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Fainardi E, Busto G, Scola E, Casetta I, Mizutani K, Consoli A, Boulouis G, Padovani A, Morotti A. Perfusion gradients promote delayed perihaematomal oedema in intracerebral haemorrhage. Brain Commun 2023; 5:fcad133. [PMID: 37151226 PMCID: PMC10162681 DOI: 10.1093/braincomms/fcad133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/23/2023] [Accepted: 04/20/2023] [Indexed: 05/09/2023] Open
Abstract
Perihaematomal oedema is a potential therapeutic target to improve outcome of patients with intracerebral haemorrhage, but its pathophysiology remains poorly elucidated. We investigated the longitudinal changes of cerebral perfusion and their influence on perihaematomal oedema development in 150 patients with intracerebral haemorrhage who underwent computed tomography perfusion within 6 h from onset, at 24 h and at 7 days. Perfusion parameters were measured in haemorrhagic core, perihaematomal rim, surrounding normal appearing and contralateral brain tissue. Computed tomography perfusion parameters gradually improved from the core to the periphery in each time interval with an early increase at 24 h followed by a delayed decline at 7 days compared with admission values (P < 0.001). Multivariable linear regression analysis showed that haematoma volume and cerebral blood flow gradient between normal appearing and perihaematomal rim were independently associated with absolute perihaematomal oedema volume in the different time points (within 6 h, B = 0.128, P = 0.032; at 24 h, B = 0.133, P = 0.016; at 7 days, B = 0.218, P < 0.001). In a secondary analysis with relative perihaematomal oedema as the outcome of interest, cerebral blood flow gradient between normal appearing and perihaematomal rim was an independent predictor of perihaematomal oedema only at 7 days (B = 0.239, P = 0.002). Our findings raise the intriguing hypothesis that perfusion gradients promote perihaematomal oedema development in the subacute phase after intracerebral haemorrhage.
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Affiliation(s)
- Enrico Fainardi
- Correspondence to: Enrico Fainardi, MD, PhD Struttura Organizzativa Dipartimentale di Neuroradiologia Dipartimento di Scienze Biomediche, Sperimentali e Cliniche ‘Mario Serio’ Università degli Studi di Firenze Ospedale Universitario Careggi Largo Brambilla 3, Firenze 50134, Italy E-mail:
| | - Giorgio Busto
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence 50139, Italy
| | - Elisa Scola
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence 50139, Italy
| | - Ilaria Casetta
- Section of Neurological, Psychiatric and Psychological Sciences, Department of Biomedical and Specialist Surgical Sciences, University of Ferrara, Ferrara 44121, Italy
| | - Katsuhiro Mizutani
- Department of Neurosurgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Arturo Consoli
- Department of Interventional and Diagnostic Neuroradiology, Hopitâl Foch, Suresnes, le de France, Paris 92150, France
| | - Gregoire Boulouis
- Department of Neuroradiology, University Hospital of Tours, Centre Val de Loire Region, Tours 37020, France
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia 25121, Italy
- Department of Neurological Sciences and Vision, Neurology Unit, ASST Spedali Civili, Brescia 25123, Italy
| | - Andrea Morotti
- Department of Neurological Sciences and Vision, Neurology Unit, ASST Spedali Civili, Brescia 25123, Italy
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Yang J, Jing J, Chen S, Liu X, Tang Y, Pan C, Tang Z. Changes in Cerebral Blood Flow and Diffusion-Weighted Imaging Lesions After Intracerebral Hemorrhage. Transl Stroke Res 2022; 13:686-706. [PMID: 35305264 DOI: 10.1007/s12975-022-00998-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/25/2022]
Abstract
Intracerebral hemorrhage (ICH) is a common subtype of stroke and places a great burden on the family and society with a high mortality and disability rate and a poor prognosis. Many findings from imaging and pathologic studies have suggested that cerebral ischemic lesions visualized on diffusion-weighted imaging (DWI) in patients with ICH are not rare and are generally considered to be associated with poor outcome, increased risk of recurrent (ischemic and hemorrhagic) stroke, cognitive impairment, and death. In this review, we describe the changes in cerebral blood flow (CBF) and DWI lesions after ICH and discuss the risk factors and possible mechanisms related to the occurrence of DWI lesions, such as cerebral microangiopathy, cerebral atherosclerosis, aggressive early blood pressure lowering, hyperglycemia, and inflammatory response. We also point out that a better understanding of cerebral DWI lesions will be a key step toward potential therapeutic interventions to improve long-term recovery for patients with ICH.
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Affiliation(s)
- Jingfei Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Jie Jing
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Shiling Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Xia Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Yingxin Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China
| | - Chao Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China.
| | - Zhouping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, NO, China.
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3
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Morotti A, Busto G, Boulouis G, Scola E, Bernardoni A, Fiorenza A, Amadori T, Carbone F, Casetta I, Montecucco F, Fainardi E. Delayed perihematomal hypoperfusion is associated with poor outcome in intracerebral haemorrhage. Eur J Clin Invest 2022; 52:e13696. [PMID: 34706061 DOI: 10.1111/eci.13696] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/16/2021] [Accepted: 10/11/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The aim of this study was to characterize the temporal evolution and prognostic significance of perihematomal perfusion in acute intracerebral haemorrhage (ICH). METHODS A single-centre prospective cohort of patients with primary spontaneous ICH receives computed tomography perfusion (CTP) within 6 h from onset (T0) and at 7 days (T7). Cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were measured in the manually outlined perihematomal low-density area. Poor functional prognosis (modified Rankin Scale 3-6) at 90 days was the outcome of interest, and predictors were explored with multivariable logistic regression. RESULTS A total of 150 patients were studied, of whom 52 (34.7%) had a mRS 3-6 at 90 days. Perihematomal perfusion decreased from T0 to T7 in all patients, but the magnitude of CBF and CBV reduction was larger in patients with unfavourable outcome (median CBF change -7.8 vs. -6.0 ml/100 g/min, p < .001, and median CBV change -0.5 vs. -0.4 ml/100 g, p = .010, respectively). This finding remained significant after adjustment for confounders (odds ratio [OR] for 1 ml/100 g/min CBF reduction: 1.33, 95% confidence interval [CI] (1.15-1.55), p < .001; OR for 0.1 ml/100 g CBV reduction: 1.67, 95% CI 1.18-2.35, p = .004). The presence of CBF < 20 ml/100 g/min at T7 was then demonstrated as an independent predictor of poor functional outcome (adjusted OR: 2.45, 95% CI 1.08-5-54, p = .032). CONCLUSION Perihaemorrhagic hypoperfusion becomes more severe in the days following acute ICH and is independently associated with poorer outcome. Understanding the underlying biological mechanisms responsible for delayed decrease in perihematomal perfusion is a necessary step towards outcome improvement in patients with ICH.
