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Gordillo-Resina M, Aranda-Martinez C, Arias-Verdú MD, Guerrero-López F, Castillo-Lorente E, Rodríguez-Rubio D, Rivera-López R, Rosa-Garrido C, Gómez-Jiménez FJ, Lafuente-Baraza J, Aguilar-Alonso E, Arráez-Sánchez MA, Rivera-Fernández R. Mortality, Functional Status, and Quality of Life after 5 Years of Patients Admitted to Critical Care for Spontaneous Intracerebral Hemorrhage. Neurocrit Care 2024:10.1007/s12028-024-01960-0. [PMID: 38589693 DOI: 10.1007/s12028-024-01960-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/13/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The objective of this study was to assess long-term outcome in patients with spontaneous intracerebral hemorrhage admitted to the intensive care unit. METHODS Mortality and Glasgow Outcome Scale, Barthel Index, and 5-level EQ-5D version (EQ-5D-5L) scores were analyzed in a multicenter cohort study of three Spanish hospitals (336 patients). Mortality was also analyzed in the Medical Information Mart for Intensive Care III (MIMIC-III) database. RESULTS The median (25th percentile-75th percentile) age was 62 (50-70) years, the median Glasgow Coma Score was 7 (4-11) points, and the median Acute Physiology and Chronic Health disease Classification System II (APACHE-II) score was 21 (15-26) points. Hospital mortality was 54.17%, mortality at 90 days was 56%, mortality at 1 year was 59.2%, and mortality at 5 years was 66.4%. In the Glasgow Outcome Scale, a normal or disabled self-sufficient situation was recorded in 21.5% of patients at 6 months, in 25.5% of patients after 1 year, and in 22.1% of patients after 5 years of follow-up (4.5% missing). The Barthel Index score of survivors improved over time: 50 (25-80) points at 6 months, 70 (35-95) points at 1 year, and 90 (40-100) points at 5 years (p < 0.001). Quality of life evaluated with the EQ-5D-5L at 1 year and 5 years indicated that greater than 50% of patients had no problems or slight problems in all items (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). In the MIMIC-III study (N = 1354), hospital mortality was 31.83% and was 40.5% at 90 days and 56.2% after 5 years. CONCLUSIONS In patients admitted to the intensive care unit with a diagnosis of nontraumatic intracerebral hemorrhage, hospital mortality up to 90 days after admission is very high. Between 90 days and 5 years after admission, mortality is not high. A large percentage of survivors presented a significant deficit in quality of life and functional status, although with progressive improvement over time. Five years after the hemorrhagic stroke, a survival of 30% was observed, with a good functional status seen in 20% of patients who had been admitted to the hospital.
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Affiliation(s)
| | | | | | | | | | | | - Ricardo Rivera-López
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Carmen Rosa-Garrido
- Biosanitary Research Foundation in Eastern Andalusia, Alejandro Otero, Hospital Universitario de Jaén, Jaén, Spain
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Foschi M, D’Anna L, Gabriele C, Conversi F, Gabriele F, De Santis F, Orlandi B, De Santis F, Ornello R, Sacco S. Sex Differences in the Epidemiology of Intracerebral Hemorrhage Over 10 Years in a Population-Based Stroke Registry. J Am Heart Assoc 2024; 13:e032595. [PMID: 38410943 PMCID: PMC10944030 DOI: 10.1161/jaha.123.032595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/14/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND We investigated incidence and outcome of spontaneous intracerebral hemorrhage (ICH) in a population-based stroke registry and provided data to inform on the figures of the disease in women and in men. METHODS AND RESULTS Our prospective population-based registry included patients with first-ever ICH occurring from January 2011 to December 2020. Incidence rates were standardized to the 2011 Italian and European population, and incidence rate ratios were calculated. Multivariate hazard ratios for 30-day and 1-year fatality were estimated with Cox regression, including components of the ICH score and sex. We included 748 first-ever ICHs (41.3% women). Women were significantly older than men at ICH onset (78.9±12.6 versus 73.2±13.6 years; P<0.001) and showed higher clinical severity on presentation (median National Institutes of Health Stroke Scale score, 11 [interquartile range, 6-20] versus 9 [interquartile range, 4-15], respectively; P=0.016). The crude annual incidence rate was 20.2 (95% CI, 18.0-22.6) per 100 000 person-years in women and 30.2 (95% CI, 27.4-33.2) per 100 000 person-years in men); incidence was lower in women versus men (incidence rate ratio, 0.67 [95% CI, 0.58-0.78]; P<0.001) and did not change over time in both sexes (P for trend=0.073 and 0.904, respectively). Unadjusted comparison showed higher 1-year case-fatality rates in women versus men (48.5% versus 40.1%; P=0.026). After adjusting for components of the ICH score, female sex lost significance as a predictor of mortality. CONCLUSIONS We found lower ICH incidence in women than in men. However, women showed a higher 1-year case-fatality rate versus men, which was likely related to older age at ICH onset and higher clinical severity. Identification of factors explaining the reported differences is important to develop targeted interventions.
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Affiliation(s)
- Matteo Foschi
- Department of Biotechnological and Applied Clinical SciencesUniversity of L’AquilaL’AquilaItaly
| | - Lucio D’Anna
- Department of Stroke and Neuroscience, Charing Cross HospitalImperial College London National Health Service Healthcare TrustLondonUK
- Department of Brain SciencesImperial College LondonLondonUK
| | - Claudia Gabriele
- Department of Life, Health and Environmental SciencesUniversity of L’AquilaL’AquilaItaly
| | - Francesco Conversi
- Department of Biotechnological and Applied Clinical SciencesUniversity of L’AquilaL’AquilaItaly
| | - Francesca Gabriele
- Department of Biotechnological and Applied Clinical SciencesUniversity of L’AquilaL’AquilaItaly
| | - Federica De Santis
- Department of Neurology and Stroke Unit of Avezzano‐SulmonaL’AquilaItaly
| | - Berardino Orlandi
- Department of Neurology and Stroke Unit of Avezzano‐SulmonaL’AquilaItaly
| | - Federico De Santis
- Department of Biotechnological and Applied Clinical SciencesUniversity of L’AquilaL’AquilaItaly
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical SciencesUniversity of L’AquilaL’AquilaItaly
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical SciencesUniversity of L’AquilaL’AquilaItaly
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Gu C, Haldrup M, Rasmussen M, Dyrskog S, Simonsen CZ, Grønhøj MH, Poulsen FR, Busse T, Wismann J, Debrabant B, Korshoej AR. Descriptive registry study on outcome and complications of external ventricular drainage treatment of intraventricular haemorrhage in a Danish cohort: a study protocol. BMJ Open 2024; 14:e075997. [PMID: 38238178 PMCID: PMC10806758 DOI: 10.1136/bmjopen-2023-075997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION Intraventricular haemorrhage (IVH) is associated with high morbidity and mortality. External ventricular drainage (EVD) has been shown to decrease mortality. Although EVD is widely used, outcome and complication rates in EVD-treated patients with IVH are not fully elucidated. This study aims to describe EVD complication rates and outcomes in patients with primary and secondary IVH at two university hospitals in Denmark. The study will provide a historical reference of relevant endpoints for use in future clinical trials involving patients with IVH. METHODS AND ANALYSIS This descriptive, multicentre registry study included adult patients (age 18+) with primary or secondary IVH and treated with at least one EVD between 2017 and 2021 at Aarhus University Hospital or Odense University Hospital. Patients are identified using the Danish National Patient Register. Data are collected and recorded from patient medical records. Relevant descriptive statistics and correlation analyses will be applied. ETHICS AND DISSEMINATION Ethical approval and authorisation to access, store and analyse data have been obtained (Central Denmark Region Committee on Health Research Ethics). The research lead will present the results of the study. Data will be reported according to the Strengthening the Reporting of Observational Studies in Epidemiology and results submitted for publication in peer-reviewed journals.
