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Zhang SQ, Zhang YL, Yuan L, Ma YB, Huang JM, Wen YQ, Zhu MH, Yang WS. A comprehensive prediction model predicts perihematomal edema growth in the acute stage after intracerebral hemorrhage. Clin Neurol Neurosurg 2024; 245:108495. [PMID: 39126898 DOI: 10.1016/j.clineuro.2024.108495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/14/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Perihematomal edema (PHE) is regarded as a potential intervention indicator of secondary injury following intracerebral hemorrhage (ICH). But it still lacks a comprehensive prediction model for early PHE formation. METHODS The included ICH patients have received an initial Computed Tomography scan within 6 hours of symptom onset. Hematoma volume and PHE volume were computed using semiautomated computer-assisted software. The volume of the hematoma, edema around the hematoma, and surface area of the hematoma were calculated. The platelet-to-lymphocyte ratio (PLR) was calculated by dividing the platelet count by the lymphocyte cell count. All analyses were 2-tailed, and the significance level was determined by P <0.05. RESULTS A total of 226 patients were included in the final analysis. The optimal cut-off values for PHE volume increase to predict poor outcomes were determined as 5.5 mL. For clinical applicability, we identified a value of 5.5 mL as the optimal threshold for early PHE growth. In the multivariate logistic regression analyses, we finally found that baseline hematoma surface area (p < 0.001), expansion-prone hematoma (p < 0.001), and PLR (p = 0.033) could independently predict PHE growth. The comprehensive prediction model demonstrated good performance in predicting PHE growth, with an area under the curve of 0.841, sensitivity of 0.807, and specificity of 0.732. CONCLUSION In this study, we found that baseline hematoma surface area, expansion-prone hematoma, and PLR were independently associated with PHE growth. Additionally, a risk nomogram model was established to predict the PHE growth in patients with ICH.
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Affiliation(s)
- Shu-Qiang Zhang
- Department of Radiology, Chongqing University FuLing Hospital, Chongqing 408000, China; Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yan-Ling Zhang
- Department of Radiology, Chongqing University FuLing Hospital, Chongqing 408000, China
| | - Liang Yuan
- Department of Radiology, University-Town Hospital of Chongqing Medical University, Chongqing 401331, China
| | - Yong-Bo Ma
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Jun-Meng Huang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yi-Qian Wen
- Department of Radiology, University-Town Hospital of Chongqing Medical University, Chongqing 401331, China
| | - Ming-Hong Zhu
- Department of Radiology, Chongqing University FuLing Hospital, Chongqing 408000, China.
| | - Wen-Song Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
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Giede-Jeppe A, Gerner ST, Sembill JA, Kuramatsu JB, Lang S, Luecking H, Staykov D, Huttner HB, Volbers B. Peak Edema Extension Distance: An Edema Measure Independent from Hematoma Volume Associated with Functional Outcome in Intracerebral Hemorrhage. Neurocrit Care 2024; 40:1089-1098. [PMID: 38030878 PMCID: PMC11147861 DOI: 10.1007/s12028-023-01886-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Our objective was to test the association between hematoma volume and long-term (> 72 h) edema extension distance (EED) evolution and the association between peak EED and early EED increase with functional outcome at 3 months in patients with intracerebral hemorrhage (ICH). METHODS This retrospective cohort study included patients with spontaneous supratentorial ICH between January 2006 and January 2014. EED, an edema measure defined as the distance between the hematoma border and the outer edema border, was calculated by using absolute hematoma and edema volumes. We used multivariable logistic regression accounting for age, ICH volume, and location and receiver operating characteristic analysis for assessing measures associated with functional outcome and EED evolution. Functional outcome after 3 months was assessed by using the modified Rankin Scale (0-3 = favorable, 4-6 = unfavorable). To identify properties associated with peak EED multivariable linear and logistic regression analyses were conducted. RESULTS A total of 292 patients were included. Median age was 70 years (interquartile range [IQR] 62-78), median ICH volume on admission 17.7 mL (IQR 7.9-40.2), median peak perihemorrhagic edema (PHE) volume was 37.5 mL (IQR 19.1-60.6), median peak EED was 0.67 cm (IQR 0.51-0.84) with an early EED increase up to 72 h (EED72-0) of 0.06 cm (- 0.02 to 0.15). Peak EED was found to be independent of ICH volume (R2 = 0.001, p = 0.6). In multivariable analyses, peak EED (odds ratio 0.224, 95% confidence interval [CI] [0.071-0.705]) and peak PHE volume (odds ratio 0.984 [95% CI 0.973-0.994]) were inversely associated with favorable functional outcome at 3 months. Receiver operating characteristic analysis identified a peak PHE volume of 26.8 mL (area under the curve 0.695 [95% CI 0.632-0.759]; p ≤ 0.001) and a peak EED of 0.58 cm (area under the curve 0.608 [95% CI 0.540-0.676]; p = 0.002) as best predictive values for outcome discrimination. CONCLUSIONS Compared with absolute peak PHE volume, peak EED represents a promising edema measure in patients with ICH that is largely hematoma volume-independent and nevertheless associated with functional outcome.
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Affiliation(s)
- Antje Giede-Jeppe
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Stefan T Gerner
- Department of Neurology, University of Gießen, Gießen, Germany
| | - Jochen A Sembill
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Joji B Kuramatsu
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - Stefan Lang
- Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Hannes Luecking
- Department of Neuroradiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Hagen B Huttner
- Department of Neurology, University of Gießen, Gießen, Germany
| | - Bastian Volbers
- Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
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Murthy SB. Emergent Management of Intracerebral Hemorrhage. Continuum (Minneap Minn) 2024; 30:641-661. [PMID: 38830066 DOI: 10.1212/con.0000000000001422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE Nontraumatic intracerebral hemorrhage (ICH) is a potentially devastating cerebrovascular disorder. Several randomized trials have assessed interventions to improve ICH outcomes. This article summarizes some of the recent developments in the emergent medical and surgical management of acute ICH. LATEST DEVELOPMENTS Recent data have underscored the protracted course of recovery after ICH, particularly in patients with severe disability, cautioning against early nihilism and withholding of life-sustaining treatments. The treatment of ICH has undergone rapid evolution with the implementation of intensive blood pressure control, novel reversal strategies for coagulopathy, innovations in systems of care such as mobile stroke units for hyperacute ICH care, and the emergence of newer minimally invasive surgical approaches such as the endoport and endoscope-assisted evacuation techniques. ESSENTIAL POINTS This review discusses the current state of evidence in ICH and its implications for practice, using case illustrations to highlight some of the nuances involved in the management of acute ICH.
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Shuvalova M, Dmitrieva A, Belousov V, Nosov G. The role of reactive oxygen species in the regulation of the blood-brain barrier. Tissue Barriers 2024:2361202. [PMID: 38808582 DOI: 10.1080/21688370.2024.2361202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/23/2024] [Indexed: 05/30/2024] Open
Abstract
The blood-brain barrier (BBB) regulates the exchange of metabolites and cells between the blood and brain, and maintains central nervous system homeostasis. Various factors affect BBB barrier functions, including reactive oxygen species (ROS). ROS can act as stressors, damaging biological molecules, but they also serve as secondary messengers in intracellular signaling cascades during redox signaling. The impact of ROS on the BBB has been observed in multiple sclerosis, stroke, trauma, and other neurological disorders, making blocking ROS generation a promising therapeutic strategy for BBB dysfunction. However, it is important to consider ROS generation during normal BBB functioning for signaling purposes. This review summarizes data on proteins expressed by BBB cells that can be targets of redox signaling or oxidative stress. It also provides examples of signaling molecules whose impact may cause ROS generation in the BBB, as well as discusses the most common diseases associated with BBB dysfunction and excessive ROS generation, open questions that arise in the study of this problem, and possible ways to overcome them.