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Affiliation(s)
- Andrea Morotti
- Neurology Unit, Department of Neurological Sciences and Vision, ASST-Spedali Civili, Brescia, Italy
| | - Giorgio Busto
- Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Gregoire Boulouis
- Department of Neuroradiology, University Hospital of Tours, Centre Val de Loire Region, France
| | - Elisa Scola
- Diagnostic Imaging Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Andrea Bernardoni
- Neuroradiology Unit, Department of Radiology, Arcispedale S. Anna, Ferrara, Italy
| | - Alessandro Fiorenza
- Radiodiagnostic Unit n. 2, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Tommaso Amadori
- Radiodiagnostic Unit n. 2, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Federico Carbone
- First Clinic of internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Ilaria Casetta
- Section of Neurology, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Fabrizio Montecucco
- First Clinic of internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa - Italian Cardiovascular Network, Genoa, Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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4
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Lansberg MG, Wintermark M, Kidwell CS, Albers GW. Magnetic Resonance Imaging of Cerebrovascular Diseases. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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5
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Intrahematomal Ultrasound Enhances RtPA-Fibrinolysis in a Porcine Model of Intracerebral Hemorrhage. J Clin Med 2021; 10:jcm10040563. [PMID: 33546160 PMCID: PMC7913235 DOI: 10.3390/jcm10040563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 11/30/2022] Open
Abstract
Catheter-based ultrasound-thrombolysis has been successfully used in a small clinical trial in order to enhance recombinant tissue plasminogen activator (rtPA)-fibrinolysis, for the treatment of spontaneous intracerebral hemorrhages (ICHs). The aim of this study was to investigate the ultra-early effects of ultrasound on hematoma and the surrounding brain tissue in a porcine ICH-model. To achieve this, 21 pigs with a right frontal ICH were randomly assigned to four groups: (1) drainage (n = 3), (2) drainage + rtPA (n = 6), (3) drainage + ultrasound (n = 6), and (4) drainage + ultrasound + rtPA (n = 6). The hematoma volume assessment was performed using cranial MRI before and after the treatments. Subsequently, the brain sections were analyzed using HE-staining and immunohistochemistry. The combined treatment using rtPA and ultrasound led to a significantly higher hematoma reduction (62 ± 5%) compared to the other groups (Group 1: 2 ± 1%; Group 2: 30 ± 12%; Group 3: 18 ± 8% (p < 0.0001)). In all groups, the MRI revealed an increase in diffusion restriction but neither hyper- or hypoperfusion, nor perihematomal edema. HE stains showed perihematomal microhemorrhages were equally distributed in each group, while edema was more pronounced within the control group. Immunohistochemistry did not reveal any ultra-early side effects. The combined therapy of drainage, rtPA and ultrasound is a safe and effective technique for hematoma-reduction and protection of the perihematomal tissue in regard to ultra-early effects.
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Boltze J, Ferrara F, Hainsworth AH, Bridges LR, Zille M, Lobsien D, Barthel H, McLeod DD, Gräßer F, Pietsch S, Schatzl AK, Dreyer AY, Nitzsche B. Lesional and perilesional tissue characterization by automated image processing in a novel gyrencephalic animal model of peracute intracerebral hemorrhage. J Cereb Blood Flow Metab 2019; 39:2521-2535. [PMID: 30239258 PMCID: PMC6893983 DOI: 10.1177/0271678x18802119] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/09/2018] [Accepted: 08/15/2018] [Indexed: 12/19/2022]
Abstract
Intracerebral hemorrhage (ICH) is an important stroke subtype, but preclinical research is limited by a lack of translational animal models. Large animal models are useful to comparatively investigate key pathophysiological parameters in human ICH. To (i) establish an acute model of moderate ICH in adult sheep and (ii) an advanced neuroimage processing pipeline for automatic brain tissue and hemorrhagic lesion determination; 14 adult sheep were assigned for stereotactically induced ICH into cerebral white matter under physiological monitoring. Six hours after ICH neuroimaging using 1.5T MRI including structural as well as perfusion and diffusion, weighted imaging was performed before scarification and subsequent neuropathological investigation including immunohistological staining. Controlled, stereotactic application of autologous blood caused a space-occupying intracerebral hematoma of moderate severity, predominantly affecting white matter at 5 h post-injection. Neuroimage post-processing including lesion probability maps enabled automatic quantification of structural alterations including perilesional diffusion and perfusion restrictions. Neuropathological and immunohistological investigation confirmed perilesional vacuolation, axonal damage, and perivascular blood as seen after human ICH. The model and imaging platform reflects key aspects of human ICH and enables future translational research on hematoma expansion/evacuation, white matter changes, hematoma evacuation, and other aspects.
