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Park J, Hwang SK. Transcranial Doppler study in acute spontaneous intracerebral hemorrhage: The role of pulsatility index. J Cerebrovasc Endovasc Neurosurg 2021; 23:334-342. [PMID: 34579508 PMCID: PMC8743820 DOI: 10.7461/jcen.2021.e2021.05.001] [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: 05/06/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Pulsatility index (PI) is a parameter calculated by transcranial Doppler sonography (TCD), which is commonly used for patients with subarachnoid hemorrhage or ischemic stroke. However, we performed a retrospective analysis of patients with acute spontaneous intracerebral hemorrhage (ICH) to assess the function of TCD, particularly the PI. Methods This study involved a total of 46 patients with acute ICH who received treatment at a single center between May 2013 and December 2014. Medical records of baseline characteristics, except for the modified Rankin scale, were obtained at initial evaluation in the emergency room, and TCD was used to calculate middle cerebral artery flow velocity (MFV) and PI at admission (baseline), 24 h, and 7 days. The PI and MFV values on the affected middle cerebral artery were compared with those on the contralateral side. Linear regression analysis was used for statistical analyses (SPSS 21.0, IBM Corp., Armonk, NY, USA). Results Statistical analysis indicated that sex, age, Glasgow coma scale, intraventricular hemorrhage, and hematoma size were not correlated with PI (p>0.05); however, only PI was positively correlated with functional outcome at 6 months after treatment (R=0.846, p=0.002). Conclusions These results provide evidence that the parameter of PI is an independent determinant prognostic factor in acute spontaneous ICH. Further research is needed to investigate the influence of cerebral blood flow dynamics on a larger, more controlled, and more randomized basis.
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Affiliation(s)
- Jiyong Park
- Department of Neurosurgery, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul, Korea
| | - Sung-Kyun Hwang
- Department of Neurosurgery, College of Medicine, Ewha Womans University, Mokdong Hospital, Seoul, Korea
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2
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Kang H, Cai Q, Gong L, Wang Y. Nomogram Prediction of Short-Term Outcome After Intracerebral Hemorrhage. Int J Gen Med 2021; 14:5333-5343. [PMID: 34522130 PMCID: PMC8434878 DOI: 10.2147/ijgm.s330742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/25/2021] [Indexed: 11/29/2022] Open
Abstract
Background The early symptoms of patients with elevated intracranial pressure (ICP) after intracerebral hemorrhage (ICH) are easily overlooked, which will result in missing the optimal opportunity for clinical intervention. However, it is difficult for ICH patients admitted to the neurology department to receive invasive ICP monitoring, although it is crucial for the early identification of neurologic deterioration (ND). Objective The aim of this study is to investigate the association between the changes of transcranial Doppler (TCD) variables and ND after onset and establish a nomogram for predicting the short-term outcome of ICH. Methods A total of 297 patients were recruited and their clinical characteristics and the changes of TCD variables were recorded. The independent prognostic factors for the ND after onset in the ICH patients were screened from multivariate Logistic regression analysis, which were served as inputs for the nomogram construction. Discrimination and calibration validations were performed to assess the performance of the nomogram [concordance index (C-index) for discrimination and Hosmer–Lemeshow (HL) test for calibration] and the decision curve analysis was applied to assess the clinical suitability. Results ΔaPI [defined as the change of pulsatility index (PI) between the 1st and 3rd day after onset for affected hemisphere] was independently associated with the ND after onset. Moreover, hematoma volume, presence of intraventricular hemorrhage, and Glasgow coma scale were also the independent prognostic factors of ND. The developed nomogram incorporating ΔaPI showed good discrimination (C-index: 0.916 after 1000 bootstrapping) and calibration (P=0.412, HL test) and yielded net benefits. Conclusion The nomogram incorporating ΔaPI might be useful in predicting the risk of ND within 14 days after onset, which might help identify patients in the neurology department in need of further care.