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Affiliation(s)
- Chenghao Gu
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Haldrup
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Mads Rasmussen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark
| | - Stig Dyrskog
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Ziegler Simonsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Mads Hjortdal Grønhøj
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Thor Busse
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
| | - Joakim Wismann
- Department of Neurosurgery, Odense University Hospital, Odense, Denmark
| | - Birgit Debrabant
- Department of Mathematics and Computer Science, University of Southern Denmark, Odense, Denmark
| | - Anders Rosendal Korshoej
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Puppala GK, Gorthi SP, Chandran V, Gandeti R, Rao SS. Prevalence of Cognitive Impairment and Dementia After Intracerebral Hemorrhage. Ann Indian Acad Neurol 2023; 26:952-957. [PMID: 38229634 PMCID: PMC10789433 DOI: 10.4103/aian.aian_731_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 01/18/2024] Open
Abstract
Objective To study the prevalence of cognitive impairment in survivors of intracerebral hemorrhage (ICH). Methods Survivors of spontaneous ICH were followed up in the neurology outpatient department when they reported for follow-up after 6 months. Neuroimaging records at the onset and at follow-up visits are studied for the location of ICH, volume of ICH, intraventricular extension, and hydrocephalus. The volume of ICH is calculated by ABC/2 method on a CT scan. All patients underwent cognitive assessment with Addenbrooke's cognitive examination ACE III and were categorized as patients having cognitive impairment (or) no cognitive impairment. Results A total of 120 patients were studied, out of which 77 (64%) are males and 43 (36%) are females with age groups ranging from 26 to 75 years. In the study population, the mean age was found to be 62.3 years. Specifically, the mean age for males was 56.9 years, while for females it was 63.4 years. Cognitive impairment was noted in 34 of 120 patients (28%) during 6 to 12 months of examination, of which 11 of 19 were in lobar location, 21 of 94 were in sub-cortical location, and 2 of 7 were in infratentorial location. Conclusion It was found that 28% of survivors of ICH were cognitively impaired. Hence, it is essential to assess cognition in post-ICH patients during follow-up, so that suitable adjustments can be made in their employment, and also in educating family members in providing a good quality of life.
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Affiliation(s)
- Goutham Kumar Puppala
- D.M Neurology Assistant Professor of Neurology, Kakatiya Medical College, Warangal, Telangana, India
| | - Sankar Prasad Gorthi
- D.M Neurology Professor and HOD of Neurology, Bhartiya Vidya Peet, Pune, Maharashtra, India
| | - Vijay Chandran
- D.M Neurology Associate Professor of Neurology, Kasturba Medical College, Manipal, Udupi, Karnataka, India
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Wang S, Zou XL, Wu LX, Zhou HF, Xiao L, Yao T, Zhang Y, Ma J, Zeng Y, Zhang L. Epidemiology of intracerebral hemorrhage: A systematic review and meta-analysis. Front Neurol 2022; 13:915813. [PMID: 36188383 PMCID: PMC9523083 DOI: 10.3389/fneur.2022.915813] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 08/16/2022] [Indexed: 12/03/2022] Open
Abstract
Background Intracerebral hemorrhage (ICH) is associated with high mortality and disability rates. This study aimed to investigate the relationship between sex, age, study year, risk factors, bleeding site, median year of study, and the incidence of ICH. Method Literature on the incidence of ICH published on 1 January 1980 and 1 January 2020, was systematically retrieved from PubMed and Embase databases. The random-effects model and subgroup analysis were used to explore the relationship between the incidence of ICH and different ages, sex, bleeding sites, and risk factors. Results We summarized the epidemiological changes in ICH in the past 40 years according to 52 studies and found that the total incidence of ICH is 29.9 per 100,000 person-years (95% CI: 26.5–33.3), which has not decreased worldwide. The incidence of ICH in the Asian population is much higher than in other continents. In addition, the incidence of ICH increases with age and differs at the 85-year-old boundary. Men are more likely to develop ICH than women, and the basal ganglia region is the most common area for ICH. Of the 10 risk factors examined in this study, those with hypertension had the highest incidence of ICH, followed by those with excessive alcohol consumption and heart disease. Conclusion The prevention and treatment of ICH still need to be improved continuously according to age, sex, risk factors, and other factors, and targeted and normative strategies should be gradually developed in the future.
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Affiliation(s)
- Sai Wang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xue-Lun Zou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Lian-Xu Wu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Hui-Fang Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Linxiao Xiao
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Tianxing Yao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yupeng Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Junyi Ma
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Zeng
- Department of Geriatrics, Second Xiangya Hospital, Central South University, Changsha, China
| | - Le Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Multi-Modal Monitoring Technology for Severe Cerebrovascular Disease of Human Engineering Research Center, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Le Zhang
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Gil-Garcia CA, Alvarez EF, Garcia RC, Mendoza-Lopez AC, Gonzalez-Hermosillo LM, Garcia-Blanco MDC, Valadez ER. Essential topics about the imaging diagnosis and treatment of Hemorrhagic Stroke: a comprehensive review of the 2022 AHA guidelines. Curr Probl Cardiol 2022; 47:101328. [PMID: 35870549 DOI: 10.1016/j.cpcardiol.2022.101328] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/17/2022] [Indexed: 11/03/2022]
Abstract
Intracerebral hemorrhage (ICH) is a severe stroke with a high death rate (40 % mortality). The prevalence of hemorrhagic stroke has increased globally, with changes in the underlying cause over time as anticoagulant use and hypertension treatment have improved. The fundamental etiology of ICH and the mechanisms of harm from ICH, particularly the complex interaction between edema, inflammation, and blood product toxicity, have been thoroughly revised by the American Heart Association (AHA) in 2022. Although numerous trials have investigated the best medicinal and surgical management of ICH, there is still no discernible improvement in survival and functional tests. Small vessel diseases, such as cerebral amyloid angiopathy (CAA) or deep perforator arteriopathy (hypertensive arteriopathy), are the most common causes of spontaneous non-traumatic intracerebral hemorrhage (ICH). Even though ICH only causes 10-15% of all strokes, it contributes significantly to morbidity and mortality, with few acute or preventive treatments proven effective. Current AHA guidelines acknowledge up to 89% sensitivity for unenhanced brain CT and 81% for brain MRI. The imaging findings of both methods are helpful for initial diagnosis and follow-up, sometimes necessary a few hours after admission, especially for detecting hemorrhagic transformation or hematoma expansion. This review summarized the essential topics on hemorrhagic stroke epidemiology, risk factors, physiopathology, mechanisms of injury, current management approaches, findings in neuroimaging, goals and outcomes, recommendations for lifestyle modifications, and future research directions ICH. A list of updated references is included for each topic.
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Affiliation(s)
| | | | | | | | | | | | - Ernesto-Roldan Valadez
- Directorado de investigación, Hospital General de Mexico "Dr. Eduardo Liceaga," 06720, CDMX, Mexico; I.M. Sechenov First Moscow State Medical University (Sechenov University), Department of Radiology, 119992, Moscow, Russia.
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Prognosis and futility in neurosurgical emergencies: A review. Clin Neurol Neurosurg 2020; 195:105851. [PMID: 32422469 DOI: 10.1016/j.clineuro.2020.105851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/10/2020] [Accepted: 04/11/2020] [Indexed: 11/22/2022]
Abstract
A patient with a life-threatening intracranial insult presents a difficult situation to the neurosurgeon. In a few short minutes the neurosurgeon must assess the patient's neurologic status, imaging, and medical condition then confer with the patient's proxy regarding treatment. This assessment ideally includes recognition of situations where aggressive care is futile and therefore such treatments should not be offered. The proxy discussion must involve surgical and nonsurgical management options and the impact of these options on survival and residual disability. Surgical decision-making is frequently difficult, even for designated proxies armed with advance directives, as these documents are usually vague with regard to acceptable functional outcomes. To complicate things further, when emergencies are off-hours, housestaff or physician extenders may need to represent the medical team in these discussions so that surgical treatment, if desired, can be arranged expeditiously. These difficulties sometimes lead to the performance of emergent surgical procedures in situations where poor outcome is certain, with deleterious effects to the patient, family, and healthcare system. It is clear then that neurosurgeons as well as their housestaff and extenders should have working knowledge of prognostic information relating to intracranial insults and familiarity with the complex ethical concept of medical futility. In this paper we review the relevant literature and our goal is to juxtapose these topics so as to provide a framework for decision making in that critical time.