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Affiliation(s)
- Margarita Shuvalova
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Pirogov Russian National Research Medical University, Moscow, Russia
- Department of metabolism and redox biology, Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Moscow, Russia
| | - Anastasiia Dmitrieva
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Vsevolod Belousov
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Pirogov Russian National Research Medical University, Moscow, Russia
- Department of metabolism and redox biology, Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian Academy of Sciences, Moscow, Russia
- Federal Center of Brain Research and Neurotechnologies, Federal Medical Biological Agency, Moscow, Russia
- Life Improvement by Future Technologies (LIFT) Center, Skolkovo, Moscow, Russia
| | - Georgii Nosov
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain Research and Neurotechnologies, Federal Medical Biological Agency, Moscow, Russia
- Life Improvement by Future Technologies (LIFT) Center, Skolkovo, Moscow, Russia
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Zhang P, Gao C, Guo Q, Yang D, Zhang G, Lu H, Zhang L, Zhang G, Li D. Single-cell RNA sequencing reveals the evolution of the immune landscape during perihematomal edema progression after intracerebral hemorrhage. J Neuroinflammation 2024; 21:140. [PMID: 38807233 PMCID: PMC11131315 DOI: 10.1186/s12974-024-03113-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/26/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Perihematomal edema (PHE) after post-intracerebral hemorrhage (ICH) has complex pathophysiological mechanisms that are poorly understood. The complicated immune response in the post-ICH brain constitutes a crucial component of PHE pathophysiology. In this study, we aimed to characterize the transcriptional profiles of immune cell populations in human PHE tissue and explore the microscopic differences between different types of immune cells. METHODS 9 patients with basal ganglia intracerebral hemorrhage (hematoma volume 50-100 ml) were enrolled in this study. A multi-stage profile was developed, comprising Group1 (n = 3, 0-6 h post-ICH, G1), Group2 (n = 3, 6-24 h post-ICH, G2), and Group3 (n = 3, 24-48 h post-ICH, G3). A minimal quantity of edematous tissue surrounding the hematoma was preserved during hematoma evacuation. Single cell RNA sequencing (scRNA-seq) was used to map immune cell populations within comprehensively resected PHE samples collected from patients at different stages after ICH. RESULTS We established, for the first time, a comprehensive landscape of diverse immune cell populations in human PHE tissue at a single-cell level. Our study identified 12 microglia subsets and 5 neutrophil subsets in human PHE tissue. What's more, we discovered that the secreted phosphoprotein-1 (SPP1) pathway served as the basis for self-communication between microglia subclusters during the progression of PHE. Additionally, we traced the trajectory branches of different neutrophil subtypes. Finally, we also demonstrated that microglia-produced osteopontin (OPN) could regulate the immune environment in PHE tissue by interacting with CD44-positive cells. CONCLUSIONS As a result of our research, we have gained valuable insight into the immune-microenvironment within PHE tissue, which could potentially be used to develop novel treatment modalities for ICH.
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Affiliation(s)
- Peng Zhang
- Department of Clinical Medicine, Jining Medical University, Jining, China
| | - Cong Gao
- Department of Clinical Medicine, Jining Medical University, Jining, China
| | - Qiang Guo
- Department of Emergency Stroke, Affiliated Hospital of Jining Medical University, Jining, China
| | - Dongxu Yang
- Department of Emergency Stroke, Affiliated Hospital of Jining Medical University, Jining, China
| | - Guangning Zhang
- Department of Neurosurgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Hao Lu
- Department of Emergency Stroke, Affiliated Hospital of Jining Medical University, Jining, China
| | - Liman Zhang
- Department of Pathology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Guorong Zhang
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Daojing Li
- Department of Neurology, Affiliated Hospital of Jining Medical University, Jining, China.
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Su Q, Su C, Zhang Y, Guo Y, Liu Y, Liu Y, Yong VW, Xue M. Adjudin protects blood-brain barrier integrity and attenuates neuroinflammation following intracerebral hemorrhage in mice. Int Immunopharmacol 2024; 132:111962. [PMID: 38565042 DOI: 10.1016/j.intimp.2024.111962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/09/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
Secondary brain injury exacerbates neurological dysfunction and neural cell death following intracerebral hemorrhage (ICH), targeting the pathophysiological mechanism of the secondary brain injury holds promise for improving ICH outcomes. Adjudin, a potential male contraceptive, exhibits neuroprotective effects in brain injury disease models, yet its impact in the ICH model remains unknown. In this study, we investigated the effects of adjudin on brain injury in a mouse ICH model and explored its underlying mechanisms. ICH was induced in male C57BL/6 mice by injecting collagenase into the right striatum. Mice received adjudin treatment (50 mg/kg/day) for 3 days before euthanization and the perihematomal tissues were collected for further analysis. Adjudin significantly reduced hematoma volume and improved neurological function compared with the vehicle group. Western blot showed that Adjudin markedly decreased the expression of MMP-9 and increased the expression of tight junctions (TJs) proteins, Occludin and ZO-1, and adherens junctions (AJs) protein VE-cadherin. Adjudin also decreased the blood-brain barrier (BBB) permeability, as indicated by the reduced albumin and Evans Blue leakage, along with a decrease in brain water content. Immunofluorescence staining revealed that adjudin noticeably reduced the infiltration of neutrophil, activation of microglia/macrophages, and reactive astrogliosis, accompanied by an increase in CD206 positive microglia/macrophages which exhibit phagocytic characteristics. Adjudin concurrently decreased the generation of proinflammatory cytokines, such as TNF-α and IL-1β. Additionally, adjudin increased the expression of aquaporin 4 (AQP4). Furthermore, adjudin reduced brain cell apoptosis, as evidenced by increased expression of anti-apoptotic protein Bcl-2, and decreased expression of apoptosis related proteins Bax, cleaved caspase-3 and fewer TUNEL positive cells. Our data suggest that adjudin protects against ICH-induced secondary brain injury and may serve as a potential neuroprotective agent for ICH treatment.
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Affiliation(s)
- Qiuyang Su
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Chunhe Su
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Yan Zhang
- Department of Neurology, People's Hospital of Qianxinan Prefecture, Guizhou, China
| | - Yan Guo
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Yang Liu
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan 450000, China
| | - Yuanyuan Liu
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan 450000, China
| | - V Wee Yong
- Hotchkiss Brain Institute and Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
| | - Mengzhou Xue
- Department of Cerebrovascular Diseases, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China; Academy of Medical Science, Zhengzhou University, Zhengzhou, Henan 450000, China.
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Kakarla R, Bhangoo G, Pandian J, Shuaib A, Kate MP. Remote Ischemic Conditioning to Reduce Perihematoma Edema in Patients with Intracerebral Hemorrhage (RICOCHET): A Randomized Control Trial. J Clin Med 2024; 13:2696. [PMID: 38731225 PMCID: PMC11084750 DOI: 10.3390/jcm13092696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Early perihematomal edema (PHE) growth is associated with worse functional outcomes at 90 days. Remote Ischemic conditioning (RIC) may reduce perihematomal inflammation if applied early to patients with intracerebral hemorrhage (ICH). We hypothesize that early RIC, delivered for seven days in patients with spontaneous ICH, may reduce PHE growth. Methods: ICH patients presenting within 6 h of symptom onset and hematoma volume < 60 milliliters (mL) were randomized to an RIC + standard care or standard care (SC) group. The primary outcome measure was calculated edema extension distance (EED), with the cm assessed on day seven. Results: Sixty patients were randomized with a mean ± SD age of 57.5 ± 10.8 years, and twenty-two (36.7%) were female. The relative baseline median PHE were similar (RIC group 0.75 (0.5-0.9) mL vs. SC group 0.91 (0.5-1.2) mL, p = 0.30). The median EEDs at baseline were similar (RIC group 0.58 (0.3-0.8) cm vs. SC group 0.51 (0.3-0.8) cm, p = 0.76). There was no difference in the median day 7 EED (RIC group 1.1 (0.6-1.2) cm vs. SC group 1 (0.9-1.2) cm, p = 0.75). Conclusions: Early RIC therapy delivered daily for seven days was feasible. However, no decrease in EED was noted with the intervention.
