heart failure. CONCLUSIONS Primary intracerebral haemorrhage has a poor short and long term outcome. The results emphasise the importance of primary and secondary prevention for ICH.
Collapse
Affiliation(s)
- R Fogelholm
- Department of Neurology, University of Helsinki, Finland.
| | | | | | | |
Collapse
|
40
|
Ariesen MJ, Algra A, van der Worp HB, Rinkel GJE. Applicability and relevance of models that predict short term outcome after intracerebral haemorrhage. J Neurol Neurosurg Psychiatry 2005; 76:839-44. [PMID: 15897508 PMCID: PMC1739684 DOI: 10.1136/jnnp.2004.048223] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Several models for prediction of short term outcome after intracerebral haemorrhage (ICH) have been published, however, these are rarely used in clinical practice for treatment decisions. This study was conducted to identify current models for prediction of short term outcome after ICH and to evaluate their clinical applicability and relevance in treatment decisions. METHODS MEDLINE was searched from 1966 to June 2003 and studies were included if they met predefined criteria. Regression coefficients of multivariate models were extracted. Two neurologists independently evaluated the models for applicability in clinical practice. To assess clinical relevance and accuracy of each model, in a validation series of 122 patients the proportion with a >or=95% probability of death or poor outcome and the actual 30 day case fatality in these patients were calculated. Receiver operator characteristic (ROC) curves were computed for assessment of discriminatory power. RESULTS A total of 18 prognostic models were identified, of which 14 appeared easy to apply. In the validation series, the proportion of patients with a >or=95% probability of death or poor outcome ranged from 0% to 43% (median 23%). The 30 day case fatality in these patients ranged from 75% to 100% (median 93%). The area under the ROC curves ranged from 0.81 to 0.90. CONCLUSIONS Most models are easy to apply and can generate a high probability of death or poor outcome. However, only a small proportion of patients have such a high probability, and 30 day case fatality is not always correctly predicted. Therefore, current models have limited relevance in triage, but can be used to estimate the chances of survival of individual patients.
Collapse
Affiliation(s)
- M J Ariesen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Str. 06.131, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | | | | | | |
Collapse
|
41
|
Flaherty ML, Woo D, Haverbusch M, Sekar P, Khoury J, Sauerbeck L, Moomaw CJ, Schneider A, Kissela B, Kleindorfer D, Broderick JP. Racial variations in location and risk of intracerebral hemorrhage. Stroke 2005; 36:934-7. [PMID: 15790947 DOI: 10.1161/01.str.0000160756.72109.95] [Citation(s) in RCA: 182] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2004] [Accepted: 01/06/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Risk factors for intracerebral hemorrhage (ICH) vary by location. Incidence rates of ICH are known to be higher in American blacks than whites, but how rates may differ by hemorrhage location is unknown. We sought to define incidence rates for different ICH locations in a biracial population. METHODS All hospitalized patients age > or =20 years with spontaneous ICH were identified in the Greater Cincinnati/Northern Kentucky metropolitan area from May 1998 to July 2001 and August 2002 to April 2003. Incidence rates per 100,000 persons were age, sex, and race adjusted as appropriate to the 2000 US population. Risk ratios (RRs) with 95% CIs were calculated from unadjusted incidence rates. RESULTS There were 1038 qualifying ICHs. Annual incidence rates per 100,000 persons > or =20 years of age were 48.9 for blacks and 26.6 for whites. Annual incidence rates per 100,000 blacks in lobar, deep cerebral, brain stem, and cerebellar locations were 15.2, 25.7, 5.1, and 2.9, respectively. Annual incidence rates per 100,000 whites in the same locations were 9.4, 13.0, 1.3, and 2.9. The greatest excess risk of ICH in blacks compared with whites was found among young to middle-aged (35 to 54 years) persons with brain stem (RR, 9.8; 95% CI, 4.2 to 23.0) and deep cerebral (RR, 4.5; 3.0 to 6.8) hemorrhage. CONCLUSIONS The excess risk of ICH in American blacks is largely attributable to higher hemorrhage rates in young and middle-aged persons, particularly for deep cerebral and brain stem locations. Hypertension is the predominant risk factor for hemorrhages in these locations.