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Bryndziar T, Sedova P, Brown RD, Fiserova E, Zvolsky M, Bednarik J, Mikulik R. Trends in One Month and One Year Hemorrhagic Stroke Case Fatality Rates in the Czech Republic between 1998 and 2015. J Stroke Cerebrovasc Dis 2020; 29:104762. [PMID: 32268973 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This retrospective cross-sectional study reports 1 month and 1 year intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) case fatality rates and their temporal trends in the Czech Republic between 1998 and 2015. METHODS Utilizing the National Register of Hospitalized Patients, we randomly selected 600 patients hospitalized for ICH and 600 patients hospitalized for SAH for each year from 1998 to 2015, and identified those who died, regardless of cause, using the Czech National Mortality Registry. We calculated crude and age-adjusted 1 month and 1 year case fatality rates for ICH and SAH. Long-term trends of the crude rates were analyzed using a one-sided Cochran Armitage test. RESULTS A total of 21,600 cases hospitalized for SAH and ICH (10,800 for each) between 1998 and 2015 were randomly selected for analysis. One month case fatality of SAH overall and in women has decreased by 0.2% (P = .006) and 0.3% per year (P = .04), respectively. Overall 1 year case fatality of SAH has decreased by 0.2% per year (P = .03). One month case fatality rate of ICH overall and in men has decreased by 0.2% (p=0.01) and 0.4% (P = .0007), respectively. One year case fatality of ICH in men has decreased by 0.2% per year (P = .047). CONCLUSIONS One month and 1 year case fatality rates for SAH and ICH have been decreasing in the Czech Republic between 1998 and 2015, and are similar or lower than those reported from other developed European countries.
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Affiliation(s)
- Tomas Bryndziar
- Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petra Sedova
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic; Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czech Republic; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert D Brown
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eva Fiserova
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Department of Mathematical Analysis and Applications of Mathematics, Faculty of Science, Palacky University Olomouc, Olomouc, Czech Republic
| | - Miroslav Zvolsky
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Josef Bednarik
- Department of Neurology, University Hospital Brno, Brno, Czech Republic
| | - Robert Mikulik
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Neurology, St. Anne's University Hospital, Brno, Czech Republic.
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Nzwalo H, Félix C, Nogueira J, Guilherme P, Ferreira F, Salero T, Ramalhete S, Martinez J, Mouzinho M, Marreiros A, Thomassen L, Logallo N. Predictors of long-term survival after spontaneous intracerebral hemorrhage in southern Portugal: A retrospective study of a community representative population. J Neurol Sci 2018; 394:122-126. [PMID: 30248570 DOI: 10.1016/j.jns.2018.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Hipólito Nzwalo
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal.
| | - Catarina Félix
- Neurology Department, Centro Hospitalar Universitário do Algarve, Algarve, Portugal
| | - Jerina Nogueira
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
| | - Patrícia Guilherme
- Neurology Department, Centro Hospitalar Universitário do Algarve, Algarve, Portugal
| | - Fátima Ferreira
- Neurology Department, Centro Hospitalar Universitário do Algarve, Algarve, Portugal
| | - Teresa Salero
- Department of Internal Medicine, Centro Hospitalar Universitário do Algarve, Algarve, Portugal
| | - Sara Ramalhete
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
| | - Joana Martinez
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
| | - Maria Mouzinho
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal
| | - Ana Marreiros
- Department of Biomedical Sciences and Medicine, University of Algarve, Faro, Portugal; Algarve Biomedical Center, Algarve, Portugal
| | - Lars Thomassen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Center for Neurovascular Diseases, Haukeland University Hospital, Bergen, Norway
| | - Nicola Logallo
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Center for Neurovascular Diseases, Haukeland University Hospital, Bergen, Norway; Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
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Lee L, Lo YT, See AAQ, Hsieh PJ, James ML, King NKK. Long-term recovery profile of patients with severe disability or in vegetative states following severe primary intracerebral hemorrhage. J Crit Care 2018; 48:269-275. [PMID: 30248648 DOI: 10.1016/j.jcrc.2018.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 09/09/2018] [Accepted: 09/10/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE We conducted a single-center retrospective review to investigate the long-term recovery of patients who were severely disabled or vegetative secondary to primary intracerebral hemorrhage upon discharge from hospital from January 2009 to November 2013. METHODS Patients were categorized into two groups based on their Glasgow outcome scale (GOS) scores at discharge, namely vegetative state (GOS 2; n = 91) and severely disabled (GOS 3; n = 278). Long-term outcomes at three years post discharge were defined as death, stable, deterioration and improvement from discharge to follow-up. RESULTS Lower mortality (29% versus 69%) and higher neurological improvement rates at three years (33% versus 10%) were observed in the SD compared to VS group (both p = .0001). Age was a significant predictor of survival in the VS group (p = .03) and the SD group (p = .012). Age was also the only predictor of neurological improvement in the SD group (p = .01). CONCLUSIONS Neurological status at discharge from hospital was not truly indicative of long-term prognosis for patients who were severely disabled or vegetative. Patients in both groups can potentially improve in the long term and may benefit from prolonged rehabilitation programmes to maximize their recovery potential.
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Affiliation(s)
- Lester Lee
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Department of Neurosurgery, Singapore General Hospital, Singapore
| | - Yu Tung Lo
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Department of Neurosurgery, Singapore General Hospital, Singapore
| | - Angela An Qi See
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Department of Neurosurgery, Singapore General Hospital, Singapore
| | - Po-Jang Hsieh
- Neuroscience and Behavioral Disorders Program, Duke-NUS Medical School, Singapore
| | - Michael Lucas James
- Departments of Anesthesiology and Neurology, Duke University, Durham, NC, United States
| | - Nicolas Kon Kam King
- Department of Neurosurgery, National Neuroscience Institute, Singapore; Duke-NUS Medical School, Singapore; Department of Neurosurgery, Singapore General Hospital, Singapore.
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Béjot Y, Blanc C, Delpont B, Thouant P, Chazalon C, Daumas A, Osseby GV, Hervieu-Bègue M, Ricolfi F, Giroud M, Cordonnier C. Increasing early ambulation disability in spontaneous intracerebral hemorrhage survivors. Neurology 2018; 90:e2017-e2024. [DOI: 10.1212/wnl.0000000000005633] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 03/09/2018] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo evaluate temporal trends in early ambulatory status in patients with spontaneous intracerebral hemorrhage (ICH).MethodsAll patients with ICH between 1985 and 2011 were prospectively registered in a population-based registry in Dijon, France, and included in the study. Outcomes of ICH survivors were assessed at discharge from their stay in an acute care ward with the use of a 4-grade ambulation scale. Time trends in ambulation disability and place of discharge were analyzed in 3 periods (1985–1993, 1994–2002, and 2003–2011). Multivariable ordinal and logistic regression models were applied.ResultsFive hundred thirty-one patients with ICH were registered, of whom 200 (37.7%) died in the acute care ward. While the proportion of deaths decreased over time, that of patients with ambulation disability increased (odds ratio [OR] 1.67, 95% confidence interval [CI] 0.87–3.23, p = 0.124 for 1994–2002; and OR 1.97, 95% CI, 1.08–3.60, p = 0.027 for 2003–2011 vs 1985–1993 in ordinal logistic regression). The proportion of patients dependent in walking rose (OR 2.11, 95% CI 1.16–3.82, p = 0.014 for 1994–2002; and OR 2.73; 95% CI 1.54–4.84, p = 0.001 for 2003–2011), and the proportion of patients discharged to home decreased (OR 0.49, 95% CI 0.24–0.99, p = 0.048 for 1994–2002; and OR 0.32, 95% CI 0.16–0.64, p = 0.001 for 2003–2011).ConclusionThe decrease in in-hospital mortality of patients with ICH translated into a rising proportion of patients with ambulation disability at discharge. A lower proportion of patients returned home. These results have major implications for the organization of postacute ICH care.
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Zhao LR, Willing A. Enhancing endogenous capacity to repair a stroke-damaged brain: An evolving field for stroke research. Prog Neurobiol 2018; 163-164:5-26. [PMID: 29476785 PMCID: PMC6075953 DOI: 10.1016/j.pneurobio.2018.01.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 01/11/2018] [Accepted: 01/30/2018] [Indexed: 02/07/2023]
Abstract
Stroke represents a severe medical condition that causes stroke survivors to suffer from long-term and even lifelong disability. Over the past several decades, a vast majority of stroke research targets neuroprotection in the acute phase, while little work has been done to enhance stroke recovery at the later stage. Through reviewing current understanding of brain plasticity, stroke pathology, and emerging preclinical and clinical restorative approaches, this review aims to provide new insights to advance the research field for stroke recovery. Lifelong brain plasticity offers the long-lasting possibility to repair a stroke-damaged brain. Stroke impairs the structural and functional integrity of entire brain networks; the restorative approaches containing multi-components have great potential to maximize stroke recovery by rebuilding and normalizing the stroke-disrupted entire brain networks and brain functioning. The restorative window for stroke recovery is much longer than previously thought. The optimal time for brain repair appears to be at later stage of stroke rather than the earlier stage. It is expected that these new insights will advance our understanding of stroke recovery and assist in developing the next generation of restorative approaches for enhancing brain repair after stroke.