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Affiliation(s)
- Raviteja Kakarla
- Department of Neurology, Rangaraya Medical College, Kakinada 533003, India;
| | - Gurpriya Bhangoo
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana 141008, India;
| | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada;
| | - Mahesh P. Kate
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada;
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Sobowale OA, Hostettler IC, Wu TY, Heal C, Wilson D, Shah DG, Strbian D, Putaala J, Tatlisumak T, Vail A, Sharma G, Davis SM, Werring DJ, Meretoja A, Allan SM, Parry-Jones AR. Baseline perihematomal edema, C-reactive protein, and 30-day mortality are not associated in intracerebral hemorrhage. Front Neurol 2024; 15:1359760. [PMID: 38645743 PMCID: PMC11026700 DOI: 10.3389/fneur.2024.1359760] [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: 12/21/2023] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Background The relationship between baseline perihematomal edema (PHE) and inflammation, and their impact on survival after intracerebral hemorrhage (ICH) are not well understood. Objective Assess the association between baseline PHE, baseline C-reactive protein (CRP), and early death after ICH. Methods Analysis of pooled data from multicenter ICH registries. We included patients presenting within 24 h of symptom onset, using multifactorial linear regression model to assess the association between CRP and edema extension distance (EED), and a multifactorial Cox regression model to assess the association between CRP, PHE volume and 30-day mortality. Results We included 1,034 patients. Median age was 69 (interquartile range [IQR] 59-79), median baseline ICH volume 11.5 (IQR 4.3-28.9) mL, and median baseline CRP 2.5 (IQR 1.5-7.0) mg/L. In the multifactorial analysis [adjusting for cohort, age, sex, log-ICH volume, ICH location, intraventricular hemorrhage (IVH), statin use, glucose, and systolic blood pressure], baseline log-CRP was not associated with baseline EED: for a 50% increase in CRP the difference in expected mean EED was 0.004 cm (95%CI 0.000-0.008, p = 0.055). In a further multifactorial analysis, after adjusting for key predictors of mortality, neither a 50% increase in PHE volume nor CRP were associated with higher 30-day mortality (HR 0.97; 95%CI 0.90-1.05, p = 0.51 and HR 0.98; 95%CI 0.93-1.03, p = 0.41, respectively). Conclusion Higher baseline CRP is not associated with higher baseline edema, which is also not associated with mortality. Edema at baseline might be driven by different pathophysiological processes with different effects on outcome.
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Affiliation(s)
- Oluwaseun A. Sobowale
- Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Center, University of Manchester, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Center, Manchester Academic Health Science Center, Northern Care Alliance NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
| | - Isabel C. Hostettler
- Stroke Research Center, UCL Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Teddy Y. Wu
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Calvin Heal
- Center for Biostatistics, The University of Manchester, Manchester Academic Health Science Center, Manchester, United Kingdom
| | - Duncan Wilson
- Stroke Research Center, UCL Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Darshan G. Shah
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Department of Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andy Vail
- Center for Biostatistics, The University of Manchester, Manchester Academic Health Science Center, Manchester, United Kingdom
| | - Gagan Sharma
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Stephen M. Davis
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - David J. Werring
- Stroke Research Center, UCL Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Atte Meretoja
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Department of Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Stuart M. Allan
- Geoffrey Jefferson Brain Research Center, Manchester Academic Health Science Center, Northern Care Alliance NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Adrian R. Parry-Jones
- Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Center, University of Manchester, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Center, Manchester Academic Health Science Center, Northern Care Alliance NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
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Rajeswaran AB, Ali A, Safi S, Abdulghani Saleh AE. Efficacy and safety of local fibrinolytic therapy in intracranial hemorrhages: A systematic review and meta-analysis of randomised controlled trials. World Neurosurg X 2024; 22:100316. [PMID: 38469383 PMCID: PMC10926218 DOI: 10.1016/j.wnsx.2024.100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/21/2024] [Indexed: 03/13/2024] Open
Affiliation(s)
- Arun Babu Rajeswaran
- Department of Neurosurgery, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Arshad Ali
- Department of Neurosurgery, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
- Department of Clinical Academic Sciences, College of Medicine, Qatar University, Doha, Qatar
- Department of Neurological Sciences, Weill Cornell Medicine, Doha, Qatar
| | - Saleh Safi
- Department of Neurosurgery, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
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10
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Haque ME, Boren SB, Mills J, Schneider KG, Parekh M, Fraser SM, Bach I, Hariharan P, Zelnick PJ, Guerra Castanon FS, Naveed A, Tariq M, Arevalo OD, Hasan KM, Escobar M, Zhao X, Sitton C, Narayana PA, Grotta JC, Aronowski J, Savitz SI. Dynamic Imaging of Blood Coagulation Within the Hematoma of Patients With Acute Hemorrhagic Stroke. Stroke 2024; 55:1015-1024. [PMID: 38275117 PMCID: PMC10962442 DOI: 10.1161/strokeaha.123.044343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 12/12/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND The dynamics of blood clot (combination of Hb [hemoglobin], fibrin, and a higher concentration of aggregated red blood cells) formation within the hematoma of an intracerebral hemorrhage is not well understood. A quantitative neuroimaging method of localized coagulated blood volume/distribution within the hematoma might improve clinical decision-making. METHODS The deoxyhemoglobin of aggregated red blood cells within extravasated blood exhibits a higher magnetic susceptibility due to unpaired heme iron electrons. We propose that coagulated blood, with higher aggregated red blood cell content, will exhibit (1) a higher positive susceptibility than noncoagulated blood and (2) increase in fibrin polymerization-restricted localized diffusion, which can be measured noninvasively using quantitative susceptibility mapping and diffusion tensor imaging. In this serial magnetic resonance imaging study, we enrolled 24 patients with acute intracerebral hemorrhage between October 2021 to May 2022 at a stroke center. Patients were 30 to 70 years of age and had a hematoma volume >15 cm3 and National Institutes of Health Stroke Scale score >1. The patients underwent imaging 3×: within 12 to 24 (T1), 36 to 48 (T2), and 60 to 72 (T3) hours of last seen well on a 3T magnetic resonance imaging system. Three-dimensional anatomic, multigradient echo and 2-dimensional diffusion tensor images were obtained. Hematoma and edema volumes were calculated, and the distribution of coagulation was measured by dynamic changes in the susceptibilities and fractional anisotropy within the hematoma. RESULTS Using a coagulated blood phantom, we demonstrated a linear relationship between the percentage coagulation and susceptibility (R2=0.91) with a positive red blood cell stain of the clot. The quantitative susceptibility maps showed a significant increase in hematoma susceptibility (T1, 0.29±0.04 parts per millions; T2, 0.36±0.04 parts per millions; T3, 0.45±0.04 parts per millions; P<0.0001). A concomitant increase in fractional anisotropy was also observed with time (T1, 0.40±0.02; T2, 0.45±0.02; T3, 0.47±0.02; P<0.05). CONCLUSIONS This quantitative neuroimaging study of coagulation within the hematoma has the potential to improve patient management, such as safe resumption of anticoagulants, the need for reversal agents, the administration of alteplase to resolve the clot, and the need for surgery.
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Affiliation(s)
- Muhammad E. Haque
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology (M.E.H, S.B.B., K.G.S., M.P., S.M.F, I.B., P.H., P.J.Z., F.S.G.C., A.N., M.T., X.Z., J.A., S.I.S.)
| | - Seth B. Boren
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology (M.E.H, S.B.B., K.G.S., M.P., S.M.F, I.B., P.H., P.J.Z., F.S.G.C., A.N., M.T., X.Z., J.A., S.I.S.)
| | - James Mills
- Department of Psychiatry, University of Iowa, Iowa City (J.M.)
| | - Kerry G. Schneider
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology (M.E.H, S.B.B., K.G.S., M.P., S.M.F, I.B., P.H., P.J.Z., F.S.G.C., A.N., M.T., X.Z., J.A., S.I.S.)
| | - Maria Parekh
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology (M.E.H, S.B.B., K.G.S., M.P., S.M.F, I.B., P.H., P.J.Z., F.S.G.C., A.N., M.T., X.Z., J.A., S.I.S.)
| | - Stuart M. Fraser
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology (M.E.H, S.B.B., K.G.S., M.P., S.M.F, I.B., P.H., P.J.Z., F.S.G.C., A.N., M.T., X.Z., J.A., S.I.S.)
| | - Ivo Bach
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology (M.E.H, S.B.B., K.G.S., M.P., S.M.F, I.B., P.H., P.J.Z., F.S.G.C., A.N., M.T., X.Z., J.A., S.I.S.)
| | - Praveen Hariharan
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology (M.E.H, S.B.B., K.G.S., M.P., S.M.F, I.B., P.H., P.J.Z., F.S.G.C., A.N., M.T., X.Z., J.A., S.I.S.)
| | - Pamela J. Zelnick
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology (M.E.H, S.B.B., K.G.S., M.P., S.M.F, I.B., P.H., P.J.Z., F.S.G.C., A.N., M.T., X.Z., J.A., S.I.S.)