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Affiliation(s)
- Johannes Boltze
- Department of Translational Medicine and
Cell Technology, Fraunhofer Research Institution for Marine Biotechnology and Cell
Technology, Lübeck, Germany
- Institute for Medical and Marine
Biotechnology, University of Lübeck, Lübeck, Germany
| | - Fabienne Ferrara
- Max Delbrück Center for Molecular
Medicine in the Helmholtz Association, Berlin, Germany
| | - Atticus H Hainsworth
- Cell Biology and Genetics Research
Centre, Molecular and Clinical Sciences Research Institute, St George’s University
of London, London, UK
| | - Leslie R Bridges
- Cell Biology and Genetics Research
Centre, Molecular and Clinical Sciences Research Institute, St George’s University
of London, London, UK
- Department of Cellular Pathology, St
George's University Hospitals NHS Foundation Trust, London, UK
| | - Marietta Zille
- Department of Translational Medicine and
Cell Technology, Fraunhofer Research Institution for Marine Biotechnology and Cell
Technology, Lübeck, Germany
- Institute for Medical and Marine
Biotechnology, University of Lübeck, Lübeck, Germany
- Institute for Experimental and Clinical
Pharmacology and Toxicology, University of Lübeck, Lübeck, Germany
| | - Donald Lobsien
- Department of Neuroradiology, University
Hospital of Leipzig, Leipzig, Germany
| | - Henryk Barthel
- Clinic for Nuclear Medicine, University
of Leipzig, Leipzig, Germany
| | - Damian D McLeod
- OncoRay – National Center for Radiation
Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus,
Technische Universität Dresden, Helmholtz-Zentrum
- School of Biomedical Sciences and
Pharmacy, Faculty of Health and Medicine, and Hunter Medical Research Institute, The
University of Newcastle, Callaghan, Australia
| | - Felix Gräßer
- Institute of Biomedical Engineering,
Faculty of Electrical and Computer Engineering, Technical University of Dresden,
Dresden, Germany
| | - Sören Pietsch
- Department of Translational Medicine and
Cell Technology, Fraunhofer Research Institution for Marine Biotechnology and Cell
Technology, Lübeck, Germany
| | - Ann-Kathrin Schatzl
- Department for Cell Therapies,
Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Antje Y Dreyer
- Department for Cell Therapies,
Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Björn Nitzsche
- Clinic for Nuclear Medicine, University
of Leipzig, Leipzig, Germany
- Department of Pharmacology and
Personalised Medicine, Faculty of Health, Medicine and Life Sciences, Maastricht
University, Maastricht, The Netherlands
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7
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Wu C, Yan X, Liao Y, Liao L, Huang S, Zuo Q, Zhou L, Gao L, Wang Y, Lin J, Li S, Wang K, Ge X, Song H, Yang R, Lu F. Increased perihematomal neuron autophagy and plasma thrombin-antithrombin levels in patients with intracerebral hemorrhage: An observational study. Medicine (Baltimore) 2019; 98:e17130. [PMID: 31574813 PMCID: PMC6775380 DOI: 10.1097/md.0000000000017130] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Animal studies have demonstrated that autophagy was involved in neuronal damage after intracerebral hemorrhage (ICH). Several studies showed thrombin-antithrombin (TAT) plasma levels were elevated in patients with ICH. In this study, we aimed to evaluate if autophagy occurred in patients with ICH; and the relationship between the severity of brain injury and plasma TAT levels.A novel tissue harvesting device was used during hematoma removal surgery to collect loose fragments of tissue surrounding the affected brain area in 27 ICH patients with hematoma volumes of >30 mL in the basal ganglia. Control tissues were obtained from patients who underwent surgery for arteriovenous malformation (n = 25). Transmission electron microscopy (TEM) and immunohistochemistry for autophagy-related proteins were used to evaluate the ultrastructural and morphologic cellular characteristics; and the extent of autophagy in the recovered tissue specimens. Stroke severity was assessed by using the Glasgow Coma Scale (GCS) and the National Institutes of Health Stroke Scale (NIHSS). An enzyme-linked immunosorbent assay (ELISA) was used to measure plasma TAT levels.Transmission electron microscopy showed autophagosomes and autolysosomes exist in neurons surrounding the hematoma, but not in the control tissues. The number of cells containing autophagic vacuoles correlated with the severity of brain injury. Immunohistochemistry showed strong LC3, beclin 1, and cathepsin D staining in ICH tissue specimens. Plasma TAT levels correlated positively with autophagic cells and ICH severity (P < .01).Autophagy was induced in perihematomal neurons after ICH. Autophagy and plasma TAT levels correlated positively with severity of brain injury. These results suggest that autophagy and increased plasma TAT levels may contribute to the secondary damage in ICH patients.
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Affiliation(s)
- Chenghan Wu
- Department of Neurology, Second Affiliated Clinical College of Fujian University of Traditional Chinese Medicine
| | - Xiaohua Yan
- Department of Neurosurgery and TCM, Fujian Provincial Hospital
| | - Yuansheng Liao
- Department of Neurology, Second Affiliated Clinical College of Fujian University of Traditional Chinese Medicine
| | - Lianming Liao
- Central Laboratory, Union Hospital of Fujian Medical University
| | - Shengyue Huang
- Department of Neurosurgery and TCM, Fujian Provincial Hospital
| | - Quanting Zuo
- Department of Neurology, Second Affiliated Clinical College of Fujian University of Traditional Chinese Medicine
| | - Linying Zhou
- Laboratory of Electron Microscopy, Department of Pathology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Lili Gao
- Department of Neurology, Second Affiliated Clinical College of Fujian University of Traditional Chinese Medicine
| | - Yinzhou Wang
- Department of Neurosurgery and TCM, Fujian Provincial Hospital
| | - Jushan Lin
- Department of Neurology, Second Affiliated Clinical College of Fujian University of Traditional Chinese Medicine
| | - Shiju Li
- Department of Neurology, Second Affiliated Clinical College of Fujian University of Traditional Chinese Medicine
| | - Kaiyu Wang
- Department of Neurosurgery and TCM, Fujian Provincial Hospital
| | - Xiuming Ge
- Department of Neurology, Second Affiliated Clinical College of Fujian University of Traditional Chinese Medicine
| | - Hailong Song
- Department of Pathology and Anatomical Sciences, University of Missouri, Columbia, MO
| | - Ruiling Yang
- Department of Neurology, Second Affiliated Clinical College of Fujian University of Traditional Chinese Medicine
| | - Feng Lu
- Fujian University of Traditional Chinese Medicine, Fuzhou, China
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Xu XH, Gao T, Zhang WJ, Tong LS, Gao F. Remote Diffusion-Weighted Imaging Lesions in Intracerebral Hemorrhage: Characteristics, Mechanisms, Outcomes, and Therapeutic Implications. Front Neurol 2017; 8:678. [PMID: 29326644 PMCID: PMC5736543 DOI: 10.3389/fneur.2017.00678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/28/2017] [Indexed: 01/05/2023] Open
Abstract
Spontaneous intracerebral hemorrhage (ICH) is one of the most fatal form of stroke, with high mortality and disability rate. Small diffusion-weighed imaging lesions are not rare to see in regions remote from the hematoma after ICH and have been generally considered as related with poor outcome. In this review, we described the characteristics of remote ischemic lesions, discussed the possible mechanisms and clinical outcomes of these lesions, and evaluated the potential therapeutic implications.