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Affiliation(s)
- Huili Kang
- Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, People's Republic of China
| | - Qiuqiong Cai
- Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, People's Republic of China
| | - Liang Gong
- Department of Neurosurgery, Shanghai Punan Hospital of Pudong New District, Shanghai, People's Republic of China
| | - Ying Wang
- Department of Ultrasound, Shanghai Punan Hospital of Pudong New District, Shanghai, People's Republic of China
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3
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Al-Mufti F, Sursal T, Kim M, Menjivar AM, Cole C, Chandy D, Schmidt M, Bowers C, Gandhi CD. Noninvasive Multimodality Cerebral Monitoring Modalities in Neurosurgical Critical Care. World Neurosurg 2018; 121:249-250. [PMID: 30347294 DOI: 10.1016/j.wneu.2018.10.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Fawaz Al-Mufti
- Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Tolga Sursal
- Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Michael Kim
- Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Alvaro Martin Menjivar
- Department of Internal Medicine - Division of Critical Care, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Chad Cole
- Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Dipak Chandy
- Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA; Department of Internal Medicine - Division of Critical Care, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Meic Schmidt
- Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Christian Bowers
- Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
| | - Chirag D Gandhi
- Department of Neurology and Neurosurgery, Westchester Medical Center at New York Medical College, Valhalla, New York, USA
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Al-Mufti F, Lander M, Smith B, Morris NA, Nuoman R, Gupta R, Lissauer ME, Gupta G, Lee K. Multimodality Monitoring in Neurocritical Care: Decision-Making Utilizing Direct And Indirect Surrogate Markers. J Intensive Care Med 2018; 34:449-463. [PMID: 30205730 DOI: 10.1177/0885066618788022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Substantial progress has been made to create innovative technology that can monitor the different physiological characteristics that precede the onset of secondary brain injury, with the ultimate goal of intervening prior to the onset of irreversible neurological damage. One of the goals of neurocritical care is to recognize and preemptively manage secondary neurological injury by analyzing physiologic markers of ischemia and brain injury prior to the development of irreversible damage. This is helpful in a multitude of neurological conditions, whereby secondary neurological injury could present including but not limited to traumatic intracranial hemorrhage and, specifically, subarachnoid hemorrhage, which has the potential of progressing to delayed cerebral ischemia and monitoring postneurosurgical interventions. In this study, we examine the utilization of direct and indirect surrogate physiologic markers of ongoing neurologic injury, including intracranial pressure, cerebral blood flow, and brain metabolism.
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Affiliation(s)
- Fawaz Al-Mufti
- 1 Division of Neuroendovascular Surgery and Neurocritical Care, Department of Neurology, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,2 Department of Neurosurgery, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Megan Lander
- 3 Division of Surgical Critical Care, Department of Surgery, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Brendan Smith
- 4 Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Nicholas A Morris
- 5 Department of Neurology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Rolla Nuoman
- 6 Department of Neurology, Rutgers University, New Jersey Medical School, Newark, NJ, USA
| | - Rajan Gupta
- 3 Division of Surgical Critical Care, Department of Surgery, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Matthew E Lissauer
- 3 Division of Surgical Critical Care, Department of Surgery, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Gaurav Gupta
- 7 Division of Neurosurgery, Department of Surgery, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Kiwon Lee
- 1 Division of Neuroendovascular Surgery and Neurocritical Care, Department of Neurology, Rutgers University, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Noninvasive Neuromonitoring: Current Utility in Subarachnoid Hemorrhage, Traumatic Brain Injury, and Stroke. Neurocrit Care 2018; 27:122-140. [PMID: 28004334 DOI: 10.1007/s12028-016-0361-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Noninvasive neuromonitoring is increasingly being used to monitor the course of primary brain injury and limit secondary brain damage of patients in the neurocritical care unit. Proposed advantages over invasive neuromonitoring methods include a lower risk of infection and bleeding, no need for surgical installation, mobility and portability of some devices, and safety. The question, however, is whether noninvasive neuromonitoring is practical and trustworthy enough already. We searched the recent literature and reviewed English-language studies on noninvasive neuromonitoring in subarachnoid hemorrhage, traumatic brain injury, and ischemic and hemorrhagic stroke between the years 2010 and 2015. We found 88 studies that were eligible for review including the methods transcranial ultrasound, electroencephalography, evoked potentials, near-infrared spectroscopy, bispectral index, and pupillometry. Noninvasive neuromonitoring cannot yet completely replace invasive methods in most situations, but has great potential being complementarily integrated into multimodality monitoring, for guiding management, and for limiting the use of invasive devices and in-hospital transports for imaging.