| | - Felix S. Guerra Castanon
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology (M.E.H, S.B.B., K.G.S., M.P., S.M.F, I.B., P.H., P.J.Z., F.S.G.C., A.N., M.T., X.Z., J.A., S.I.S.)
| | - Asim Naveed
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology (M.E.H, S.B.B., K.G.S., M.P., S.M.F, I.B., P.H., P.J.Z., F.S.G.C., A.N., M.T., X.Z., J.A., S.I.S.)
| | - Muhammad Tariq
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology (M.E.H, S.B.B., K.G.S., M.P., S.M.F, I.B., P.H., P.J.Z., F.S.G.C., A.N., M.T., X.Z., J.A., S.I.S.)
| | - Octavio D. Arevalo
- Department of Radiology, Louisiana State University, Shreveport (O.D.A.)
| | - Khader M. Hasan
- Department of Interventional Diagnostic Radiology (K.M.H., P.A.N., C.S.)
| | - Miguel Escobar
- McGovern Medical School, The University of Texas Health Science Center at Houston (M.E.)
| | - Xiurong Zhao
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology (M.E.H, S.B.B., K.G.S., M.P., S.M.F, I.B., P.H., P.J.Z., F.S.G.C., A.N., M.T., X.Z., J.A., S.I.S.)
| | - Clark Sitton
- Department of Interventional Diagnostic Radiology (K.M.H., P.A.N., C.S.)
| | | | - James C. Grotta
- Stroke Research and Mobile Stroke Unit, Department of Neurology, Memorial Hermann Hospital, Houston, TX (J.C.G.)
| | - Jaroslaw Aronowski
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology (M.E.H, S.B.B., K.G.S., M.P., S.M.F, I.B., P.H., P.J.Z., F.S.G.C., A.N., M.T., X.Z., J.A., S.I.S.)
| | - Sean I. Savitz
- Institute for Stroke and Cerebrovascular Diseases and Department of Neurology (M.E.H, S.B.B., K.G.S., M.P., S.M.F, I.B., P.H., P.J.Z., F.S.G.C., A.N., M.T., X.Z., J.A., S.I.S.)
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11
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Yuan S, Ma Q, Hou C, Zhao Y, Liu KJ, Ji X, Qi Z. Association of serum occludin levels and perihematomal edema volumes in intracranial hemorrhage patients. CNS Neurosci Ther 2024; 30:e14450. [PMID: 37721332 PMCID: PMC10916427 DOI: 10.1111/cns.14450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 07/18/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND AND PURPOSE Perihematomal edema (PHE) is one of the severe secondary damages following intracranial hemorrhage (ICH). Studies showed that blood-brain barrier (BBB) injury contributes to the development of PHE. Previous studies showed that occludin protein is a potential biomarker of BBB injury. In the present study, we investigated whether the levels of serum occludin on admission are associated with PHE volumes in ICH patients. METHODS This cross-sectional study included 90ICH patients and 32 healthy controls.The volumes of hematoma and PHE were assessed using non-contrast cranial CT within 30 min of admission. Blood samples were drawn on admission, and the levels of baseline serum occludin were detected using enzyme-linked immunosorbent assay. Partial correlation analysis and multiple linear regression analysis were performed to evaluate the association between serum occludin levels and PHE volumes in ICH patients. RESULTS The serum occludin levels in ICH patients were much higher than health controls (median 0.27 vs. 0.13 ng/mL, p < 0.001). At admission, 34 ICH patients (37.78%) had experienced a severe PHE (≥30 mL), and their serum occludin levels were higher compared to those with mild PHE (<30 mL) (0.78 vs. 0.21 ng/mL, p < 0.001). The area under the receiver operating characteristics curve (ROC) of serum occludin level in predicting severe PHE was 0.747 (95% confidence interval CI 0.644-0.832, p < 0.001). There was a significant positive correlation between serum occludin levels and PHE volumes (partial correlation r = 0.675, p < 0.001). Multiple linear regression analysis showed that serum occludin levels remained independently associated with the PHE volumes after adjusting other confounding factors. CONCLUSION The present study showed that serum occludin levels at admission were independently correlated with PHE volumes in ICH patients, which may provide a biomarker indicating PHE volume change.
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Affiliation(s)
- Shuhua Yuan
- Cerebrovascular Diseases Research InstituteXuanwu Hospital of Capital Medical UniversityBeijingChina
| | - Qingfeng Ma
- Department of NeurologyXuanwu Hospital of Capital Medical UniversityBeijingChina
| | - Chengbei Hou
- Center for Evidence‐Based Medicine, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Yue Zhao
- Clinical Lab, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Ke Jian Liu
- Department of Pathology, Renaissance School of MedicineStony Brook UniversityStony BrookNew YorkUSA
| | - Xunming Ji
- Cerebrovascular Diseases Research InstituteXuanwu Hospital of Capital Medical UniversityBeijingChina
- Center of Stroke, Beijing Institute for Brain DisordersCapital Medical UniversityBeijingChina
| | - Zhifeng Qi
- Cerebrovascular Diseases Research InstituteXuanwu Hospital of Capital Medical UniversityBeijingChina
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Cliteur MP, van der Kolk AG, Hannink G, Hofmeijer J, Jolink WMT, Klijn CJM, Schreuder FHBM. Anakinra in cerebral haemorrhage to target secondary injury resulting from neuroinflammation (ACTION): Study protocol of a phase II randomised clinical trial. Eur Stroke J 2024; 9:265-273. [PMID: 37713268 PMCID: PMC10916813 DOI: 10.1177/23969873231200686] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/10/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Inflammation plays a vital role in the development of secondary brain injury after spontaneous intracerebral haemorrhage (ICH). Interleukin-1 beta is an early pro-inflammatory cytokine and a potential therapeutic target. AIM To determine the effect of treatment with recombinant human interleukin-1 receptor antagonist anakinra on perihematomal oedema (PHO) formation in patients with spontaneous ICH compared to standard medical management, and investigate whether this effect is dose-dependent. METHODS ACTION is a phase-II, prospective, randomised, three-armed (1:1:1) trial with open-label treatment and blinded end-point assessment (PROBE) at three hospitals in The Netherlands. We will include 75 patients with a supratentorial spontaneous ICH admitted within 8 h after symptom onset. Participants will receive anakinra in a high dose (loading dose 500 mg intravenously, followed by infusion with 2 mg/kg/h over 72 h; n = 25) or in a low dose (loading dose 100 mg subcutaneously, followed by 100 mg subcutaneous twice daily for 72 h; n = 25), plus standard care. The control group (n = 25) will receive standard medical management. OUTCOMES Primary outcome is PHO, measured as oedema extension distance on MRI at day 7 ± 1. Secondary outcomes include the safety profile of anakinra, the effect of anakinra on serum inflammation markers, MRI measures of blood brain barrier integrity, and functional outcome at 90 ± 7 days. DISCUSSION The ACTION trial will provide insight into whether targeting interleukin-1 beta in the early time window after ICH onset could ameliorate secondary brain injury. This may contribute to the development of new treatment options to improve clinical outcome after ICH.
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Affiliation(s)
- MP Cliteur
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - AG van der Kolk
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G Hannink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Hofmeijer
- Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
| | - WMT Jolink
- Department of Neurology, Isala Hospital, Zwolle, The Netherlands
| | - CJM Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - FHBM Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
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Tang Z, Huang W, Chen Q, Guo C, Zheng K, Wei W, Jiang Q, Yang R. Curative effect analysis of robot-assisted drainage surgery in treatment of spontaneous hypertensive brainstem hemorrhage. Front Neurol 2024; 15:1352949. [PMID: 38469591 PMCID: PMC10925720 DOI: 10.3389/fneur.2024.1352949] [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: 12/15/2023] [Accepted: 02/13/2024] [Indexed: 03/13/2024] Open
Abstract
Objective Spontaneous hypertensive brainstem hemorrhage (HBSH) is characterized by sudden onset, rapid progression and poor prognosis. There has been a growing tendency of surgical treatment for HBSH. This study aimed to investigate outcomes and potential factors associated with the prognosis of robot-assisted drainage surgery for HBSH treatment. Methods Patients with HBSH from July 2016 to March 2023 at a single neurosurgery center were included and divided into conservative group and surgical groups. Baseline and clinical data, radiographic characteristics, complications, and outcome evaluations were recorded and analyzed. Results A total of 125 patients, with 74 in the conservative group and 51 in the surgical group, were enrolled in the study. Mortality at 6 months was 59/74 (79.7%) in the conservative group and 9/51 (17.6%) in the surgical group. Twenty-four patients (47.1%) achieved favorable outcomes in the surgical group, whereas this rate in the conservative group was only 5.4% (4/74). There was a significant difference in NIHSS, GCS, and mRS at 6 months between surviving patients in the conservative and surgical groups. In prognostic analysis in the surgical subgroup, initial GCS score [5 (IQR 4-7) vs. 3 (IQR 3-4), p < 0.001], NIHSS [36 (IQR 32-38) vs. 40 (IQR 38-40), p < 0.001], smoking history [45.8% (11/24) vs. 74.1% (20/27), p = 0.039], hematoma volume [6.9 (IQR 6.2-7.6) vs. 9.6 (IQR 7.3-11.4), p = 0.001], and hemorrhage location (p = 0.001) were potential risk factors for poor 6-month prognosis after robot-assisted surgery for HBSH. Conclusion Based on the results of this study, robot-assisted minimally invasive drainage of brain stem hematoma may significantly reduce mortality and improve prognosis. Surgery should be conducted for selected patients.