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Affiliation(s)
- Li-Ru Zhao
- Department of Neurosurgery, State University of New York, Upstate Medical University, Syracuse, NY, 13210, USA.
| | - Alison Willing
- Center for Excellence in Aging and Brain Repair, Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, FL, 33612, USA.
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Liu JC, Wang TJ, Sung LC, Kao PF, Yang TY, Hao WR, Chen CC, Hsu YP, Wu SY. Influenza vaccination reduces hemorrhagic stroke risk in patients with atrial fibrillation: A population-based cohort study. Int J Cardiol 2017; 232:315-323. [PMID: 28089151 DOI: 10.1016/j.ijcard.2016.12.074] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/27/2016] [Accepted: 12/16/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE The risk of hemorrhagic stroke in patients with atrial fibrillation (AF) is low but the consequences of its occurrence are extremely severe. In this study, we investigated the association of influenza vaccination with the risk of hemorrhagic stroke to develop an efficient strategy for reducing this risk in patients with AF. METHODS In this study, data were retrieved from the Taiwan National Health Insurance Research Database. The study cohort comprised all patients who received a diagnosis of AF (n=14,454) before January 1, 2005 (index date) and were followed until December 31, 2012. Propensity scores were calculated using a logistic regression model to determine the effects of vaccination by accounting for covariates that predict receiving the intervention (vaccine). A time-dependent Cox proportional hazard model was used to calculate the hazard ratios (HRs) for hemorrhagic stroke in vaccinated and unvaccinated patients with AF. RESULTS The study population comprised 6570 patients who did (2547 [38.77%]) and did not receive (4023 [61.23%]) influenza vaccination. The adjusted HRs (aHRs) for hemorrhagic stroke were lower in the vaccinated patients than in the unvaccinated patients (influenza season, noninfluenza season, and all seasons: aHRs=0.97 [0.59-1.60], 0.51 [0.30-0.87], and 0.72 [0.50-1.03], respectively). CONCLUSIONS Influenza vaccination exerts dose-response and synergistic protective effects against hemorrhagic stroke in patients with AF who have a high risk of hemorrhagic stroke (i.e., male sex, age≥75years, Charlson comorbidity index ≥3, and hypertension) and reduces the incidence of hemorrhagic stroke.
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Affiliation(s)
- Ju-Chi Liu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ta-Jung Wang
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Li-Chin Sung
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Pai-Feng Kao
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tsung-Yeh Yang
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Wen-Rui Hao
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chun-Chao Chen
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yi-Ping Hsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Szu-Yuan Wu
- Institute of Toxicology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Biotechnology, Hungkuang University, Taichung, Taiwan.
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Asadollahi S, Vafaei A, Heidari K. CT imaging for long-term functional outcome after spontaneous intracerebral haemorrhage: A 3-year follow-up study. Brain Inj 2016; 30:1626-1634. [DOI: 10.1080/02699052.2016.1199909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Shadi Asadollahi
- School of Medicine
- Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Vafaei
- Department of Emergency Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamran Heidari
- Department of Emergency Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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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.
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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
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Abstract
About half of patients survive intracerebral hemorrhage (ICH), but most are left with significant disability. Rehabilitation after ICH is the mainstay of treatment to reduce impairment, improve independence in activities, and return patients to meaningful participation in the community. The authors discuss the neuroplastic mechanisms underlying recovery in ICH, preclinical and clinical interventional studies to augment recovery, and the rehabilitative and medical management of post-ICH patients.
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Affiliation(s)
- Michael F Saulle
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York
| | - Heidi M Schambra
- Department of Rehabilitation and Regenerative Medicine, Columbia University, New York, New York
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Xiong L, Reijmer YD, Charidimou A, Cordonnier C, Viswanathan A. Intracerebral hemorrhage and cognitive impairment. Biochim Biophys Acta Mol Basis Dis 2015; 1862:939-44. [PMID: 26692171 DOI: 10.1016/j.bbadis.2015.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 11/05/2015] [Accepted: 12/10/2015] [Indexed: 02/01/2023]
Abstract
Vascular cognitive impairment and vascular dementia are composed of cognitive deficits resulted from a range of vascular lesions and pathologies, including both ischemic and hemorrhagic. However the contribution of spontaneous intracerebral hemorrhage presumed due to small vessel diseases on cognitive impairment is underestimated, in contrast to the numerous studies about the role of ischemic vascular disorders on cognition. In this review we summarize recent findings from clinical studies and appropriate basic science research to better elucidate the role and possible mechanisms of intracerebral hemorrhage in cognitive impairment and dementia. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock.
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Affiliation(s)
- Li Xiong
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Neurology Department, Zhongnan Hospital, Wuhan University, Wuhan 430071, China.
| | - Yael D Reijmer
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Andreas Charidimou
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
| | - Charlotte Cordonnier
- Department of Neurology and Stroke Unit, Hôpital Roger Salengro, Lille University Hospital, Lille Cedex 59037, France.
| | - Anand Viswanathan
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Tseng CH, Muo CH, Hsu CY, Kao CH. Increased Risk of Intracerebral Hemorrhage Among Patients With Hepatitis C Virus Infection. Medicine (Baltimore) 2015; 94:e2132. [PMID: 26579831 PMCID: PMC4652840 DOI: 10.1097/md.0000000000002132] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
This research explored whether hepatitis C virus (HCV) infection leads to the development of intracerebral hemorrhage (ICH).Using Taiwan National Health Insurance claims data, 9023 patients newly diagnosed with HCV infection between 2000 and 2010 were identified, and 36,092 age- and sex-frequency-matched patients without HCV infection were selected randomly as the control group. The risk of ICH for patients with HCV infection and comorbidities of diabetes, hypertension, ischemic heart disease, hyperlipidemia, atrial fibrillation, alcoholic liver disorder, and head injury was evaluated at the end of 2011.The risk of ICH was higher in the HCV cohort than in the control group, with an adjusted hazard ratio (aHR) of 1.60 (95% confidence interval [CI]: 1.24-2.06), estimated using a multivariate Cox regression model. Age-specific analysis revealed that the risk of ICH in the HCV patients was higher in the younger groups, with aHRs of 1.92 (95% CI: 1.18-3.11) and 2.45 (95% CI: 1.52-3.98) in the ≤55 and 56 to 64 years age groups, respectively. The risk of ICH increased with the severity of HCV infection, from an aHR of 1.66 (95% CI: 1.21-2.30) in mild HCV patients to 2.12 (95% CI: 1.47-3.06) in severe HCV patients. For patients without comorbidities, the risk of ICH was 2.33 (95% CI: 1.36-3.98) higher in the HCV cohort than in the control group.We found that HCV infection is associated with an increased risk to develop ICH, particularly in the patients with relatively younger ages.
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Affiliation(s)
- Chun-Hung Tseng
- From the Department of Neurology (C-HT, CYH), China Medical University Hospital; School of Medicine (C-HT, C-HM), China Medical University College of Medicine; Management Office for Health Data (C-HM), China Medical University Hospital; Graduate Institute of Clinical Medical Science and School of Medicine (CYH, C-HK), College of Medicine, China Medical University; and Department of Nuclear Medicine and PET Center (C-HK), China Medical University Hospital, Taichung, Taiwan
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Camacho E, LoPresti MA, Bruce S, Lin D, Abraham M, Appelboom G, Taylor B, McDowell M, DuBois B, Sathe M, Sander Connolly E. The role of age in intracerebral hemorrhages. J Clin Neurosci 2015; 22:1867-70. [PMID: 26375325 DOI: 10.1016/j.jocn.2015.04.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 03/06/2015] [Accepted: 04/11/2015] [Indexed: 11/30/2022]
Abstract
We aimed to identify the role of age in intracerebral hemorrhage (ICH), as well as characterize the most commonly used age cut off points in the literature, with the hope of understanding and guiding treatment. Strokes are one of the leading causes of death in the USA, and ICH is the deadliest type. Age is a strong risk factor, but it also affects the body in numerous ways, including changes to the cardiovascular and central nervous systems that interplay with the multiple risk factors for ICH. Understanding the role of age in risk and outcomes of ICH can guide treatment and future clinical trials. A current review of the literature suggests that the age cut offs for increased rates of mortality and morbidity vary from 60-80 years of age, with the most common age cut offs being at 65 or 70 years of age. In addition to age as a determinant of ICH outcomes, age has its own effects on the maturing body in terms of changes in physiology, while also increasing the risk of multiple chronic health conditions and comorbidities, including hypertension, diabetes, and anticoagulant treatment for atrial fibrillation, all of which contribute to the pathology of ICH. The interaction of these chronic conditions, changes in physiology, age, and ICH is evident. However, the exact mechanism and extent of the impacts remains unclear. The ambiguity of these connections may be further obscured by individual patient preferences, and there are limitations in the literature which guides the current recommendations for aging patients.