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Al-Mufti F, Smith B, Lander M, Damodara N, Nuoman R, El-Ghanem M, Kamal N, Al-Marsoummi S, Alzubaidi B, Nuoaman H, Foreman B, Amuluru K, Gandhi CD. Novel minimally invasive multi-modality monitoring modalities in neurocritical care. J Neurol Sci 2018; 390:184-192. [PMID: 29801883 DOI: 10.1016/j.jns.2018.03.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 03/14/2018] [Accepted: 03/25/2018] [Indexed: 11/19/2022]
Abstract
Elevated intracranial pressure (ICP) following brain injury contributes to poor outcomes for patients, primarily by reducing the caliber of cerebral vasculature, and thereby reducing cerebral blood flow. Careful monitoring of ICP is critical in these patients in order to determine prognosis, implement treatment when ICP becomes elevated, and to judge responsiveness to treatment. Currently, the gold standard for monitoring is invasive pressure transducers, usually an intraventricular monitor, which presents significant risk of infection and hemorrhage. These risks made discovering non-invasive methods for monitoring ICP and cerebral perfusion a priority for researchers. Herein we sought to review recent publications on novel minimally invasive multi-modality monitoring techniques that provide surrogate data on ICP, cerebral oxygenation, metabolism and blood flow. While limitations in various forms preclude them from supplanting the use of invasive monitors, these modalities represent useful screening tools within our armamentarium that may be invaluable when the risks of invasive monitoring outweigh the associated benefits.
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Affiliation(s)
- Fawaz Al-Mufti
- Department of Neurology, Neurosurgery and Radiology, Westchester Medical Center at New York Medical College, Valhalla, NY, United States; Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, NJ, United States.
| | - Brendan Smith
- Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Megan Lander
- Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Nitesh Damodara
- Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Rolla Nuoman
- Department of Neurology, Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Mohammad El-Ghanem
- Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Naveed Kamal
- Department of Neurosurgery, Rutgers University - New Jersey Medical School, Newark, NJ, United States
| | - Sarmad Al-Marsoummi
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, ND, United States
| | - Basim Alzubaidi
- Department of Neurology, Neurosurgery and Radiology, Westchester Medical Center at New York Medical College, Valhalla, NY, United States
| | - Halla Nuoaman
- Department of Neurology, Neurosurgery and Radiology, Westchester Medical Center at New York Medical College, Valhalla, NY, United States
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, Division of Neurocritical Care, University of Cincinnati, Cincinnati, OH, United States
| | - Krishna Amuluru
- Department of Neurointerventional Radiology, University of Pittsburgh, Hamot, Erie, PA, United States
| | - Chirag D Gandhi
- Department of Neurosurgery, Westchester Medical Center - New York Medical College, Valhalla, NY, United States
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Chen Y, Xu W, Wang L, Yin X, Cao J, Deng F, Xing Y, Feng J. Transcranial Doppler combined with quantitative EEG brain function monitoring and outcome prediction in patients with severe acute intracerebral hemorrhage. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:36. [PMID: 29463290 PMCID: PMC5820804 DOI: 10.1186/s13054-018-1951-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 01/10/2018] [Indexed: 12/15/2022]
Abstract
Background Neurological deterioration after intracerebral hemorrhage (ICH) is thought to be closely related to increased intracranial pressure (ICP), decreased cerebral blood flow (CBF), and brain metabolism. Transcranial Doppler (TCD) is increasingly used as an indirect measure of ICP, and quantitative EEG (QEEG) can reflect the coupling of CBF and metabolism. We aimed to combine TCD and QEEG to comprehensively assess brain function after ICH and provide prognostic diagnosis. Methods We prospectively enrolled patients with severe acute supratentorial (SAS)-ICH from June 2015 to December 2016. Mortality was assessed at 90-day follow-up. We collected demographic data, serological data, and clinical factors, and performed neurophysiological tests at study entry. Quantitative brain function monitoring was performed using a TCD-QEEG recording system at the patient’s bedside (NSD-8100; Delica, China). Univariate and multivariable analyses and receiver operating