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Affiliation(s)
- Xu-Hua Xu
- School of Medicine, Zhejiang University, Hangzhou, China.,Department of Neurology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Ting Gao
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Wen-Ji Zhang
- Department of Radiology, The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Lu-Sha Tong
- Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Feng Gao
- School of Medicine, Zhejiang University, Hangzhou, China.,Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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9
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Aminmansour B, Tabesh H, Rezvani M, Poorjafari H. Effects of Mannitol 20% on Outcomes in Nontraumatic Intracerebral Hemorrhage. Adv Biomed Res 2017; 6:75. [PMID: 28706883 PMCID: PMC5501019 DOI: 10.4103/2277-9175.192628] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND A large number of stroke patients are not the perfect candidate for craniotomy and invasive procedures, so providing an alternative and noninvasive method, which is applicable in terms of costs and facilities, is necessary. Thus, the present study aimed to determine the effects of mannitol 20% on outcome of the patients with nontraumatic intracerebral hemorrhage (ICH) in patients admitted to Isfahan's Al-Zahra Hospital during 2012 and 2013. MATERIALS AND METHODS This is a clinical trial study which is conducted during 2012-2013 in Isfahan's Al-Zahra Hospital. In this study, 41 patients suffering from ICH received mannitol 20% for 3 days, and volume of hemorrhage and Glasgow Coma Scale (GCS) of patients were controlled every 12 h. The collected data were analyzed via SPSS software. RESULTS The mean ICH volume was 22.1 ± 6.3 ml in pre intervention and 38.4 ± 19.3 ml in post intervention, and according to the t-paired test, before and after treatment the difference was significant (P < 0.001). Hemorrhage volume was stable in nine patients (22%), it increased in 25 patients (61%), and decreased in seven patients (17.1%). The mean index of GCS before and after treatment was 11.85 ± 1.6 and 9.37 ± 2.65, respectively. Moreover according to t-paired test, the difference was significant before and after treatment (P < 0.001). During using mannitol, the GCS index was stable in eight patients (19.5%), it increased in eight patients (19.5%) and decreased in 25 patients (61%). CONCLUSIONS Mannitol injection was not effective in reducing hemorrhage size, and its use is not recommended, also, further studies in this field have been proposed.
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Affiliation(s)
- Bahram Aminmansour
- From the Department of Neurosurgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Homayoun Tabesh
- From the Department of Neurosurgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Rezvani
- From the Department of Neurosurgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossain Poorjafari
- From the Department of Neurosurgery, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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10
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Orakcioglu B, Kentar MM, Schiebel P, Uozumi Y, Unterberg A, Sakowitz OW. Perihemorrhagic ischemia occurs in a volume-dependent manner as assessed by multimodal cerebral monitoring in a porcine model of intracerebral hemorrhage. Neurocrit Care 2016; 22:133-9. [PMID: 25052158 DOI: 10.1007/s12028-014-0027-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Changes in the perihemorrhagic zone (PHZ) of intracerebral hemorrhage (ICH) are variable. Different mechanisms contribute to secondary neuronal injury after ICH. This multimodal monitoring study investigated early changes in the PHZ of ICH. METHODS Twenty-four swine were anesthetized, ventilated, and underwent monitoring of vital parameters. Next to an intracranial pressure-probe (ICP), microdialysis (MD), thermodiffusion cerebral blood flow (td-CBF), and oxygen probes (PbrO2) were placed into the gray white matter junction for 12 h of monitoring. ICH was induced using the autologous blood injection model. Pre-defined volumes were 0 ml (sham), 1.5 ml ipsilateral (1.5 ml), 3.0 ml ipsilateral (3.0 ml), and 3.0 ml contralateral (3.0 ml contra). RESULTS ICP equally increased in all groups after ICH. In the 3.0 ml group tissue oxygenation decreased to ischemic values of 9 ± 7 mmHg early after 6 h of monitoring. This decrease was associated with a significant perfusion reduction from 36 ± 8 ml/100 g/min to 20 ± 10 ml/100 g/min. MD correlated with a threefold lactate/pyruvate ratio increase. Measurements in all other groups were unchanged. CONCLUSION Multimodal monitoring demonstrates volume-dependent changes of tissue oxygenation, blood flow, and ischemic MD markers in the PHZ independent of increased ICP suggesting early moderate ischemia. No evidence was found for the existence of a perihemorrhagic ischemia in the small hematoma groups.
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Affiliation(s)
- Berk Orakcioglu
- Department of Neurosurgery, Ruprecht-Karls-University, Heidelberg, Germany,
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11
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Magnetic Resonance Imaging of Cerebrovascular Diseases. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00048-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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12
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Noguchi T, Nishihara M, Egashira Y, Azama S, Hirai T, Kitano I, Yakushiji Y, Kawashima M, Irie H. Arterial spin-labeling MR imaging of cerebral hemorrhages. Neuroradiology 2015; 57:1135-44. [PMID: 26280515 DOI: 10.1007/s00234-015-1574-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/05/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The purpose of this study is to identify the characteristics of brain perfusion measured by arterial spin-labeling magnetic resonance imaging (ASL-MRI) in cerebral hemorrhages. METHODS Brain blood flow values (CBF-ASL values) for cerebral and cerebellar hemispheres and segmented cerebral regions were measured by ASL-MRI in 19 putaminal hemorrhage patients and 20 thalamic hemorrhage patients in acute or subacute stages. We assessed the lateralities of CBF-ASL values and the relationships between CBF-ASL values and other imaging findings and clinical manifestations. RESULTS Both the 19 putaminal hemorrhage patients and the 20 thalamic hemorrhage patients had significantly low CBF-ASL values of the contralateral cerebellum in subacute stage, suggesting that ASL-MRI might delineate crossed cerebellar diaschisis (CCD). Ipsilateral low CBF-ASL values were observed in frontal lobes and thalami with a putaminal hemorrhage and lentiform nuclei, temporal lobes, and parietal lobes with a thalamic hemorrhage, suggesting that ASL-MRI showed the ipsilateral cerebral diaschisis (ICD). In the putaminal hemorrhage patients, the hematoma volume negatively affected both the bilateral cerebellar and cerebral hemispheric CBF-ASL values. In the thalamic hemorrhage patients, a concomitant intraventricular hemorrhage caused low cerebral hemispheric CBF-ASL values. CONCLUSION The use of ASL-MRI is sensitive to the perfusion abnormalities and could thus be helpful to estimate functional abnormalities in cerebral hemorrhage patients.