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Affiliation(s)
- Elvis Camacho
- Department of Neurological Surgery, Cerebrovascular Laboratory, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Melissa A LoPresti
- Department of Neurological Surgery, Cerebrovascular Laboratory, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Sam Bruce
- Department of Neurological Surgery, Cerebrovascular Laboratory, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Derek Lin
- Department of Neurological Surgery, Cerebrovascular Laboratory, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Mickey Abraham
- Department of Neurological Surgery, Cerebrovascular Laboratory, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Geoff Appelboom
- Department of Neurological Surgery, Cerebrovascular Laboratory, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA.
| | - Blake Taylor
- Department of Neurological Surgery, Cerebrovascular Laboratory, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Michael McDowell
- Department of Neurological Surgery, Cerebrovascular Laboratory, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Byron DuBois
- Department of Neurological Surgery, Cerebrovascular Laboratory, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Mihika Sathe
- Department of Neurological Surgery, Cerebrovascular Laboratory, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - E Sander Connolly
- Department of Neurological Surgery, Cerebrovascular Laboratory, Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
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Gokhale S, Caplan LR, James ML. Sex Differences in Incidence, Pathophysiology, and Outcome of Primary Intracerebral Hemorrhage. Stroke 2015; 46:886-92. [DOI: 10.1161/strokeaha.114.007682] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sankalp Gokhale
- From the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (S.G.); Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); and Departments of Neurology and Anesthesiology, Duke University, Durham, NC (M.L.J.)
| | - Louis R. Caplan
- From the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (S.G.); Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); and Departments of Neurology and Anesthesiology, Duke University, Durham, NC (M.L.J.)
| | - Michael L. James
- From the Department of Neurology, University of Texas Southwestern Medical Center, Dallas (S.G.); Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA (L.R.C.); and Departments of Neurology and Anesthesiology, Duke University, Durham, NC (M.L.J.)
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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]
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Tveiten A, Ljøstad U, Mygland Å, Naess H. Functioning of long-term survivors of first-ever intracerebral hemorrhage. Acta Neurol Scand 2014; 129:269-75. [PMID: 24444381 DOI: 10.1111/ane.12185] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVES There are few data on long-term functional outcome after intracerebral hemorrhage (ICH). We aimed to assess functional dependency and cognitive impairment in long-term survivors of first-ever intracerebral hemorrhage. MATERIALS AND METHODS Between August and November 2011, we contacted all survivors from a cohort of 134 consecutive patients hospitalized with a first-ever ICH in the period 2005-2009 in a well-defined catchment area. We did an extensive face-to-face follow-up including the National Institute of Health Stroke Scale (NIHSS), the modified Rankin Scale (mRS), the Barthel Index (BI), and the Montreal Cognitive Assessment (MoCA). RESULTS Fifty-one patients (38%) were alive. Fifty agreed to take part in the follow-up. The median follow-up time was 3.8 years. Thirty-four patients (68%) were independent (mRS 0-2) and 16 (32%) dependent (mRS 3-5). Factors independently associated with dependency were leukoaraiosis score (OR 2.3 per increasing point, P = 0.003) and female sex (OR 5.1, P = 0.038). Twenty-seven patients (61%) had cognitive impairment (MoCA ≤ 23). Factors independently associated with cognitive impairment were age (OR 2.4 per 10 years, P = 0.010) and lobar ICH location (OR 14.1, P = 0.016). CONCLUSIONS A large proportion of long-term survivors of ICH in Southern Norway live functionally independent lives in their private homes. Dependency is linked to leukoaraiosis and female sex. Cognitive impairment is common and linked to lobar location of ICH.
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Affiliation(s)
- A. Tveiten
- Department of Neurology; Sørlandet Hospital Kristiansand; Kristiansand Norway
| | - U. Ljøstad
- Department of Neurology; Sørlandet Hospital Kristiansand; Kristiansand Norway
- Department of Clinical Medicine; University of Bergen; Bergen Norway
| | - Å. Mygland
- Department of Neurology; Sørlandet Hospital Kristiansand; Kristiansand Norway
- Department of Clinical Medicine; University of Bergen; Bergen Norway
- Department of Habilitation; Sørlandet Hospital Kristiansand; Kristiansand Norway
| | - H. Naess
- Department of Clinical Medicine; University of Bergen; Bergen Norway
- Department of Neurology; Bergen University Hospital; Bergen Norway
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Park CH, Kim YS. Effects of Salviae Miltiorrhizae Radix on Blood-Brain Barrier Impairment of ICH-Induced Rats. ACTA ACUST UNITED AC 2014. [DOI: 10.6116/kjh.2014.29.1.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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.
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Affiliation(s)
- Seiji Gotoh
- Department of Environmental Medicine, Graduate School of Medical Sciences, Kyushu University
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The Impact of Left Ventricular Hypertrophy and Diastolic Dysfunction on Outcome in Intracerebral Hemorrhage Patients. ACTA ACUST UNITED AC 2013; 2013. [PMID: 24416619 PMCID: PMC3886815 DOI: 10.1155/2013/898163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background The objective of this study was to determine the prevalence of LVH and DD in patients presenting with supratentorial deep ICH and to determine if the presence of LVH or DD was an independent predictor of initial ICH volume, hematoma expansion, or poor outcome. Methods A cross-sectional study was performed on ICH patients who presented from 7/2008 to 12/2010. Cases were excluded if ICH was traumatic, lobar, infratentorial, secondary to elevated international normalized ratio, suspicious for underlying structural malformation, or where surgical evacuation was performed. Logistic and linear regressions were used to assess the ability of LVH to predict ICH imaging characteristics and patient outcomes. Results After adjusting for use of hemostatic agents, LVH was not a significant independent predictor of initial ICH volume (P = 0.344) or 33% volume expansion (P = 0.378). After adjusting for age, infectious complications, and use of hemostatic agents, LVH was not a significant independent predictor of poor functional outcome (P = 0.778). Similar results were seen for DD. Conclusion In our sample, patients with deep ICH and LVH were more likely to develop IVH, but LVH was not a significant independent predictor of initial ICH volume, hematoma expansion, or poor short-term outcome.
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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.
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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.
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Herweh C, Prager E, Sykora M, Bendszus M. Cerebral atrophy is an independent risk factor for unfavorable outcome after spontaneous supratentorial intracerebral hemorrhage. Stroke 2013; 44:968-71. [PMID: 23412376 DOI: 10.1161/strokeaha.111.670901] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To investigate the influence of cerebral atrophy on clinical outcome in patients with supratentorial intracerebral hemorrhage. METHODS Computed tomography scans of 320 patients included in a prospective, multicenter trial were used for a segmentation analysis to determine the supratentorial cerebral volume. A logistic regression analysis was used to explore its effect on outcome after 90 days in addition to other clinical and imaging parameters. RESULTS Cerebral volume loss significantly reduced the odds for favorable outcome after 90 days (odds ratio=0.91; confidence interval, 0.85-0.99; P=0.02). CONCLUSIONS Cerebral atrophy is an independent predictor of unfavorable outcome after intracerebral hemorrhage, indicating reduced functional recovery potential in these individuals.
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Affiliation(s)
- Christian Herweh
- Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany.