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Affiliation(s)
- Zhiji Tang
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Weilong Huang
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Qiqi Chen
- Department of Magnetoencephalography, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Changgui Guo
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Kuan Zheng
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Wenjin Wei
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Qiuhua Jiang
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
| | - Ruijin Yang
- Department of Neurosurgery, Ganzhou People’s Hospital, Ganzhou, Jiangxi, China
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14
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Witsch J, Cao Q, Song JW, Luo Y, Sloane KL, Rothstein A, Favilla CG, Cucchiara BL, Kasner SE, Messé SR, Choi HA, McCullough LD, Mayer SA, Gusdon AM. Sex Differences in Perihematomal Edema Volume and Outcome After Intracerebral Hemorrhage. Neurocrit Care 2024:10.1007/s12028-024-01945-z. [PMID: 38379104 DOI: 10.1007/s12028-024-01945-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Although larger hematoma volume is associated with worse outcome after intracerebral hemorrhage (ICH), the association between perihematomal edema (PHE) volume and outcome remains uncertain, as does the impact of sex on PHE and outcome. Here we aimed to determine whether larger PHE volume is associated with worse outcome and whether PHE volume trajectories differ by sex. METHODS We conducted a post hoc analysis of the Factor VIIa for Acute Hemorrhagic Stroke Treatment (FAST) trial, which randomized patients with ICH to receive recombinant activated factor VIIa or placebo. Computerized planimetry calculated PHE and ICH volumes on serial computed tomography (CT) scans (at baseline [within 3 h of onset], at 24 h, and at 72 h). Generalized estimating equations examined interactions between sex, CT time points, and FAST treatment arm on PHE and ICH volumes. Mixed and multivariable logistic models examined associations between sex, PHE, and outcomes. RESULTS A total of 781 patients with supratentorial ICH (mean age 65 years) were included. Compared to women (n = 296), men (n = 485) had similar median ICH (14.9 vs. 13.6 mL, p = 0.053) and PHE volumes (11.1 vs. 10.5 mL, p = 0.56) at baseline but larger ICH and PHE volumes at 24 h (19.0 vs. 14.0 mL, p < 0.001; 22.2 vs. 15.7 mL, p < 0.001) and 72 h (16.0 vs. 11.8 mL, p < 0.001; 28.7 vs. 19.9 mL, p < 0.001). Men had higher absolute early PHE expansion (p < 0.001) and more hematoma expansion (growth ≥ 33% or 6 mL at 24 h, 33% vs. 22%, p < 0.001). An interaction between sex and CT time points on PHE volume (p < 0.001), but not on ICH volume, confirmed a steeper PHE trajectory in men. PHE expansion (per 5 mL, odds radio 1.19, 95% confidence interval 1.10-1.28), but not sex, was associated with poor outcome. CONCLUSIONS Early PHE expansion and trajectory in men were significantly higher. PHE expansion was associated with poor outcomes independent of sex. Mechanisms leading to sex differences in PHE trajectories merit further investigation.
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Affiliation(s)
- Jens Witsch
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Quy Cao
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jae W Song
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Yunshi Luo
- Graduate School of Education, University of Pennsylvania, Philadelphia, PA, USA
| | - Kelly L Sloane
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Aaron Rothstein
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Christopher G Favilla
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Brett L Cucchiara
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Scott E Kasner
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Steve R Messé
- Department of Neurology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Huimahn A Choi
- Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Louise D McCullough
- Department of Neurobiology & Anatomy, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stephan A Mayer
- Departments of Neurology and Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Aaron M Gusdon
- Department of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, USA
- Department of Neurobiology & Anatomy, University of Texas Health Science Center at Houston, Houston, TX, USA
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Chen S, Su T, Wang Y, Li Z, Li Y, Ge Y, Mi D. Automatic cerebral computed tomography venographic imaging based on the prior knowledge of cerebral blood circulation. J Neuroradiol 2023; 50:556-561. [PMID: 36773846 DOI: 10.1016/j.neurad.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND AND PURPOSE Current clinical computed tomography venographic (cCTV) images present limited cerebral venous profiles. Therefore, this study aimed to develop an automatic cerebral CTV imaging technique using computed tomographic perfusion (CTP) images in a cohort of patients with stroke. MATERIALS AND METHODS We retrospectively evaluated 10 (intracerebral hemorrhage) and 2 (acute ischemic stroke) patients who underwent institutional CTP imaging. CTV images were processed with the proposed CTV (pCTV) technique, and pCTV and cCTV images were then independently evaluated by two experienced neuroradiologists blinded to all clinical information using a novel scoring method that considered overall image quality, venous visibility, and arterial mis-segmentation. Venous visibility was separately evaluated for the dural sinus, superficial vein, and deep vein. Then, statistical analysis was performed to determine whether the pCTV technique was superior to the cCTV technique. RESULTS In total, 14 sets of pCTV images were generated and compared with cCTV images. The overall image quality and venous visibility scores of pCTV images were significantly higher than those of cCTV images (all values of p<0.05), especially for the dural sinus (median [25th, 75th percentiles], 14.00 [13.63, 15.50] vs. 7.50 [7.00, 10.88]), and superficial vein (9.00 [8.88, 10.00] vs. 3.25 [1.63, 8.25]), while the difference in arterial mis-segmentation was not statistically significant (p= 0.164). CONCLUSIONS This study proposed an automatic cerebral CTV imaging technique to eliminate residual bone and soft tissues, minimize the impact of the cerebral arterial system, and present a relatively comprehensive cerebral venous system, which would help physicians assess cerebral venous outflow profiles after stroke and seek imaging markers associated with clinical outcomes.
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Affiliation(s)
- Siqi Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Ting Su
- Research Center for Medical Artificial Intelligence, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Yicong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Zixiao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yinsheng Li
- Research Center for Medical Artificial Intelligence, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China..
| | - Yongshuai Ge
- Research Center for Medical Artificial Intelligence, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China.; Paul C Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China..
| | - Donghua Mi
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
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Li Y, Tao C, An N, Liu H, Liu Z, Zhang H, Sun Y, Xing Y, Gao Y. Revisiting the role of the complement system in intracerebral hemorrhage and therapeutic prospects. Int Immunopharmacol 2023; 123:110744. [PMID: 37552908 DOI: 10.1016/j.intimp.2023.110744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/21/2023] [Accepted: 07/29/2023] [Indexed: 08/10/2023]
Abstract
Intracerebral hemorrhage (ICH) is a stroke subtype characterized by non-traumatic rupture of blood vessels in the brain, resulting in blood pooling in the brain parenchyma. Despite its lower incidence than ischemic stroke, ICH remains a significant contributor to stroke-related mortality, and most survivors experience poor outcomes that significantly impact their quality of life. ICH has been accompanied by various complex pathological damage, including mechanical damage of brain tissue, hematoma mass effect, and then leads to inflammatory response, thrombin activation, erythrocyte lysis, excitatory amino acid toxicity, complement activation, and other pathological changes. Accumulating evidence has demonstrated that activation of complement cascade occurs in the early stage of brain injury, and the excessive complement activation after ICH will affect the occurrence of secondary brain injury (SBI) through multiple complex pathological processes, aggravating brain edema, and pathological brain injury. Therefore, the review summarized the pathological mechanisms of brain injury after ICH, specifically the complement role in ICH, and its related pathological mechanisms, to comprehensively understand the specific mechanism of different complements at different stages after ICH. Furthermore, we systematically reviewed the current state of complement-targeted therapies for ICH, providing a reference and basis for future clinical transformation of complement-targeted therapy for ICH.