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Affiliation(s)
- Tomoyuki Noguchi
- Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan. .,Department of Radiology, Faculty of Medicine and Graduate School of Medicine, Saga University, Saga, Japan.
| | - Masashi Nishihara
- Department of Radiology, Faculty of Medicine and Graduate School of Medicine, Saga University, Saga, Japan
| | - Yoshiaki Egashira
- Department of Radiology, Faculty of Medicine and Graduate School of Medicine, Saga University, Saga, Japan
| | - Shinya Azama
- Department of Radiology, Faculty of Medicine and Graduate School of Medicine, Saga University, Saga, Japan
| | - Tetsuyoshi Hirai
- Department of Radiology, Faculty of Medicine and Graduate School of Medicine, Saga University, Saga, Japan
| | - Isao Kitano
- Department of Radiology, Faculty of Medicine and Graduate School of Medicine, Saga University, Saga, Japan
| | - Yusuke Yakushiji
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Saga University, Saga, Japan
| | - Masatou Kawashima
- Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Saga University, Saga, Japan
| | - Hiroyuki Irie
- Department of Radiology, Faculty of Medicine and Graduate School of Medicine, Saga University, Saga, Japan
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Beseoglu K, Etminan N, Turowski B, Steiger HJ, Hänggi D. The extent of the perihemorrhagic perfusion zone correlates with hematoma volume in patients with lobar intracerebral hemorrhage. Neuroradiology 2014; 56:535-41. [PMID: 24777306 DOI: 10.1007/s00234-014-1371-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/11/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Existing data on perfusion imaging assumes the perihemorrhagic zone (PHZ) in patients with intracerebral hemorrhage (ICH) to be size steady. This study investigates the size of the perihemorrhagic zone (PHZ) in patients with lobar ICH in relation to hematoma volume during the course of treatment using perfusion CT (PCT). METHODS The present analysis is based on a previously reported cohort of 20 patients undergoing surgical evacuation for lobar SICH, with pre- and early postoperative PCT scanning. Time to peak of the residue function (T max) was measured based on the 360° cortical banding method and singular value decomposition. The size of PHZ was determined before and after treatment and correlated with hematoma volume. RESULTS Preoperative mean hematoma volume constituted 63.0 ml (interquartile ranges (IQR) 39.7-99.4 ml), which correlated significantly (r=0.563, p=0.010) with mean PHZ size (5.67 cm, IQR 5.44-8.17 cm). Following a surgical hematoma evacuation, mean hematoma volume was reduced to 2.5 ml IQR 0.0-9.5 ml, which also resulted in a significant reduction of PHZ size to 0.45 cm(IQR 0.0-1.36 cm; p<0.001). There was no association between postoperative hematoma volume and size of the PHZ. CONCLUSION Our findings illustrate that the extent of the PHZ cannot be generally assumed to be constant in size and that this differs significantly following hematoma reduction in patients with space occupying lobar SICH.
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Affiliation(s)
- Kerim Beseoglu
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany,
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Sonni S, Lioutas VA, Selim MH. New avenues for treatment of intracranial hemorrhage. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 16:277. [PMID: 24366522 DOI: 10.1007/s11936-013-0277-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OPINION STATEMENT The mortality and morbidity from intracerebral hemorrhage (ICH) remain high despite advances in medical, neurologic, and surgical care during the past decade. The lessons learned from previous therapeutic trials in ICH, improved understanding of the pathophysiology of neuronal injury after ICH, and advances in imaging and pre-hospital assessment technologies provide optimism that more effective therapies for ICH are likely to emerge in the coming years. The potential new avenues for the treatment of ICH include a combination of increased utilization of minimally invasive surgical techniques with or without thrombolytic usage to evacuate or reduce the size of the hematoma; utilization of advanced imaging to improve selection of patients who are likely to benefit from reversal of coagulopathy or hemostatic therapy; ultra-early diagnosis and initiation of therapy in the ambulance; and the use of novel drugs to target the secondary injury mechanisms, including the inflammatory cascade, perihematomal edema reduction, and hemoglobin degradation products-mediated toxicity.
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Affiliation(s)
- Shruti Sonni
- Department of Neurology, Cambridge Hospital, 1493 Cambridge Street, Cambridge, MA, 02139, USA,
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Ye H, Su Y. Hemodynamic effects of mannitol infusion in patients with acute intracerebral hemorrhage. Acta Cir Bras 2013; 28:106-11. [PMID: 23370923 DOI: 10.1590/s0102-86502013000200004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 12/11/2012] [Indexed: 03/29/2023] Open
Abstract
PURPOSE To evaluate hemodynamic effects of mannitol infusion in patients with acute intracerebral hemorrhage. METHODS Thirty patients with acute intracerebral hemorrhage were enrolled. Transcranial doppler was used to detect variables of bilateral middle cerebral arteria (MCA) including mean velocity (Vm) and pulsitility index (PI) before and after 125 ml and 250 ml mannitol infusion (0, 30, 60, 90, 120, 180, 240 min). RESULTS When 125 ml or 250 ml mannitol was infused in patients with acute intracerebral hemorrhage, Vm of bilateral MCA elevated, and reached the top at 30 min, and then decreased. PI decreased in the affected MCA (250 ml) and in the unaffected MCA (125 ml and 250 ml). CONCLUSION Mannitol infusion in patients with acute intracerebral hemorrhage can improve cerebral blood flow in bilateral hemispheres and decrease intracranial pressure in the hemorrhagic hemisphere (250 ml) and in the nonhemorrhagic hemisphere (125 ml and 250 ml).