Collapse
Affiliation(s)
- Matthew L Flaherty
- Department of Neurology, University of Cincinnati Medical Center, Ohio 45267-0525, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Roch A, Michelet P, Jullien AC, Thirion X, Bregeon F, Papazian L, Roche P, Pellet W, Auffray JP. Long-term outcome in intensive care unit survivors after mechanical ventilation for intracerebral hemorrhage. Crit Care Med 2003; 31:2651-6. [PMID: 14605538 DOI: 10.1097/01.ccm.0000094222.57803.b4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To evaluate long-term survival and functional outcome in intensive care unit survivors after mechanical ventilation for intracerebral hemorrhage. DESIGN Retrospective chart review and prospective follow-up study. SETTING Outpatient follow-up. PATIENTS Between 1997 and 2000, 120 patients were mechanically ventilated for an intracerebral hemorrhage at our intensive care unit. Sixty-two patients were discharged from hospital (in-hospital mortality = 48%). Sixty patients were evaluated for survival and functional outcome (two were lost to follow-up). Time between discharge and follow-up was > or =1 yr and was a mean of 27 +/- 14 months (range, 12-56). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patients' physicians were first asked about survival, and patients or proxies were interviewed by phone. Barthel Index and modified Rankin Scale scores were collected, and demographic information and general data were reviewed. The estimated life-table survival curve after discharge was 64.6% at 1 yr and 57% at 3 yrs. In the 24 patients who died, the mean time between discharge and death was 5 +/- 6 months. Probability of death after discharge significantly increased if age at admission was >65 yrs (p <.01; odds ratio, 3.5; 95% confidence interval, 1.4-9.1) and if Glasgow Coma Scale score at discharge was <15 (p <.01; odds ratio, 3.9; 95% confidence interval, 1.6-9.5). In the 36 long-term survivors, Barthel Index was 67.5 +/- 15 (median +/- median absolute dispersion) and modified Rankin Scale score was 2.6 +/- 0.5. Fifteen patients (42%) had a slight or no disability (Barthel Index > or =90 and modified Rankin Scale score < or =2), whereas 21 patients (58%) had moderate or severe disability (Barthel Index < or =85 and modified Rankin Scale score >2). CONCLUSIONS Probability of survival at 3 yrs after mechanical ventilation for an intracerebral hemorrhage was >50%. Age was an important determinant of long-term survival. Forty-two percent of long-term survivors were independent for activities of daily living. Only a few long-term survivors had a very high degree of disability.
Collapse
Affiliation(s)
- Antoine Roch
- Service de Réanimation Polyvalente, Hôpitaux Sud, Marseilles, France
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Abstract
Primary intracerebral haemorrhage (ICH) refers to spontaneous bleeding from intraparenchymal vessels. It accounts for 10-20% of all strokes, with higher incidence rates amongst African and Asian populations. The major risk factors are hypertension and age. In addition to focal neurological findings, patients may present with symptoms of elevated intracranial pressure. The diagnosis of ICH can only be made through neuro-imaging. A CT scan is presently standard, although MRI is increasingly important in the evaluation of acute cerebrovascular disease. A significant proportion of intracerebral haematomas expand in the first hours post-ictus and this is often associated with clinical worsening. There is evidence that the peri-haematomal region is compromised in ICH. This tissue is oedematous, although the precise pathogenesis is controversial. An association between elevated arterial pressure and haematoma expansion has been reported. Although current guidelines recommend conservative management of arterial pressure in ICH, an acute blood pressure lowering trial is overdue. ICH is associated with a high early mortality rate, although a significant number of survivors make a functional recovery. Current medical management is primarily aimed at prevention of complications including pneumonia and peripheral venous thromboembolism. Elevated intracranial pressure may be treated medically or surgically. Although the latter definitively lowers elevated intracranial pressure, the optimal patient selection criteria are not clear. Aggressive treatment of hypertension is essential in the primary and secondary prevention of ICH.