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Narayan SK, Sivaprasad P, Sushma S, Sahoo RK, Dutta TK. Etiology and outcome determinants of intracerebral hemorrhage in a south Indian population, A hospital-based study. Ann Indian Acad Neurol 2013; 15:263-6. [PMID: 23349590 PMCID: PMC3548363 DOI: 10.4103/0972-2327.104333] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 03/20/2012] [Accepted: 06/24/2012] [Indexed: 11/05/2022] Open
Abstract
Background: There is paucity of methodologically sound published studies on intracerebral hemorrhage (ICH) from India, on pub med/embase search. Aims: To explore etiology of ICH and correlate the causes, location, and size of hemorrhage to clinical outcome. Materials and Methods: A hospital-based descriptive study from South Indian eastern coastal town of Puducherry; 60 consecutive subjects aged > 12 years, predominantly of inbred Tamil population, with head CT evidence of intracerebral hemorrhage not associated with trauma and brain tumors, were recruited. Outcome at three months was measured using Glasgow Outcome scale, NIHSS and mortality. SPSS v 19 was used for statistical analysis. Results: Commonest etiological factor was hypertension, followed by bleeding diathesis, thrombolysis for myocardial infarction, and cortical vein thrombosis. Most frequent locations of hematoma were basal ganglia, thalamus, internal capsule, and cerebral and cerebellar parenchyma. Hematoma volume correlated significantly with systolic and mean arterial pressure but not with diastolic blood pressure. Poor outcome was correlated to size (P < 0.05) and intraventricular extension of hematoma (P < 0.05), and to systolic, diastolic and mean arterial pressure, but not to age, gender, smoking, alcoholism, ischemic heart disease, and blood sugar level. Among diabetic patients with ICH, the size of hematoma (P = 0.04) and severity of coma (P = 0.01) at admission were significantly worse compared to the non-diabetic, but not the outcome at three months [Glasgow outcome scale or mortality (P = 0.94 and 0.14)]. Conclusions: The location of hemorrhage and correlation with outcome agreed with the patterns described for the non-white races in prior reports. Independence of outcome to diabetic status despite a more severe initial presentation may indicate importance of good care, even in high risk groups.
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Affiliation(s)
- Sunil K Narayan
- Department of Neurology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Abstract
PURPOSE OF REVIEW : Limited data are available on the prevention of intracerebral hemorrhage (ICH) recurrence, which is substantial, especially in the case of lobar ICH related to cerebral amyloid angiopathy. In view of the relative paucity of prospectively generated data, current strategies for the secondary prevention of ICH involve the extrapolation of data on primary prevention of ICH to its secondary prevention and the avoidance of certain agents that have been shown in clinical series to be associated with increased risk of ICH recurrence. This review analyzes ways to approach the secondary prevention of ICH in the setting of a paucity of adequate prospectively generated data on the subject. RECENT FINDINGS : Risk factors for ICH recurrence identified through data extrapolation include hypertension, diabetes, excessive alcohol consumption, cigarette smoking, and probably migraine with aura. Agents associated with increased risk of ICH recurrence include warfarin, antiplatelet agents, statins, and vitamin E. SUMMARY : This article reviews the prevention of ICH recurrence based on extrapolating data from primary prevention of ICH along with the clinically appropriate strategy of avoiding the use of agents that have been shown to carry an increased risk of ICH recurrence.
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Maslehaty H, Petridis AK, Barth H, Doukas A, Mehdorn HM. Treatment of 817 patients with spontaneous supratentorial intracerebral hemorrhage: characteristics, predictive factors and outcome. Clin Pract 2012; 2:e56. [PMID: 24765455 PMCID: PMC3981302 DOI: 10.4081/cp.2012.e56] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 03/30/2012] [Accepted: 05/07/2012] [Indexed: 01/01/2023] Open
Abstract
The aim of this study was to present the data of a large cohort of patients with spontaneous supratentorial intracerebral hemorrhage (ICH), who were treated in our department and give a current overview considering special clinical characteristics, performed therapy and different predictive factors for morbidity and mortality. We reviewed the data of all patients with spontaneous ICH, who were treated in our department in a time span of 11 years through an analysis of our prospective database. Patients with spontaneous supratentorial ICH were included in the study. Patients with hemorrhage associated to vascular malformation or to cerebral ischemic stroke were excluded. The clinical performance at time of admission and discharge were scored using the Glasgow coma scale (GCS) and the Glasgow outcome scale (GOS) respectively. The patients' cohort was divided into surgically and conservatively treated groups. Statistical analysis [Analysis of Variance (ANOVA) and χ2-test] was done for various parameters to analyze their impact on morbidity and mortality. In total, we analyzed the data of 817 patients (364 female and 453 male). Two hundred and sixty-nine patients (32%) were treated conservatively and 556 patients (68%) underwent surgical procedures, i.e. cerebrospinal fluid drainage in 110 (19.8%), craniotomy in 338 (60.7%) and application of both methods in 108 patients (19.4%). Total mortality rate was estimated with 23.5%. GCS<8, age over 70 years, intraventricular and basal ganglia hemorrhage, coumadin medication, combination of co-morbidities, hypertensive hemorrhage and postoperative re-bleeding were statistically significant risk factors for worse outcome (GOS 1 and 2) in the operated group. Similar to the observations of the operated group, GCS<8, age over 70 years and coumadin medication were statistically significant for worse outcome in the conservative group. In contrast, lobar plus basal ganglia ICH and multi-lobar hemorrhages were the most significant factors for worse outcome in the conservative group. The results of our study show that ICH remains a multifarious disease and challenges neurosurgeons repeatedly. Selection of the treatment modality and prediction for neurofunc-tional outcome underlies various parameters. Treatment recommendations of ICH remain an unsolved issue. The consideration of the GCS grade at admission is the most important predictive factor. Old age is not an absolute contraindication for surgery, but cumulative multi-morbidity, especially cerebrovascular and cardiovascular diseases and oral anticoagulant therapy should be regarded critically in view of surgical treatment.
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Affiliation(s)
- Homajoun Maslehaty
- Department of Neurosurgery, University Hospitals Schleswig-Holstein, Campus Kiel, Germany
| | - Athanasios K Petridis
- Department of Neurosurgery, University Hospitals Schleswig-Holstein, Campus Kiel, Germany
| | - Harald Barth
- Department of Neurosurgery, University Hospitals Schleswig-Holstein, Campus Kiel, Germany
| | - Alexandros Doukas
- Department of Neurosurgery, University Hospitals Schleswig-Holstein, Campus Kiel, Germany
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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.
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Pong V, Chan KH, Chong BH, Lui WM, Leung GKK, Tse HF, Pu JKS, Siu CW. Long-Term Outcome and Prognostic Factors After Spontaneous Cerebellar Hemorrhage. THE CEREBELLUM 2012; 11:939-45. [DOI: 10.1007/s12311-012-0371-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chiu D, Peterson L, Elkind MSV, Rosand J, Gerber LM, Silverstein MD. Comparison of outcomes after intracerebral hemorrhage and ischemic stroke. J Stroke Cerebrovasc Dis 2010; 19:225-229. [PMID: 20434051 DOI: 10.1016/j.jstrokecerebrovasdis.2009.06.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Revised: 06/02/2009] [Accepted: 06/16/2009] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is associated with a greater average initial stroke severity, higher mortality, and poorer long-term neurologic outcomes than ischemic stroke. The purpose of this study was to determine whether the poorer prognosis of ICH is independent of initial stroke severity. METHODS We analyzed data from the Glycine Antagonist in Neuroprotection (GAIN) Americas trial, in which 1604 non-obtunded patients with acute stroke were treated within 6 hours of symptom onset irrespective of hemorrhagic (N = 237) versus ischemic (N = 1367) subtype. Multiple logistic regression analysis was performed to evaluate predictors of mortality and neurologic outcome (modified Rankin scale [mRS] score of 0-1 v 2-6 at 3 months) adjusting for baseline National Institutes of Health Stroke Scale score, stroke risk factors, clinical and demographic characteristics, and gavestinel treatment group. Multiple linear regression techniques were used to assess the impact of various predictors on the full mRS score at 3 months. RESULTS ICH significantly increased the odds of a poor neurologic outcome (odds ratio 1.94, 95% confidence interval 1.23-3.06) and was independently associated with a mean 0.25-point increase in the 3-month mRS score (P = .04). ICH had no effect on mortality compared with ischemic stroke (odds ratio 1.01, 95% confidence interval .68-1.49) after adjusting for initial stroke severity (National Institutes of Health Stroke Scale score) and other baseline characteristics. CONCLUSIONS Among conscious stroke patients, ICH is an independent predictor of poor neurologic outcome, nearly doubling the odds of long-term disability. However, ICH is not associated with higher mortality compared with ischemic stroke after adjusting for initial stroke severity and other baseline characteristics.