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Affiliation(s)
- Hong Ye
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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El Ahmadieh TY, El Tecle NE, Lall RR, Park AE, Bendok BR. Blood Pressure Control for Spontaneous Intracerebral Hemorrhage. Neurosurgery 2013; 72:N14-6. [DOI: 10.1227/01.neu.0000430734.71114.bc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Etminan N, Beseoglu K, Turowski B, Steiger HJ, Hänggi D. Perfusion CT in patients with spontaneous lobar intracerebral hemorrhage: effect of surgery on perihemorrhagic perfusion. Stroke 2011; 43:759-63. [PMID: 22198980 DOI: 10.1161/strokeaha.111.616730] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The aim of the present study was to investigate cerebral hemodynamics in patients requiring surgical treatment for lobar intracerebral hemorrhage. METHODS Twenty patients who underwent surgery to remove a lobar spontaneous intracerebral hemorrhage were scanned before and after surgery using perfusion CT mapping. Mean transit time, time to peak of the residue function, cerebral blood volume, and cerebral blood flow were measured in 4 defined regions of interest. RESULTS Preoperatively, time to peak of the residue function, cerebral blood volume, and cerebral blood flow were significantly impaired in the perihemorrhagic zone as compared with the ipsilateral and contralateral hemisphere. Perihematomal perfusion improved significantly after clot evacuation and there was no difference in time to peak of the residue function, cerebral blood flow, and cerebral blood volume values between the perihemorrhagic zone and ipsilateral as well as contralateral hemisphere after surgical treatment. CONCLUSIONS Our findings illustrate distinct perihemorrhagic perfusion impairments in a selected patient population with lobar intracerebral hemorrhage as evident by impaired time to peak of the residue function, cerebral blood flow, and cerebral blood volume and their improvement after early surgical treatment. Whether these early improvements in hemodynamic measurements may influence secondary neuronal injury and ultimately clinical outcome, as opposed to the natural course of spontaneous intracerebral hemorrhage remains unclear.
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Affiliation(s)
- Nima Etminan
- Department of Neurosurgery, University of Düsseldorf, Medical Faculty, Düsseldorf, Germany.
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Jin K, Mao X, Xie L, Greenberg DA. Neuroglobin expression in human arteriovenous malformation and intracerebral hemorrhage. ACTA NEUROCHIRURGICA. SUPPLEMENT 2011; 111:315-9. [PMID: 21725774 DOI: 10.1007/978-3-7091-0693-8_52] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
We reported previously that Notch signaling is activated in human arteriovenous malformations (AVMs) and that intracerebral hemorrhage (ICH) in humans is accompanied by increased neurogenesis. The former phenomenon may be involved in AVM pathogenesis and the latter in the brain's response to ICH-induced injury. Here we describe increased expression of the hypoxia-inducible neuroprotective protein, neuroglobin (Ngb), in neurons surrounding unruptured AVMs and in the perihematomal region adjacent to ICH. In these disorders, as in other clinical settings, such as ischemic stroke, AVM- and ICH-induced overexpression of Ngb may be stimulated by ischemic hypoxia and may help to constrain brain injury.
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Affiliation(s)
- Kunlin Jin
- Buck Institute for Age Research, 8001 Redwood Boulevard, Novato, CA 94945, USA
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Orakcioglu B, Kentar M, Uozumi Y, Santos E, Schiebel P, Unterberg A, Sakowitz OW. Multiparametric characterisation of the perihemorrhagic zone in a porcine model of lobar ICH. ACTA NEUROCHIRURGICA. SUPPLEMENT 2011; 111:19-23. [PMID: 21725726 DOI: 10.1007/978-3-7091-0693-8_4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
OBJECTIVES To describe early perihemorrhagic changes after lobar intracerebral hemorrhage (ICH) using multiparametric neuromonitoring [intracranial pressure (ICP), cerebral blood flow (CBF), tissue oxygenation (PbrO2), microdialysis (MD)]. METHODS Seven anaesthetized male swine were examined over 12 h. Four cerebral probes were inserted around the ICH (ICP, MD, CBF and PbrO2). A right frontal autologous arterial ICH (1.5 mL) was induced in all animals. RESULTS Initial ICH creation was hampered by using a soft 22-G cannula. A modified injection technique with a 90° bent steel cannula (20 G) allowed for an 87.5% success rate in ICH formation. After induction of ICH, ICP significantly increased from 2 mmHg to 9 mmHg. No significant PbrO2 or CBF reduction occurred during the monitoring period. Consequently, microdialysis did not indicate overall mean deterioration in the hematoma group over time. The indicator of ischemia (extracellular lactate) did not increase significantly during the monitoring period. Individual monitoring episodes demonstrated hypoxic episodes with consecutive metabolic derangement. These effects were reversible by optimizing CPP and FiO2. CONCLUSION We established a reproducible cortical ICH model using multiparametric neuromonitoring. Subtle changes in ICP were observed. No evidence for the existence of a perihemorrhagic ischemic area was found, hypothetically because of the small hematoma size. Individual animals underwent critical PbrO2 and CBF decreases with consecutive metabolic derangement. The effect of larger hematoma volumes should be evaluated with this setup in future studies to study volume-dependent deterioration.
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Affiliation(s)
- Berk Orakcioglu
- Department of Neurosurgery, University Hospital Heidelberg, and Ruprecht-Karl-University, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
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Abstract
Stroke, whether hemorrhagic or ischemic in nature, has the ability to lead to devastating and debilitating patient outcomes, which not only has direct implications from a healthcare standpoint, but its effects are longstanding and they impact the community as a whole. For decades, the goal of advancement and refinement in imaging modalities has been to develop the most precise, convenient, widely available and reproducible interpretable modality for the detection of stroke, not only in its hyperacute phase, but a method to be able to predict its evolution through the natural course of disease. Diagnosis is one of the most important initial roles, which imaging fulfills after the identification of existent pathology. However, imaging fulfills an even more important goal by using a combination of imaging modalities and their precise interpretation, which lends itself to understanding the mechanisms and pathophysiology of underlying disease, and therefore guides therapeutic decision-making in a patient-tailored fashion. This review explores the most commonly used brain imaging modalities, computer tomography, and magnetic resonance imaging, with an aim to demonstrate their dynamic use in uncovering stroke mechanism, facilitating prognostication, and potentially guiding therapy.