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Affiliation(s)
- Yuanyuan Li
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Chenxi Tao
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Na An
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Haoqi Liu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Zhenhong Liu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Hongrui Zhang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Yikun Sun
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Yanwei Xing
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China.
| | - Yonghong Gao
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China; Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing 100700, China.
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Chen Y, Jiang C, Chang J, Qin C, Zhang Q, Ye Z, Li Z, Tian F, Ma W, Feng M, Wei J, Yao J, Wang R. An artificial intelligence-based prognostic prediction model for hemorrhagic stroke. Eur J Radiol 2023; 167:111081. [PMID: 37716178 DOI: 10.1016/j.ejrad.2023.111081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/22/2023] [Accepted: 09/04/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE The prognosis following a hemorrhagic stroke is usually extremely poor. Rating scales have been developed to predict the outcomes of patients with intracerebral hemorrhage (ICH). To date, however, the prognostic prediction models have not included the full range of relevant imaging features. We constructed a clinic-imaging fusion model based on convolutional neural networks (CNN) to predict the short-term prognosis of ICH patients. MATERIALS AND METHODS This was a multi-center retrospective study, which included 1990 patients with ICH. Two CNN-based deep learning models were constructed to predict the neurofunctional outcomes at discharge; these were validated using a nested 5-fold cross-validation approach. The models' predictive efficiency was compared with the original ICH scale and the ICH grading scale. Poor neurological outcome was defined as a Glasgow Outcome Scale (GOS) score of 1-3. RESULTS The training and test sets included 1599 and 391 patients, respectively. For the test set, the clinic-imaging fusion model had the highest area under the curve (AUC = 0.903), followed by the imaging-based model (AUC = 0.886), the ICH scale (AUC = 0.777), and finally the ICH grading scale (AUC = 0.747). CONCLUSION The CNN prognostic prediction model based on neuroimaging features was more effective than the ICH scales in predicting the neurological outcomes of ICH patients at discharge. The CNN model's predictive efficiency slightly improved when clinical data were included.
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Affiliation(s)
- Yihao Chen
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Jianbo Chang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Qinghua Zhang
- Department of Neurosurgery, Shenzhen Nanshan Hospital, Shen Zhen, China
| | - Zeju Ye
- Department of Neurosurgery, Dongguan People's Hospital, Guangdong Province, China
| | - Zhaojian Li
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, China; Department of Medicine, Qingdao University, Qingdao, China
| | - Fengxuan Tian
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Qinghai Province, China
| | - Wenbin Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Junji Wei
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
| | | | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
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Witsch J, Cao Q, Song JW, Luo Y, Sloane KL, Rothstein A, Favilla CG, Cucchiara BL, Kasner SE, Messé SR, Choi HA, McCullough LD, Mayer SA, Gusdon AM. Sex differences in perihematomal edema volume and outcome after intracerebral hemorrhage. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.28.23296302. [PMID: 37808630 PMCID: PMC10557833 DOI: 10.1101/2023.09.28.23296302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Objective To determine whether in patients with intracerebral hemorrhage (ICH) perihematomal edema (PHE) volume trajectories differ by sex. Methods We conducted a post-hoc analysis of the Factor-VII-for-Acute-Hemorrhagic-Stroke-Treatment (FAST) trial that randomized patients with ICH to receive recombinant activated Factor VIIa or placebo. Computerized planimetry calculated PHE and ICH volumes on serial CT scans (at baseline [within 3 hours of onset], at 24, and at 72 hours). Generalized estimating equations examined interactions between sex, CT-timepoints, and FAST treatment-arm on PHE and ICH volumes. Mixed and multivariate logistic models examined associations between sex, PHE, and outcomes. Results 781 with supratentorial ICH (mean age 65 years) were included. Compared to women (n=296), men (n=485) had similar median ICH (14.9 versus 13.6 ml, p=0.053), and PHE volumes (11.1 versus 10.5 ml, p=0.56) at baseline but larger ICH and PHE at 24 hours (19.0 versus 14.0, p<0.001; 22.2 versus 15.7, p<0.001) and 72 hours (16.0 versus 11.8, p<0.001; 28.7 versus 19.9, p<0.001). Men had higher absolute PHE expansion (p<0.001), and more hematoma expansion (growth ≥33% or 6 mL at 24 hours, 33% versus 22%, p<0.001). An interaction between sex and CT-timepoints on PHE (p<0.001) but not on ICH volumes confirmed a steeper PHE trajectory in men. PHE expansion (per 5mL, odds radio, 1.19, 95%-confidence interval 1.10-1.28), but not sex, was associated with poor outcome. Conclusions PHE expansion and trajectory in men were significantly higher. PHE expansion was associated with poor outcomes independent of sex. Mechanisms leading to sex differences in PHE trajectories merit further investigation. What is already known on this topic Prior research has reported sex differences in intracerebral hemorrhage (ICH) characteristics and some studies suggest worse outcome after ICH in women. However, we do not have a good understanding whether there are sex differences in perihematomal edema (PHE) volume trajectories, or whether sex, independent of confounders, is associated with poor after ICH. What this study adds In this post-hoc analysis of 781 patients with supratentorial ICH from the Factor-VII-for-Acute-Hemorrhagic-Stroke-Treatment (FAST) trial in which patients underwent brain CT imaging time-locked to symptom onset (within 3 hours of symptom onset, at 24 hours, and at 72 hours), men compared to women had similar ICH and PHE volumes at baseline, but larger ICH expansion and PHE expansion on follow up imaging. The PHE but not the ICH volume trajectory across scans was significantly higher in men than in women. While PHE expansion was associated with poor outcome at 90 days, outcome between the sexes was similar at 90 days, and sex was not associated with outcome. How this study might affect research practice or policy The finding of heightened early PHE and ICH expansion in men may inform study design, patient recruitment strategies, and pre-specification of subgroup analyses in future interventional trials. The findings of this study also suggest that focusing on sex-specific factors may allow novel mechanistic insight into PHE, a major cause of secondary injury and poor outcome after ICH.
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Huang X, Wang D, Ma Y, Zhang Q, Ren J, Zhao H, Li S, Deng J, Yang J, Zhao Z, Xu M, Zhou Q, Zhou J. Perihematomal edema-based CT-radiomics model to predict functional outcome in patients with intracerebral hemorrhage. Diagn Interv Imaging 2023; 104:391-400. [PMID: 37179244 DOI: 10.1016/j.diii.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE The purpose of this study was to identify possible association between noncontrast computed tomography (NCCT)-based radiomics features of perihematomal edema (PHE) and poor functional outcome at 90 days after intracerebral hemorrhage (ICH) and to develop a NCCT-based radiomics-clinical nomogram to predict 90-day functional outcomes in patients with ICH. MATERIALS AND METHODS In this multicenter retrospective study, 107 radiomics features were extracted from 1098 NCCT examinations obtained in 1098 patients with ICH. There were 652 men and 446 women with a mean age of 60 ± 12 (SD) years (range: 23-95 years). After harmonized and univariable and multivariable screening, seven of these radiomics features were closely associated with the 90-day functional outcome of patients with ICH. The radiomics score (Rad-score) was calculated based on the seven radiomics features. A clinical-radiomics nomogram was developed and validated in three cohorts. The model performance was evaluated using area under the curve analysis and decision and calibration curves. RESULTS Of the 1098 patients with ICH, 395 had a good outcome at 90 days. Hematoma hypodensity sign and intraventricular and subarachnoid hemorrhages were identified as risk factors for poor outcomes (P < 0.001). Age, Glasgow coma scale score, and Rad-score were independently associated with outcome. The clinical-radiomics nomogram showed good predictive performance with AUCs of 0.882 (95% CI: 0.859-0.905), 0.834 (95% CI: 0.776-0.891) and 0.905 (95% CI: 0.839-0.970) in the three cohorts and clinical applicability. CONCLUSION NCCT-based radiomics features from PHE are highly correlated with outcome. When combined with Rad-score, radiomics features from PHE can improve the predictive performance for 90-day poor outcome in patients with ICH.