characteristic (ROC) curves were employed to assess the relationships between variables and outcome. Results Forty-seven patients (67.3 ± 12.6 years; 23 men) were studied. Mortality at 90 days was 55.3%. Statistical results showed there were no significant differences in brain symmetry index between survivors and nonsurvivors, nor between patients and controls (all p > 0.05). Only TCD indicators of the pulsatility index from unaffected hemispheres (UPI) (OR 2.373, CI 1.299–4.335, p = 0.005) and QEEG indicators of the delta/alpha ratio (DAR) (OR 5.306, CI 1.533–18.360, p = 0.008) were independent predictors for clinical outcome. The area under the ROC curve after the combination of UPI and DAR was 0.949, which showed better predictive accuracy compared to individual variables. Conclusions In patients with SAS-ICH, multimodal neuromonitoring with TCD combined with QEEG indicated that brain damage caused diffuse changes, and the predictive accuracy after combined use of TCD-QEEG was statistically superior in performance to any single variable, whether clinical or neurophysiological.
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Affiliation(s)
- Ying Chen
- Department of Neurology, The First Norman Bethune Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Weihai Xu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan 1, Dong Cheng District, Beijing, 100730, China
| | - Lijuan Wang
- Department of Neurology, The First Norman Bethune Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Xiaoming Yin
- Department of Neurology, The First Norman Bethune Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Jie Cao
- Department of Neurology, The First Norman Bethune Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Fang Deng
- Department of Neurology, The First Norman Bethune Hospital of Jilin University, Changchun, Jilin, 130021, China
| | - Yingqi Xing
- Department of Neurology, The First Norman Bethune Hospital of Jilin University, Changchun, Jilin, 130021, China.
| | - Jiachun Feng
- Department of Neurology, The First Norman Bethune Hospital of Jilin University, Changchun, Jilin, 130021, China.
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Lahiri S, Schlick KH, Padrick MM, Rinsky B, Gonzalez N, Jones H, Mayer SA, Lyden PD. Cerebral Pulsatility Index Is Elevated in Patients with Elevated Right Atrial Pressure. J Neuroimaging 2017; 28:95-98. [DOI: 10.1111/jon.12456] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/06/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Shouri Lahiri
- Departments of Neurology; Cedars-Sinai Medical Center; Los Angeles CA
- Neurosurgery; Cedars-Sinai Medical Center; Los Angeles CA
| | - Konrad H. Schlick
- Departments of Neurology; Cedars-Sinai Medical Center; Los Angeles CA
| | | | - Brenda Rinsky
- Departments of Neurology; Cedars-Sinai Medical Center; Los Angeles CA
| | | | - Heather Jones
- Medicine; Cedars-Sinai Medical Center; Los Angeles CA
| | | | - Patrick D. Lyden
- Departments of Neurology; Cedars-Sinai Medical Center; Los Angeles CA
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Helbok R, Olson DM, Le Roux PD, Vespa P. Intracranial pressure and cerebral perfusion pressure monitoring in non-TBI patients: special considerations. Neurocrit Care 2015; 21 Suppl 2:S85-94. [PMID: 25208677 DOI: 10.1007/s12028-014-0040-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The effect of intracranial pressure (ICP) and the role of ICP monitoring are best studied in traumatic brain injury (TBI). However, a variety of acute neurologic illnesses e.g., subarachnoid hemorrhage, intracerebral hemorrhage, ischemic stroke, meningitis/encephalitis, and select metabolic disorders, e.g., liver failure and malignant, brain tumors can affect ICP. The purpose of this paper is to review the literature about ICP monitoring in conditions other than TBI and to provide recommendations how the technique may be used in patient management. A PubMed search between 1980 and September 2013 identified 989 articles; 225 of which were reviewed in detail. The technique used to monitor ICP in non-TBI conditions is similar to that used in TBI; however, indications for ICP monitoring often are intertwined with the presence of obstructive hydrocephalus and hence the use of ventricular catheters is more frequent. Increased ICP can adversely affect outcome, particularly when it fails to respond to treatment. However, patients with elevated ICP can still have favorable outcomes. Although the influence of ICP-based care on outcome in non-TBI conditions appears less robust than in TBI, monitoring ICP and cerebral perfusion pressure can play a role in guiding therapy in select patients.