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Affiliation(s)
- May Nour
- University of California at Los Angeles Stroke Center, UCLA Medical Center, Los Angeles, CA 90095 USA
| | - David S. Liebeskind
- University of California at Los Angeles Stroke Center, UCLA Medical Center, Los Angeles, CA 90095 USA
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Abstract
Intracerebral haemorrhage is a devastating condition lacking effective therapies, with an uncertain role for surgery in many. Early research described an ischaemic penumbra around the haematoma, representing an area of potential therapeutic intervention. This article discusses the evidence for and against the existence of an ischaemic penumbra in ICH, with particular reference to recent imaging studies.
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Warach S, Baird AE, Dani KA, Wintermark M, Kidwell CS. Magnetic Resonance Imaging of Cerebrovascular Diseases. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10046-6] [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]
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Josephson CB, Frantzias J, Samarasekera N, Al-Shahi Salman R. The persisting burden of intracerebral haemorrhage: can effective treatments be found? PLoS Med 2010; 7:e1000353. [PMID: 20976102 PMCID: PMC2957399 DOI: 10.1371/journal.pmed.1000353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Colin Josephson, Rustam Al-Shahi Salman, and colleagues discuss the effectiveness of treatments for intracerebral haemorrhage.
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Affiliation(s)
- Colin B. Josephson
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
| | - Joseph Frantzias
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
| | - Neshika Samarasekera
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
| | - Rustam Al-Shahi Salman
- Division of Clinical Neurosciences, Centre for Clinical Brain Sciences, University of Edinburgh, Western General Hospital, Edinburgh, United Kingdom
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Olivot JM, Mlynash M, Kleinman JT, Straka M, Venkatasubramanian C, Bammer R, Moseley ME, Albers GW, Wijman CAC. MRI profile of the perihematomal region in acute intracerebral hemorrhage. Stroke 2010; 41:2681-3. [PMID: 20947849 DOI: 10.1161/strokeaha.110.590638] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE The pathophysiology of the presumed perihematomal edema immediately surrounding an acute intracerebral hemorrhage is poorly understood, and its composition may influence clinical outcome. Method-Twenty-three patients from the Diagnostic Accuracy of MRI in Spontaneous intracerebral Hemorrhage (DASH) study were prospectively enrolled and studied with MRI. Perfusion-weighted imaging, diffusion-weighted imaging, and fluid-attenuated inversion recovery sequences were coregistered. TMax (the time when the residue function reaches its maximum) and apparent diffusion coefficient values in the presumed perihematomal edema regions of interest were compared with contralateral mirror and remote ipsilateral hemispheric regions of interest. RESULTS Compared with mirror and ipsilateral hemispheric regions of interest, TMax (the time when the residue function reaches its maximum) and apparent diffusion coefficient were consistently increased in the presumed perihematomal edema. Two thirds of the patients also exhibited patchy regions of restricted diffusion in the presumed perihematomal edema. CONCLUSIONS The MRI profile of the presumed perihematomal edema in acute intracerebral hemorrhage exhibits delayed perfusion and increased diffusivity mixed with areas of reduced diffusion.
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Affiliation(s)
- Jean-Marc Olivot
- Department of Neurology and Neurological Sciences, Stanford Stroke Center, Stanford University Medical Center, Palo Alto, CA 94304, USA
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Autoregulation and brain metabolism in the perihematomal region of spontaneous intracerebral hemorrhage: an observational pilot study. J Neurol Sci 2010; 295:16-22. [PMID: 20557898 DOI: 10.1016/j.jns.2010.05.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 04/20/2010] [Accepted: 05/27/2010] [Indexed: 11/22/2022]
Abstract
The metabolic and hemodynamic processes in the edema surrounding spontaneous, supratentorial intracerebral hemorrhage (ICH) are poorly understood. Specifically, the local metabolic effects of autoregulatory failure have not been described previously. In the current observational pilot study, microdialysis and brain tissue oxygenation probes (P(br)O(2)) were placed in the perihemorrhagic edema using neuronavigation in five non-surgically treated patients with deep ICH. The cerebrovascular pressure reactivity index (PRx, moving correlation between mean arterial and intracranial pressure) and P(br)O(2) reactivity index (ORx, correlation between P(br)O(2) and cerebral perfusion pressure) were used to characterize cerebral autoregulation. While all five patients had ORx values indicative for severely disturbed autoregulation, assessment of PRx only in one patient was consistent with sustained failure of cerebrovascular reactivity. This patient at the same time had the worst metabolic parameters and the poorest tissue oxygenation. We conclude that multimodality monitoring in the perihemorrhagic penumbra is feasible. A study in a larger population is needed to clarify the relationship between PRx and ORx in ICH patients, the local metabolic effects of autoregulatory failure and its relation to brain edema formation and clinical outcome.