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Affiliation(s)
- Xiaoyu Huang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Dan Wang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Yaqiong Ma
- Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Department of Radiology, Gansu Provincial Hospital, Lanzhou, 730030, China
| | - Qiaoying Zhang
- Department of Radiology, Xi'an Central Hospital, Xi An, 710000, China
| | | | - Hui Zhao
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Shenglin Li
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Juan Deng
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Jingjing Yang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Zhiyong Zhao
- Department of Neurosurgery, Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Min Xu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Qing Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China.
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Yang D, Wang X, Zhang X, Zhu H, Sun S, Mane R, Zhao X, Zhou J. Temporal Evolution of Perihematomal Blood-Brain Barrier Compromise and Edema Growth After Intracerebral Hemorrhage. Clin Neuroradiol 2023; 33:813-824. [PMID: 37185668 PMCID: PMC10449681 DOI: 10.1007/s00062-023-01285-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/23/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE The aim of this study was to investigate the temporal evolution of perihematomal blood-brain barrier (BBB) compromise and edema growth and to determine the role of BBB compromise in edema growth. METHODS Spontaneous intracerebral hemorrhage patients who underwent computed tomography perfusion (CTP) were divided into five groups according to the time interval from symptom onset to CTP examination. Permeability-surface area product (PS) maps were generated using CTP source images. Ipsilateral and contralateral mean PS values were computed in the perihematomal and contralateral mirror regions. The relative PS (rPS) value was calculated as a ratio of ipsilateral to contralateral PS value. Hematoma and perihematomal edema volume were determined on non-contrast CT images. RESULTS In the total of 101 intracerebral hemorrhage patients, the ipsilateral mean PS value was significantly higher than that in contralateral region (z = -8.284, p < 0.001). The perihematomal BBB permeability showed a course of dynamic changes including an increase in the hyperacute and acute phases, a decrease in the early subacute phase and a second increase in the late subacute phase and chronic phase. Perihematomal edema increased gradually until the late subacute phase and then slightly increased. There was a relationship between rPS value and edema volume (β = 0.254, p = 0.006). CONCLUSION The perihematomal BBB permeability is dynamic changes, and edema growth is gradually increased in patients following intracerebral hemorrhage. BBB compromise plays an essential role in edema growth. The quantitative assessment of BBB compromise may provide valuable information in therapeutic interventions of intracerebral hemorrhage patients.
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Affiliation(s)
- Dan Yang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, 100070 Beijing, China
| | - Xin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xue Zhang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, 100070 Beijing, China
| | - Huachen Zhu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, 100070 Beijing, China
| | - Shengjun Sun
- Department of Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ravikiran Mane
- China National Clinical Research Center-Hanalytics Artificial Intelligence Research Centre for Neurological Disorders, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jian Zhou
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119, South Fourth Ring West Road, Fengtai District, 100070 Beijing, China
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Marchina S, Lee KH, Lioutas VA, Carvalho F, Incontri D, Heistand EC, Lin D, Selim M. An updated systematic review and meta-analysis investigating perihematomal edema and clinical outcome after intracerebral hemorrhage. J Stroke Cerebrovasc Dis 2023; 32:107204. [PMID: 37302208 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVES The relationship between perihematomal edema (PHE) and intracerebral hemorrhage (ICH) outcomes is uncertain. Given newly published studies, we updated a previous systematic review and meta-analysis assessing the prognostic impact of PHE on ICH outcomes. MATERIALS AND METHODS Databases were searched through September 2022 using pre-defined keywords. Included studies used regression to examine the association between PHE and functional outcome (assessed by modified Rankin Scale [mRS]) and mortality. The study quality was assessed using the Newcastle-Ottawa Scale. The overall pooled effect, and secondary analyses exploring different subgroups were obtained by entering the log transformed odds ratios and their confidence intervals into a DerSimonian-Laird random effects meta-analysis. RESULTS Twenty-eight studies (n=8655) were included. The pooled effect size for overall outcome (mRS and mortality) was 1.05 (95% CI 1.03, 1.07; p<0.00). In secondary analyses, PHE volume and growth effect sizes were 1.03 (CI 1.01, 1.05) and 1.12 (CI 1.06, 1.19), respectively. Results of subgroup analyses assessing absolute PHE volume and growth at different time points were: baseline volume 1.02 (CI 0.98, 1.06), 72-hour volume 1.07 (CI 0.99, 1.16), growth at 24 hours 1.30 (CI 0.96, 1.74) and growth at 72 hours 1.10 (CI 1.04, 1.17). Heterogeneity across studies was substantial. CONCLUSIONS This meta-analysis indicates that PHE growth, especially within the first 24 hours after ictus, has a stronger impact on functional outcome and mortality than PHE volume. Definitive conclusions are limited by the large variability of PHE measures, heterogeneity, and different evaluation time points between studies.
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Affiliation(s)
- Sarah Marchina
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA 02215, United States.
| | - Kun He Lee
- Department of Neurology, Stroke Division, Yale New Haven Hospital, New Haven, CT, United States
| | - Vasileios-Arsenios Lioutas
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA 02215, United States
| | - Filipa Carvalho
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA 02215, United States
| | - Diego Incontri
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA 02215, United States
| | - Elizabeth C Heistand
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA 02215, United States
| | - David Lin
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA 02215, United States
| | - Magdy Selim
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center and Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA 02215, United States
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Li YL, Chen C, Zhang LJ, Zheng YN, Lv XN, Zhao LB, Li Q, Lv FJ. Prediction of Early Perihematomal Edema Expansion Based on Noncontrast Computed Tomography Radiomics and Machine Learning in Intracerebral Hemorrhage. World Neurosurg 2023; 175:e264-e270. [PMID: 36958717 DOI: 10.1016/j.wneu.2023.03.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVES To investigate the predictive value of noncontrast computed tomography (NCCT) models based on radiomics features and machine learning for early perihematomal edema (PHE) expansion in patients with spontaneous intracerebral hemorrhage (ICH). METHODS We retrospectively reviewed NCCT data from 214 patients with spontaneous ICH. All radiomics features were extracted from volume of interest of hematomas on admission scans. A total of 8 machine learning methods were applied for constructing models in the training and the test set. Receiver operating characteristic analysis and the areas under the curve were used to evaluate the predictive value. RESULTS A total of 23 features were finally selected to establish models of early PHE expansion after feature screening. Patients were randomly assigned into training (n = 171) and test (n = 43) sets. The accuracy, sensitivity, and specificity in the test set were 72.1%, 90.0%, and 66.7% for the support vector machine model; 79.1%, 70.0%, and 84.4% for the k-nearest neighbor model; 88.4%, 90.0%, and 87.9% for the logistic regression model; 74.4%, 90.0%, and 69.7% for the extra tree model; 74.4%, 90.0%, and 69.7% for the extreme gradient boosting model; 83.7%, 100%, and 78.8% for the multilayer perceptron (MLP) model; 72.1%, 100%, and 65.6% for the light gradient boosting machine model; and 60.5%, 90.0%, and 53.1% for the random forest model, respectively. CONCLUSIONS The MLP model seemed to be the best model for prediction of PHE expansion in patients with ICH. NCCT models based on radiomics features and machine learning could predict early PHE expansion and improve the discrimination of identify spontaneous intracerebral hemorrhage patients at risk of early PHE expansion.
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Affiliation(s)
- Yu-Lun Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chu Chen
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li-Juan Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yi-Neng Zheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin-Ni Lv
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li-Bo Zhao
- Chongqing Key Laboratory of Cerebrovascular Disease Research, Chongqing, China; Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China; Chongqing Key Laboratory of Cerebrovascular Disease Research, Chongqing, China.