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Affiliation(s)
- Raimund Helbok
- Department of Neurology, Neurocritical Care Unit, Innsbruck Medical University, Anichstr. 35, 6020, Innsbruck, Austria,
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Barlinn K, Kolieskova S, Shahripour RB, Kepplinger J, Boehme AK, Siepmann T, Puetz V, Bodechtel U, Jordan WD, Alexandrov AV. Increased pulsatility of the intracranial blood flow spectral waveform on transcranial Doppler does not point to peripheral arterial disease in stroke patients. J Stroke Cerebrovasc Dis 2014; 24:189-95. [PMID: 25440327 DOI: 10.1016/j.jstrokecerebrovasdis.2014.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/12/2014] [Accepted: 08/16/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Peripheral arterial disease (PAD) is common in patients with acute cerebral ischemia. Indexes of resistance derived from the systolic and diastolic velocities are routinely used in diagnostic transcranial Doppler (TCD) to detect intracranial arterial disease. We sought to explore whether these indexes can predict the presence of PAD in acute cerebral ischemia. METHODS We prospectively evaluated consecutive patients with acute cerebral ischemia. On TCD, peak-systolic and end-diastolic velocities in both middle cerebral and basilar arteries were manually measured to calculate pulsatility index (PI) and resistance index (RI). Increased resistance was defined as PI equal to 1.2 or more and RI equal to .75 or more. Ankle-brachial index (ABI) measurements were performed and an ABI equal to .9 or more was considered predictive of definite PAD. RESULTS We included 95 patients (45 male, 50 female) aged 66 ± 9 years with a median National Institutes Health Stroke Scale score of 3 (interquartile range, 8) points. The ABI was abnormal and consistent with definite PAD in 24 of 95 (25.3%; 95% confidence interval [CI], 16.4-34.2) patients. Increased PI did not differ among patients with and without PAD (20.8% vs. 28.2%, P = .60). Only 1 patient with PAD had increased RI as opposed to 4 patients without PAD (4.2% vs. 5.6%, P = 1.0). Increased PI was not found to be an independent predictor of PAD (odds ratio [OR], .68; 95% CI, .22-2.12; P = .51). Increases in both PI and RI independently predicted arterial hypertension (OR, 1.62; 95% CI, 1.19-2.21; P = .002 and OR, 3.20; 95% CI, 1.51-6.77; P = .002, respectively). CONCLUSIONS Our findings indicate that PAD cannot be inferred from intracranial flow parameters predictive of arterial disease and risk factors such as hypertension among patients with acute cerebral ischemia.