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Affiliation(s)
- David Chiu
- Methodist Neurological Institute, Weill Cornell Medical College, Houston, TX.
| | - Leif Peterson
- Methodist Neurological Institute, Weill Cornell Medical College, Houston, TX
| | | | - Jonathan Rosand
- Vascular and Critical Care Neurology and Center for Human Genetic Research, Massachusetts General Hospital, Boston
| | - Linda M Gerber
- Weill Cornell Medical College, Department of Public Health, New York, NY
| | - Marc D Silverstein
- Methodist Neurological Institute, Weill Cornell Medical College, Houston, TX
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Suzuki M, Hayashi A, Sasamata M. Nicardipine, a calcium antagonist, does not aggravate intracerebral haemorrhage in an intracerebral haemorrhage model in rats. J Pharm Pharmacol 2010; 57:483-8. [PMID: 15831209 DOI: 10.1211/0022357055759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
Despite controversy over their safety in patients with intracerebral haemorrhage, calcium antagonists are widely used in the treatment of hypertensive emergencies. Here, we investigated the effects of nicardipine on haematoma size and neurological deficit in a rat model of collagenase-induced intracerebral haemorrhage. Injection of collagenase (0.014 U) into the striatum induced haematoma (19.9 ± 3.4 mm3) in the striatum and brain oedema. Drugs were infused from 30 min after collagenase injection for 3 h under conscious conditions. Nicardipine intravenously at 0.1, 1 and 10 μg kg−1 min−1 affected neither haematoma size nor the degree of brain oedema. Nicardipine at these doses provided a stable and dose-dependent decrease in mean blood pressure of 6%, 13% and 33%, respectively, with an increase in heart rate that was apparently caused reflexively. Further, nicardipine did not aggravate the neurological deficits in these intracerebral haemorrhage rats, primarily forearm flexion behaviour on suspension by the tail and circling behaviour. These results indicate that nicardipine infusion stably decreased blood pressure without affecting intracerebral haemorrhage in an intracerebral haemorrhage model in rats.
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Affiliation(s)
- Masanori Suzuki
- Applied Pharmacology Research, Pharmacology Laboratories, Yamanouchi Pharmaceutical Co. Ltd, Ibaraki, Japan.
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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: 1730] [Impact Index Per Article: 123.6] [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.
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Affiliation(s)
- Charlotte Jj van Asch
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Utrecht, Netherlands.
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Decavel P, Medeiros de Bustos E, Revenco E, Vuillier F, Tatu L, Moulin T. Ematomi intracerebrali spontanei. Neurologia 2010. [DOI: 10.1016/s1634-7072(10)70498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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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.
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Affiliation(s)
- Kyu-Hong Kim
- Department of Neurosurgery, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
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Lara FA, Kahn SA, da Fonseca AC, Bahia CP, Pinho JP, Graca-Souza AV, Houzel JC, de Oliveira PL, Moura-Neto V, Oliveira MF. On the fate of extracellular hemoglobin and heme in brain. J Cereb Blood Flow Metab 2009; 29:1109-20. [PMID: 19337276 DOI: 10.1038/jcbfm.2009.34] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Intracerebral hemorrhage (ICH) is a major cause of disability in adults worldwide. The pathophysiology of this syndrome is complex, involving both inflammatory and redox components triggered by the extravasation of blood into the cerebral parenchyma. Hemoglobin, heme, and iron released therein seem be important in the brain damage observed in ICH. However, there is a lack of information concerning hemoglobin traffic and metabolism in brain cells. Here, we investigated the fate of hemoglobin and heme in cultured neurons and astrocytes, as well as in the cortex of adult rats. Hemoglobin was made traceable by conjugation to Alexa 488, whereas a fluorescent heme analogue (tin-protoporphyrin IX) was prepared to allow heme tracking. Using fluorescence microscopy we observed that neurons were more efficient in uptake hemoglobin and heme than astrocytes. Exposure of cortical neurons to hemoglobin or heme resulted in an oxidative stress condition. Viability assays showed that neurons were more susceptible to both hemoglobin and heme toxicity than astrocytes. Together, these results show that neurons, rather than astrocytes, preferentially take up hemoglobin-derived products, indicating that these cells are actively involved in the ICH-associated brain damage.
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Affiliation(s)
- Flavio A Lara
- Laboratório de Morfogênese Celular, Departamento de Anatomia, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Cidade Universitária, Rio de Janeiro, Brazil.
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Chao CC, Wang TL, Chong CF, Lin YM, Chen CC, Tang GJ, Yen DHT. Prognostic value of QT parameters in patients with acute hemorrhagic stroke: a prospective evaluation with respect to mortality and post-hospitalization bed confinement. J Chin Med Assoc 2009; 72:124-32. [PMID: 19299219 DOI: 10.1016/s1726-4901(09)70037-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND This prospective study was performed to evaluate the prognostic prediction value of QT parameters and clinical characteristics exhibited by patients with acute hemorrhagic stroke at the time of presenting to the emergency department (ED). METHODS One hundred and sixty-six patients admitted to the ED of Taipei Veterans General Hospital from January 2006 to October 2006 because of acute hemorrhagic stroke were enrolled. Glasgow Coma Scale (GCS) scores between 3 and 8 were taken to indicate severe neurologic deficits. QT parameters (QT max, QT min, QT dispersion, QTc max, QTc min, QTc dispersion) and other pertinent clinical variables were determined on admission. Logistic regression model was applied to evaluate prognostic prediction values. RESULTS Mortality was higher among stroke patients with low GCS scores (p < 0.01). Leukocyte counts and systolic blood pressures were significantly higher among non-surviving patients (p = 0.04). No association was found between QT parameters and mortality (all p > 0.05). Among survivors, post-hospitalization bed confinement was required for those significantly older (p = 0.01) and those with higher QT max and QTc max values in multivariate analyses (p = 0.04 and p < 0.01, respectively). CONCLUSION Low GCS scores, increased leukocyte counts, and elevated systolic blood pressures predict increased mortality for subjects with acute hemorrhagic stroke. Advanced age and prolongations in QTc and QT max at the time of stroke predicted poor functional recovery for these subjects.
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Affiliation(s)
- Chun-Chieh Chao
- Department of Emergency Medicine, Zhong-Xiao Branch, Taipei City Hospital, Taipei, Taiwan, Republic of China
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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]
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Patient and aneurysm characteristics in multiple intracranial aneurysms. CHANGING ASPECTS IN STROKE SURGERY: ANEURYSMS, DISSECTIONS, MOYAMOYA ANGIOPATHY AND EC-IC BYPASS 2008; 103:19-28. [DOI: 10.1007/978-3-211-76589-0_6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Khan FY, Yasin M, Abu-Khattab M, El Hiday AH, Errayes M, Lotf AK, Ibrahim AS, Abbas MT, Matar I, Alsamawi M, Alhail H. Stroke in Qatar: a first prospective hospital-based study of acute stroke. J Stroke Cerebrovasc Dis 2008; 17:69-78. [PMID: 18346648 DOI: 10.1016/j.jstrokecerebrovasdis.2007.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 11/18/2007] [Accepted: 11/30/2007] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Stroke is a major cause of morbidity and mortality in Qatar. OBJECTIVES The aim of our study was to determine types of strokes, the associated risk factors, clinical presentation, outcome, and time to hospital admission among Qatari and non-Qatari patients as well as young and nonyoung patients. METHODS We conducted a hospital-based prospective observational study including all patients admitted to Hamad Medical Corporation with first-ever stroke from September 15, 2004, to September 14, 2005. A stroke was defined according to World Health Organization criteria. RESULTS Stroke was confirmed in 270 patients of whom 217 (80.4%) had ischemic stroke and 53 (19.6%) had hemorrhagic stroke. Male patients predominated in all types of stroke. The main risk factors for stroke were hypertension and diabetes, whereas lacunar infarct was the most common subtype of ischemic stroke. Risk factor profiles were similar between Qatari and non-Qatari patients except for hypercholesterolemia, which was observed with a higher frequency in Qatari compared with non-Qatari patients with ischemic stroke. There were significant differences between the young and nonyoung patients with ischemic stroke with respect to risk factors, ejection fraction, ventricular wall-motion abnormalities, time to hospital admission, and outcome. Most patients arrived at the hospital more than 3 hours from stroke onset because of unawareness of stroke symptoms. The overall in-hospital mortality was 9.3%. CONCLUSIONS Hypertension and diabetes mellitus were the main risk factors for stroke in Qatar, whereas lacunar infarct was the most common subtype. Significant differences between the young and nonyoung patients were observed with respect to risk factors, ejection fraction, ventricular wall-motion abnormalities, time to hospital admission, and outcome.