Collapse
Affiliation(s)
- Kenneth Butcher
- Department of Neurosciences, Royal Melbourne Hospital, Melbourne, Australia.
| | | |
Collapse
|
44
|
|
45
|
Keris V, Buks M, Macane I, Kalnina Z, Vetra A, Jurjane N, Mikelsone A. Aneurysmal subarachnoid hemorrhage in Baltic population: experience from Latvia (1996-2000). Eur J Neurol 2002; 9:601-7. [PMID: 12453075 DOI: 10.1046/j.1468-1331.2002.00498.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Better knowledge of clinical epidemiology and course of aneurysmal subarachnoid hemorrhage (ASAH) is essential for dedicated planning of the need for services. The aim of the study was to obtain a picture of epidemiology and clinical course of ASAH in Riga City (the capital of Latvia). A retrospective population-based study included residents of Riga City who suffered their first ASAH during a 5-year period from the beginning of 1996 till the end of 2000. The total number of ASAH events in the population during the study period was 292, of which 56 (19%) were fatal before reaching the hospital. There was no significant difference between age-specific incidence rates in men and women. The mean ASAH rates per 100 000 per year were 10.3 for age-adjusted incidence (in the population aged 20-79 years) and 7.2 for crude incidence. The mean age-adjusted case fatality rates were 57% for all ASAH events and 45% for those who survived admission. Our data suggest that incidence of ASAH in Baltic population can be recognized as average compared with other European regions. However, the case fatality rate of ASAH in the study population was higher than those of SAH reported from MONICA Collaborating Centers.
Collapse
Affiliation(s)
- V Keris
- Clinic of Neurology and Neurosurgery, Hospital 'Gailezers', Medical Academy of Latvia, Riga, Latvia.
| | | | | | | | | | | | | |
Collapse
|
46
|
Rohde V, Rohde I, Thiex R, Ince A, Jung A, Dückers G, Gröschel K, Röttger C, Küker W, Müller HD, Gilsbach JM. Fibrinolysis therapy achieved with tissue plasminogen activator and aspiration of the liquefied clot after experimental intracerebral hemorrhage: rapid reduction in hematoma volume but intensification of delayed edema formation. J Neurosurg 2002; 97:954-62. [PMID: 12405387 DOI: 10.3171/jns.2002.97.4.0954] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Fibrinolysis therapy accomplished using tissue plasminogen activator (tPA) and aspiration is considered to be a viable alternative to microsurgery and medical therapy for the treatment of deep-seated spontaneous intracerebral hematomas (SICHs). Tissue plasminogen activator is a mediator of thrombin- and ischemia-related delayed edema. Because both thrombin release and ischemia occur after SICH, the authors planned to investigate the effect of fibrinolytic therapy on hematoma and delayed edema volume. METHODS A spherical hematoma was created in the frontal white matter of 18 pigs. In the tPA-treated group (nine pigs), a mean of 1.55 ml tPA was injected into the clot and the resulting liquefied blood was aspirated. Magnetic resonance (MR) imaging was performed on Days 0 (after surgery), 4, and 10, and the volumes of hematoma and edema were determined. In the animals not treated with tPA (untreated group; nine pigs), the volume of hematoma dropped from 1.43+/-0.42 ml on Day 0 to 0.85+/-0.28 ml on Day 10. In the tPA-treated group, the volume of hematoma was reduced from 1.51 +/- 0.28 ml on Day 0 to 0.52 +/- 0.39 ml on Day 10. In comparison with the untreated group, the reduction in hematoma volume was significantly accelerated (p = 0.02). In the untreated group, perihematomal edema increased from 0.32 +/- 0.61 ml to 1.73 +/- 0.73 ml on Day 4, before dropping to 1.17 +/- 0.92 ml on Day 10. In the tPA-treated group, the volume of the edema increased from 0.09 +/- 0.21 ml on Day 0 to 1.93 +/- 0.79 ml on Day 4, and further to 3.34 +/- 3.21 ml on Day 10. The increase in edema volume was significantly more pronounced in the tPA-treated group (p = 0.04). CONCLUSIONS Despite a significantly accelerated reduction in hematoma volume, the development of delayed perifocal edema was intensified by fibrinolytic therapy, which is probably related to the function of tPA as a mediator of edema formation after thrombin release and ischemia. Further experimental and clinical investigations are required to establish the future role of fibrinolysis in the management of SICH.
Collapse
Affiliation(s)
- Veit Rohde
- Department of Neurosurgery, Aachen University, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Nilsson OG, Lindgren A, Brandt L, Säveland H. Prediction of death in patients with primary intracerebral hemorrhage: a prospective study of a defined population. J Neurosurg 2002; 97:531-6. [PMID: 12296635 DOI: 10.3171/jns.2002.97.3.0531] [Citation(s) in RCA: 144] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object. Predictors of early (30-day) and long-term (1-year) mortality rates after primary intracerebral hemorrhage (ICH) were studied in a large population in southern Sweden.