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Affiliation(s)
- Kristian Barlinn
- Department of Neurology, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, Alabama; Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany.
| | - Stanislava Kolieskova
- Department of Neurology, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, Alabama; International Clinical Research Centre, St. Anne's University Hospital, Brno, Czech Republic; Neurology Department, Masaryk University, Brno, Czech Republic
| | - Reza Bavarsad Shahripour
- Department of Neurology, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, Alabama
| | - Jessica Kepplinger
- Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany
| | - Amelia K Boehme
- Department of Epidemiology, School of Public Health, University of Alabama Hospital, Birmingham, Alabama
| | - Timo Siepmann
- Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany
| | - Volker Puetz
- Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany
| | - Ulf Bodechtel
- Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany
| | - William D Jordan
- Department of Vascular Surgery, University of Alabama Hospital, Birmingham, Alabama
| | - Andrei V Alexandrov
- Department of Neurology, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, Alabama; Department of Neurology, The University of Tennessee Health Science Center, Memphis, Tennessee
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Ovesen C, Havsteen I, Rosenbaum S, Christensen H. Prediction and observation of post-admission hematoma expansion in patients with intracerebral hemorrhage. Front Neurol 2014; 5:186. [PMID: 25324825 PMCID: PMC4179532 DOI: 10.3389/fneur.2014.00186] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/09/2014] [Indexed: 11/13/2022] Open
Abstract
Post-admission hematoma expansion in patients with intracerebral hemorrhage (ICH) comprises a simultaneous major clinical problem and a possible target for medical intervention. In any case, the ability to predict and observe hematoma expansion is of great clinical importance. We review radiological concepts in predicting and observing post-admission hematoma expansion. Hematoma expansion can be observed within the first 24 h after symptom onset, but predominantly occurs in the early hours. Thus capturing markers of on-going bleeding on imaging techniques could predict hematoma expansion. The spot sign observed on computed tomography angiography is believed to represent on-going bleeding and is to date the most well investigated and reliable radiological predictor of hematoma expansion as well as functional outcome and mortality. On non-contrast CT, the presence of foci of hypoattenuation within the hematoma along with the hematoma-size is reported to be predictive of hematoma expansion and outcome. Because patients tend to arrive earlier to the hospital, a larger fraction of acute ICH-patients must be expected to undergo hematoma expansion. This renders observation and radiological follow-up investigations increasingly relevant. Transcranial duplex sonography has in recent years proven to be able to estimate hematoma volume with good precision and could be a valuable tool in bedside serial observation of acute ICH-patients. Future studies will elucidate, if better prediction and observation of post-admission hematoma expansion can help select patients, who will benefit from hemostatic treatment.
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Affiliation(s)
- Christian Ovesen
- Department of Neurology, Bispebjerg Hospital, University of Copenhagen , Copenhagen , Denmark
| | - Inger Havsteen
- Department of Radiology, Bispebjerg Hospital, University of Copenhagen , Copenhagen , Denmark
| | - Sverre Rosenbaum
- Department of Neurology, Bispebjerg Hospital, University of Copenhagen , Copenhagen , Denmark
| | - Hanne Christensen
- Department of Neurology, Bispebjerg Hospital, University of Copenhagen , Copenhagen , Denmark
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12
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Abstract
Primary, spontaneous intracerebral hemorrhage (ICH) confers significant early mortality and long-term morbidity worldwide. Advances in acute care including investigative, diagnostic, and management strategies are important to improving outcomes for patients with ICH. Physicians caring for patients with ICH should anticipate the need for emergent blood pressure reduction, coagulopathy reversal, cerebral edema management, and surgical interventions including ventriculostomy and hematoma evacuation. This article reviews the pathogenesis and diagnosis of ICH, and details the acute management of spontaneous ICH in the critical care setting according to existing evidence and published guidelines.
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Affiliation(s)
- Sheila Chan
- Neurocritical Care Program, Department of Neurology, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, USA
| | - J Claude Hemphill
- Neurocritical Care Program, Department of Neurology, Brain and Spinal Injury Center, San Francisco General Hospital, University of California, San Francisco, Building 1, Room 101, 1001 Potrero Avenue, San Francisco, CA 94110, USA; Department of Neurological Surgery, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
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