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Sykora M, Diedler J, Turcani P, Rupp A, Steiner T. Subacute perihematomal edema in intracerebral hemorrhage is associated with impaired blood pressure regulation. J Neurol Sci 2009; 284:108-12. [DOI: 10.1016/j.jns.2009.04.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Revised: 03/01/2009] [Accepted: 04/20/2009] [Indexed: 11/30/2022]
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Herweh C, Jüttler E, Schellinger PD, Klotz E, Schramm P. Perfusion CT in Hyperacute Cerebral Hemorrhage Within 3 Hours after Symptom Onset: Is There an Early Perihemorrhagic Penumbra? J Neuroimaging 2009; 20:350-3. [DOI: 10.1111/j.1552-6569.2009.00408.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Zhou J, Zhang H, Gao P, Lin Y, Li X. Assessment of perihematomal hypoperfusion injury in subacute and chronic intracerebral hemorrhage by CT perfusion imaging. Neurol Res 2009; 32:642-9. [PMID: 19660194 DOI: 10.1179/016164109x12445616596328] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To study alterations of perihematomal cerebral perfusion associated to subacute and chronic intracerebral hemorrhage (ICH) by means of computed tomography perfusion (CTP) imaging. METHODS Non-enhanced CT scan and CTP examination were performed in 12 patients with subacute and chronic supratentorial ICH. The hematoma volume was measured, and the regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), mean transit time (MTT) and time-to-peak (TTP) adjacent to hematoma were measured in 11 of 12 cases. RESULTS Eleven patients with mean age of 58.1 years were finally analysed. Mean time interval from symptom onset to initial CTP scanning was 18.4 days; mean hematoma volume was 26.8 ml. The gradient of hypoperfusion around the hematoma was revealed by rCBF maps in 11 cases, and by rCBV maps in ten cases. The areas of delayed TTP and MTT were showed in 11 and ten cases, respectively. The degree of reduction in rCBV correlated strongly with the hematoma volume (r(inner)=0.764, p=0.006;r(outer)=0.703, p=0.016). There was no correlation between the changes in rCBF, rCBV, MTT and TTP and the time interval from symptom onset to initial CTP examination. CONCLUSION We have concluded that the gradient of hypoperfusion surrounding the hematoma may still exist during the subacute and chronic phases after ICH. The alterations in rCBV correlate with the hematoma volume. We believe that the reperfusion injury marked by increased rCBV contributes to the perilesional brain injury. The quantitative CT perfusion measurements can provide valuable information in individual management and prognostic evaluation of ICH.
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Affiliation(s)
- Jian Zhou
- Neuroimaging Center, Beijing Tiantan Hospital, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, China
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Orakcioglu B, Becker K, Sakowitz OW, Herweh C, Köhrmann M, Huttner HB, Steiner T, Unterberg A, Schellinger PD. MRI of the perihemorrhagic zone in a rat ICH model: effect of hematoma evacuation. Neurocrit Care 2008; 8:448-55. [PMID: 18188706 DOI: 10.1007/s12028-007-9047-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Perihemorrhagic pathophysiology of spontaneous intracerebral hemorrhages (ICH) remains unclear. Recently, ischemic changes in the perihemorrhagic zone (PHZ) have been discussed as a potential source of secondary damage. In this study, we focussed on diffusion and perfusion characteristics of experimental ICH. METHODS Experimental ICH was induced with a double injection model in rats. In total, 49 animals were examined at three timepoints within 3.5 h after ICH with a 2.35T animal scanner. We investigated perihemorrhagic relative apparent diffusion coefficients (rADC) and relative mean transit time (rMTT). Animals were divided into 2 groups; controls (gr1, n = 27) and facilitated hematoma evacuation with recombinant tissue plasminogen activator (rt-PA) after the first of 3 imaging time points (gr2, n = 22). Diffusion (rADC) and perfusion (rMTT) characteristics were analyzed in 3 regions of interest surrounding the hematoma (ROI1-3). RESULTS Overall rADC and rMTT values in ROI3 (normal tissue) did not show any changes. There was mild edema--not ischemia--in ROIs1 and 2 at TP1 with rADC of 1.05-1.18 in both groups indicating vasogenic edema (not ischemia). This did not change with hematoma evacuation. There was mild (non-critical) perfusion reduction in ROIs1 and 2 at TP1, which disappeared after clot evacuation in group 2 (P < 0.05 for TP3). Multifactorial ANOVA showed a solid trend (0.06 < P < 0.1) for clot evacuation associated normalization of perfusion in ROIs 1 and 2 within and in between groups 1 and 2. CONCLUSIONS We demonstrated vasogenic edema and mild perfusion reduction in the PHZ above the ischemic threshold. The existence of a perihemorrhagic "penumbra" indicating critically ischemic tissue analogous to ischemic stroke is unlikely.
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Affiliation(s)
- Berk Orakcioglu
- Department of Neurosurgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, Heidelberg, Germany.
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Knight RA, Han Y, Nagaraja TN, Whitton P, Ding J, Chopp M, Seyfried DM. Temporal MRI assessment of intracerebral hemorrhage in rats. Stroke 2008; 39:2596-602. [PMID: 18635862 DOI: 10.1161/strokeaha.107.506683] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE MRI was used to evaluate the effects of experimental intracerebral hemorrhage (ICH) on brain tissue injury and recovery. METHODS Primary ICH was induced in rats (n=6) by direct infusion of autologous blood into the striatum. The evolution of ICH damage was assessed by MRI estimates of T(2) and T(1sat) relaxation times, cerebral blood flow, vascular permeability, and susceptibility-weighted imaging before surgery (baseline) and at 2 hours and 1, 7, and 14 days post-ICH. Behavioral testing was done before and at 1, 7, and 14 days post-ICH. Animals were euthanized for histology at 14 days. RESULTS The MRI appearance of the hemorrhage and surrounding regions changed in a consistent manner over time. Two primary regions of interest were identified based on T(2) values. These included a core, corresponding to the bulk of the hemorrhage, and an adjacent rim; both varied with time. The core was associated with significantly lower cerebral blood flow values at all post-ICH time points, whereas cerebral blood flow varied in the rim. Increases in vascular permeability were noted at 1, 7, and 14 days. Changes in T(1sat) were similar to those of T(2). MRI and histological estimates of tissue loss were well correlated and showed approximately 9% hemispheric tissue loss. CONCLUSIONS Although the cerebral blood flow changes observed with this ICH model may not exactly mimic the clinical situation, our results suggest that the evolution of ICH injury can be accurately characterized with MRI. These methods may be useful to evaluate therapeutic interventions after experimental ICH and eventually in humans.
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Affiliation(s)
- Robert A Knight
- Henry Ford Hospital, Department of Neurology-NMR Research, 2799 West Grand Blvd, Detroit, MI 48202, USA.
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CT perfusion mapping of hemodynamic disturbances associated to acute spontaneous intracerebral hemorrhage. Neuroradiology 2008; 50:729-40. [DOI: 10.1007/s00234-008-0402-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2007] [Accepted: 04/16/2008] [Indexed: 11/30/2022]
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