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MacLellan CL, Silasi G, Poon CC, Edmundson CL, Buist R, Peeling J, Colbourne F. Intracerebral hemorrhage models in rat: comparing collagenase to blood infusion. J Cereb Blood Flow Metab 2008; 28:516-25. [PMID: 17726491 DOI: 10.1038/sj.jcbfm.9600548] [Citation(s) in RCA: 264] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Many therapies have shown promise in preclinical stroke studies, but few benefit patients. A greater understanding of stroke pathophysiology is needed to successfully develop therapies, and this depends on appropriate animal models. The collagenase and blood infusion models of intracerebral hemorrhage (ICH) are widely used; yet, investigators often prefer using one model for a variety of reasons. Thus, we directly compared these to highlight advantages and limitations of each as well as the assessment approach. An ICH was created by infusing blood or bacterial collagenase into the rats' striatum. We matched initial hematoma volume in each model (Experiment 1) and assessed the time course of bleeding (Experiment 2). Functional deficits and the progression of injury were tracked over 6 weeks using behavior, magnetic resonance imaging, and histology (Experiment 3). Despite similar initial hematoma volumes, collagenase-induced ICH resulted in a greater blood-brain barrier breakdown and more damage to the striatum, substantia nigra, white matter, and cortex. Magnetic resonance imaging revealed faster hematoma resolution in the blood model, and little increase in the volume of tissue lost from 1 to 6 weeks. In contrast, tissue loss continued over 4 weeks in the collagenase model. Finally, functional deficits recovered more quickly and completely in the blood model. This study highlights key differences between these models and that neither closely replicates the human condition. Thus, both should be used whenever possible taking into account the significant differences between these models and their limitations. Furthermore, this work illustrates significant weaknesses with several outcome measures.
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Affiliation(s)
- Crystal L MacLellan
- Department of Psychology and Centre for Neuroscience, University of Alberta, Edmonton, Alberta, Canada
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Hemorrhagic stroke syndromes: clinical manifestations of intracerebral and subarachnoid hemorrhage. HANDBOOK OF CLINICAL NEUROLOGY 2008; 93:577-94. [PMID: 18804669 DOI: 10.1016/s0072-9752(08)93028-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hill MD, Silver FL. Epidemiologic predictors of 30-day survival in cerebellar hemorrhage. J Stroke Cerebrovasc Dis 2007; 10:118-21. [PMID: 17903811 DOI: 10.1053/jscd.2001.25459] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2000] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Outcome after cerebellar hemorrhage is relatively poorly understood. OBJECTIVES To describe cerebellar hemorrhage and to establish if there were epidemiologic risk factors associated with early mortality. METHODS Computerized records were searched to identify intracerebral hemorrhage (ICD-9-CM code 431) from 1986 to 1996 at 2 hospitals. Charts were abstracted using a standardized protocol. The provincial vital statistics registry was used to confirm mortality data. A multivariable logistic regression model was developed to identify predictors of 30-day mortality. RESULTS Of 629 identified cases of intracerebral hemorrhage, 79 (12.5%) were cerebellar. The 30-day mortality was 41.7%. Approximately one third (31.7%) had an identifiable underlying cause. The odds of survival at 30 days was significantly reduced (odds ratio = 0.24; 95% confidence interval, 0.08 to 0.74) if the hemorrhage was caused by an identifiable underlying cause. CONCLUSIONS Cerebellar hemorrhage with an underlying cause is more likely to be fatal than idiopathic or hypertensive cerebellar hemorrhage.
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Affiliation(s)
- M D Hill
- Division of Neurology, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
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Hanger HC, Wilkinson TJ, Fayez-Iskander N, Sainsbury R. The risk of recurrent stroke after intracerebral haemorrhage. J Neurol Neurosurg Psychiatry 2007; 78:836-40. [PMID: 17220294 PMCID: PMC2117741 DOI: 10.1136/jnnp.2006.106500] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIM The risks of recurrent intracerebral haemorrhage (ICH) vary widely (0-24%). Patients with ICH also have risk factors for ischaemic stroke (IS) and a proportion of ICH survivors re-present with an IS. This dilemma has implications for prophylactic treatment. This study aims to determine the risk of recurrent stroke events (both ICH and IS) following an index bleed and whether ICH recurrence risk varies according to location of index bleed. PATIENTS AND METHODS All patients diagnosed with an acute ICH presenting over an 8.5 year period were identified. Each ICH was confirmed by reviewing all of the radiology results and, where necessary, the clinical case notes or post-mortem data. Recurrent stroke events (ICH and IS) were identified by reappearance of these patients in our stroke database. Coronal post-mortem results for the same period were also reviewed. Each recurrent event was reviewed to confirm the diagnosis and location of the stroke. RESULTS Of the 7686 stroke events recorded, 768 (10%) were ICH. In the follow-up period, there were 19 recurrent ICH and 17 new IS in the 464 patients who survived beyond the index hospital stay. Recurrence rate for ICH was 2.1/100 in the first year but 1.2/100/year overall. This compares with 1.3/100/year overall for IS. Most recurrences were "lobar-lobar" type. CONCLUSION The cumulative risk of recurrent ICH in this population is similar to that of IS after the first year.
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Affiliation(s)
- H C Hanger
- Older Persons Health, The Princess Margaret Hospital, PO Box 800, Christchurch, New Zealand.
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Lee WC, Joshi AV, Wang Q, Pashos CL, Christensen MC. Morbidity and mortality among elderly Americans with different stroke subtypes. Adv Ther 2007; 24:258-68. [PMID: 17565915 DOI: 10.1007/bf02849893] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The long-term outcomes of hemorrhagic stroke (HS), which includes subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), are not well understood relative to ischemic stroke (IS). This analysis was undertaken to assess short and long-term survival and morbidity of patients with hemorrhagic stroke, as well as risk factors associated with these outcomes. American Medicare beneficiaries >65 y of age in whom SAH, ICH, or IS was diagnosed were identified and followed over 4 y through the use of longitudinal claims data. Primary endpoints consisted of survival, recurrence of stroke, and readmission. A survival analysis estimated long-term survival. Logistic regression and Cox proportional hazards models identified factors associated with recurrence and death. A total of 11,430 patients with SAH (3.0%), ICH (17.1%), or IS (79.9%) were identified. At stroke onset, about 45% of SAH and ICH cohorts had congestive heart failure, about 50% had diabetes, and more than 90% had hypertension. In comparison, 30% of the IS cohort had congestive heart failure, 32%, diabetes, and 75%, hypertension. Acute in hospital mortality rates were 31.9%, 25.6%, and 6.8% for SAH, ICH, and IS, respectively; estimated median survival through 4 y was 256 d for SAH, 353 d for ICH, and 533 d for IS. The recurrence rate was highest among patients with SAH. Those with HS tended to be younger than those with IS and had a greater number of comorbidities at the time of stroke. Among the elderly, patients with HS have a substantially worse prognosis than do those with IS, which highlights the need for more effective treatment of patients with HS.
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Affiliation(s)
- Won Chan Lee
- HERQuLES, Abt Associates Inc, Bethesda, MD 20814-5341, USA.
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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.
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Affiliation(s)
- Georgios Pantazis
- Department of Neurosurgery, Thriassio General Hospital, 19600 Magoula, Athens, Greece.
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McGuire AJ, Raikou M, Whittle I, Christensen MC. Long-Term Mortality, Morbidity and Hospital Care following Intracerebral Hemorrhage: An 11-Year Cohort Study. Cerebrovasc Dis 2006; 23:221-8. [PMID: 17143007 DOI: 10.1159/000097645] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2006] [Accepted: 09/22/2006] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Intracerebral hemorrhage (ICH) represents the severest form of stroke, yet examinations of long-term prognosis and associated health care use are rare. This study assessed survival, morbidity and cost of hospital care over 11 years following a first-ever ICH in the UK. METHODS We used a population-based retrospective inception cohort design using data from the Hospital Record Linkage System in Scotland. Long-term survival, morbidity and treatment provided in hospitals were evaluated in all patients with a first diagnosis of ICH in 1995. A cohort of ischemic stroke (IS) patients was also examined for comparison. RESULTS A total of 705 patients with ICH and 8,893 with IS were identified. The mean age was 65 years (SD = 17.2) for ICH and 73 years (SD = 11.8) for IS at stroke onset. The acute in-hospital mortality was 45.7 and 30.1% for ICH and IS, 51.2 and 39.9% at 1 year, while 76.0 and 80.4% were dead 11 years later. The cumulative risk of nonfatal or fatal ICH was 8.0, 12.7 and 13.7% at 1, 5 and 10 years, and 7.0, 11.1 and 12.9% for IS in the ICH cohort. The mean cost of initial hospital care was GBP 10,332 (SD = 19,919) for ICH and GBP 9,937 (SD = 15,777) for IS. The mean total costs over 11 years were GBP 18,629 (SD = 29,943) for ICH and GBP 21,505 (SD = 27,190) for IS. CONCLUSION Following a first ICH, individuals have a poorer short-term prognosis than individuals with IS, yet both ICH and IS imply significant follow-up care.
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