Methods. All cases of primary ICH, verified using computerized tomography (CT) scanning or autopsy study, were prospectively registered at the 12 hospitals covering a defined population of 1.14 million during the calendar year 1996. Mortality was analyzed in relation to CT findings (hematoma location and volume and ventricular extension) and clinical parameters (patient age and sex, level of consciousness on admission, and history of preictal risk factors) by using univariate and multivariate statistical methods.
Three hundred forty-one cases of primary ICH were detected. The overall mortality rate was 36% at the 30-day and 47% at the 1-year follow up. Multivariate analysis revealed that initial level of consciousness, hematoma volume, and a history of heart disease were independent predictors of death at 30 days postictus. One year after bleeding, independent predictors of mortality were the initial level of consciousness, patient age, and hematoma location.
Conclusions. Primary ICH remains a stroke subtype associated with a high mortality rate and for which the level of consciousness on admission is the strongest predictor of fatal outcome both at 30 days and during the 1st year after bleeding. A preictal history of heart disease increased the 30-day mortality rate.
Collapse
Affiliation(s)
- Ola G Nilsson
- Department of Neurosurgery, Lund University Hospital, Sweden.
| | | | | | | |
Collapse
|
48
|
Skidmore CT, Andrefsky J. Spontaneous intracerebral hemorrhage: epidemiology, pathophysiology, and medical management. Neurosurg Clin N Am 2002; 13:281-8, v. [PMID: 12486918 DOI: 10.1016/s1042-3680(02)00019-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article introduces the basic epidemiology of intracerebral hemorrhage (ICH) and discusses the current available literature on the pathophysiology of primary ICH, hematoma enlargement, and cerebral edema. The article also includes a brief presentation of the basic steps regarding initial ICH management is presented as a framework for patient care.
Collapse
Affiliation(s)
- Christopher T Skidmore
- Department of Neurology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | | |
Collapse
|
49
|
Arboix A, Comes E, García-Eroles L, Massons J, Oliveres M, Balcells M, Targa C. Site of bleeding and early outcome in primary intracerebral hemorrhage. Acta Neurol Scand 2002; 105:282-8. [PMID: 11939940 DOI: 10.1034/j.1600-0404.2002.1o170.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To describe the influence of the site of the bleeding on clinical spectrum and early outcome of patients with acute spontaneous intracerebral hemorrhage (ICH). MATERIALS AND METHODS ICH was diagnosed in 229 (11%) of 2000 consecutive stroke patients included in a prospective stroke registry over a 10-year period. Frequency of demographic variables, risk factors, clinical events, neuroimaging data, and early outcome (until hospital discharge) according to different sites of bleeding was assessed. Each topography of the bleeding (independent variable) was compared with the remaining ICH cases by means of logistic regression analysis. RESULTS In the multivariate analysis, sensory deficit was significantly associated with ICH in the thalamus; lacunar syndrome and hypertension with ICH in the internal capsule-basal ganglia; seizures, non-sudden stroke onset, and hypertension with lobar ICH; ataxia and sensory deficit with ICH in the cerebellum; cranial nerve palsy with ICH in the brainstem; and limb weakness, diabetes, and altered consciousness with multiple topographic involvement. The overall in-hospital mortality rate was 31%, but this varied from 65% for multiple topographic involvement, 44% for intraventricular ICH, and 40% for ICH in the brainstem to 16% for ICH in the internal capsule-basal ganglia. CONCLUSION These data show the heterogeneous clinical profile of ICH, but they also suggest a difference in the clinical spectrum and in-hospital mortality according to the site of bleeding.
Collapse
Affiliation(s)
- A Arboix
- Acute Stroke Unit, Department of Neurology, Hospital del Sagrat Cor, Barcelona, Spain.
| | | | | | | | | | | | | |
Collapse
|
50
|
Affiliation(s)
- A I Qureshi
- Department of Neurology, Johns Hopkins Hospital, Baltimore, USA.
| | | | | | | | | | | |
Collapse
|