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Cliteur MP, Sondag L, Cunningham L, Al-Shahi Salman R, Samarasekera N, Klijn CJM, Schreuder FHBM. The association between perihaematomal oedema and functional outcome after spontaneous intracerebral haemorrhage: A systematic review and meta-analysis. Eur Stroke J 2023; 8:423-433. [PMID: 37231691 PMCID: PMC10334181 DOI: 10.1177/23969873231157884] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 01/27/2023] [Indexed: 08/17/2023] Open
Abstract
PURPOSE Perihaematomal oedema (PHO) formation has gained increasing interest as a therapeutic target after spontaneous intracerebral haemorrhage (ICH). Whether PHO contributes to poor outcome is unclear. We aimed to determine the association between PHO and outcome in patients with spontaneous ICH. METHOD We searched five databases up to 17 November 2021 for studies of ⩾10 adults with ICH reporting the presence of PHO and outcome. We assessed risk of bias, extracted aggregate data and used random effects meta-analysis to pool studies that reported odds ratios (OR) with 95% confidence intervals (CI). Primary outcome was poor functional outcome defined as modified Rankin Scale score of 3-6 at 3 months. Additionally, we assessed PHO growth and poor outcome at any time of follow-up. We prospectively registered the protocol in PROSPERO (CRD42020157088). FINDINGS We identified 12,968 articles, of which we included 27 studies (n = 9534). Eighteen studies reported an association between larger PHO volume and poor outcome, six a neutral result and three an inverse relationship. Larger absolute PHO volume was associated with poor functional outcome at 3 months (OR per mL increase of absolute PHO 1.03, 95% CI 1.00-1.06, I2 44%, four studies). Additionally, PHO growth was associated with poor outcome (OR 1.04, 95% CI 1.02-1.06, I2 0%, seven studies). DISCUSSION In patients with spontaneous ICH, larger PHO volume is associated with poor functional outcome at 3 months. These findings support the development and investigation of new therapeutic interventions targeting PHO formation to evaluate if reduction of PHO improves outcome after ICH.
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Affiliation(s)
- Maaike P Cliteur
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Lotte Sondag
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Laura Cunningham
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | | | | | - Catharina JM Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Floris HBM Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
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Sondag L, Wolsink A, Jolink WMT, Voigt S, van Walderveen MAA, Wermer MJH, Klijn CJM, Schreuder FHBM. The association between blood pressure variability and perihematomal edema after spontaneous intracerebral hemorrhage. Front Neurol 2023; 14:1114602. [PMID: 37006500 PMCID: PMC10060834 DOI: 10.3389/fneur.2023.1114602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundPerihematomal edema (PHE) after spontaneous intracerebral hemorrhage (sICH) is associated with clinical deterioration, but the etiology of PHE development is only partly understood.AimsWe aimed to investigate the association between systemic blood pressure (BP) variability (BPV) and formation of PHE.MethodsFrom a multicenter prospective observational study, we selected patients with sICH who underwent 3T brain MRI within 21 days after sICH, and had at least 5 BP measurements available in the first week after sICH. Primary outcome was the association between coefficient of variation (CV) of systolic BP (SBP) and edema extension distance (EED) using multivariable linear regression, adjusting for age, sex, ICH volume and timing of the MRI. In addition, we investigated the associations of mean SBP, mean arterial pressure (MAP), their CVs with EED and absolute and relative PHE volume.ResultsWe included 92 patients (mean age 64 years; 74% men; median ICH volume 16.8 mL (IQR 6.6–36.0), median PHE volume 22.5 mL (IQR 10.2–41.4). Median time between symptom onset and MRI was 6 days (IQR 4–11), median number of BP measurements was 25 (IQR 18–30). Log-transformed CV of SBP was not associated with EED (B = 0.050, 95%-CI −0.186 to 0.286, p = 0.673). Furthermore, we found no association between mean SBP, mean and CV of MAP and EED, nor between mean SBP, mean MAP or their CVs and absolute or relative PHE.DiscussionOur results do not support a contributing role for BPV on PHE, suggesting mechanisms other than hydrostatic pressure such as inflammatory processes, may play a more important role.
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Affiliation(s)
- Lotte Sondag
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Axel Wolsink
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Sabine Voigt
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Catharina J. M. Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Floris H. B. M. Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
- *Correspondence: Floris H. B. M. Schreuder
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Ratcliff JJ, Hall AJ, Porto E, Saville BR, Lewis RJ, Allen JW, Frankel M, Wright DW, Barrow DL, Pradilla G. Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH): Study protocol for a multi-centered two-arm randomized adaptive trial. Front Neurol 2023; 14:1126958. [PMID: 37006503 PMCID: PMC10061000 DOI: 10.3389/fneur.2023.1126958] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundIntracerebral hemorrhage (ICH) is a potentially devastating condition with elevated early mortality rates, poor functional outcomes, and high costs of care. Standard of care involves intensive supportive therapy to prevent secondary injury. To date, there is no randomized control study demonstrating benefit of early evacuation of supratentorial ICH.MethodsThe Early Minimally Invasive Removal of Intracerebral Hemorrhage (ENRICH) Trial was designed to evaluate the minimally invasive trans-sulcal parafascicular surgery (MIPS) approach, a technique for safe access to deep brain structures and ICH removal using the BrainPath® and Myriad® devices (NICO Corporation, Indianapolis, IN). ENRICH is a multi-centered, two-arm, randomized, adaptive comparative-effectiveness study, where patients are block randomized by ICH location and Glasgow Coma Score (GCS) to early ICH evacuation using MIPS plus standard guideline-based management vs. standard management alone to determine if MIPS results in improved outcomes defined by the utility-weighted modified Rankin score (UWmRS) at 180 days as the primary endpoint. Secondary endpoints include clinical and economic outcomes of MIPS using cost per quality-adjusted life years (QALYs). The inclusion and exclusion criteria aim to capture a broad group of patients with high risk of significant morbidity and mortality to determine optimal treatment strategy.DiscussionENRICH will result in improved understanding of the benefit of MIPS for both lobar and deep ICH affecting the basal ganglia. The ongoing study will lead to Level-I evidence to guide clinicians treatment options in the management of acute treatment of ICH.Trial registrationThis study is registered with clinicaltrials.gov (Identifier: NCT02880878).
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Affiliation(s)
- Jonathan J. Ratcliff
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, Emory University School of Medicine, Grady Hospital, Atlanta, GA, United States
| | - Alex J. Hall
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Edoardo Porto
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Benjamin R. Saville
- Berry Consultants LLC, Austin, TX, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Roger J. Lewis
- Berry Consultants LLC, Austin, TX, United States
- Department of Emergency Medicine, Harbor-UCLA Medical Center, UCLA, Torrance, CA, United States
| | - Jason W. Allen
- Department of Neurology, Emory University School of Medicine, Grady Hospital, Atlanta, GA, United States
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Michael Frankel
- Department of Neurology, Emory University School of Medicine, Grady Hospital, Atlanta, GA, United States
| | - David W. Wright
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Daniel L. Barrow
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Gustavo Pradilla
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, United States
- *Correspondence: Gustavo Pradilla
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Feng X, Li X, Feng J, Xia J. Intracranial hemorrhage management in the multi-omics era. Heliyon 2023; 9:e14749. [PMID: 37101482 PMCID: PMC10123201 DOI: 10.1016/j.heliyon.2023.e14749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Intracranial hemorrhage (ICH) is a devastating disorder. Neuroprotective strategies that prevent tissue injury and improve functional outcomes have been identified in multiple animal models of ICH. However, these potential interventions in clinical trials produced generally disappointing results. With progress in omics, studies of omics data, including genomics, transcriptomics, epigenetics, proteomics, metabolomics, and the gut microbiome, may help promote precision medicine. In this review, we focused on introducing the applications of all omics in ICH and shed light on all of the considerable advantages to systematically analyze the necessity and importance of multiple omics technology in ICH.
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Affiliation(s)
- Xianjing Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xi Li
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jian Xia
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
- Clinical Research Center for Cerebrovascular Disease of Hunan Province, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Corresponding author. Department of Neurology, Xiangya Hospital, Central South University, No.87, Xiangya Road, Changsha, 410008, China
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Fan YH, He ZY, Zheng WX, Hu LT, Wang BY. Exosomal miR-23b from bone marrow mesenchymal stem cells alleviates oxidative stress and pyroptosis after intracerebral hemorrhage. Neural Regen Res 2023; 18:560-567. [DOI: 10.4103/1673-5374.346551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wan Y, Holste KG, Hua Y, Keep RF, Xi G. Brain edema formation and therapy after intracerebral hemorrhage. Neurobiol Dis 2023; 176:105948. [PMID: 36481437 PMCID: PMC10013956 DOI: 10.1016/j.nbd.2022.105948] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/28/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022] Open
Abstract
Intracerebral hemorrhage (ICH) accounts for about 10% of all strokes in the United States of America causing a high degree of disability and mortality. There is initial (primary) brain injury due to the mechanical disruption caused by the hematoma. There is then secondary injury, triggered by the initial injury but also the release of various clot-derived factors (e.g., thrombin and hemoglobin). ICH alters brain fluid homeostasis. Apart from the initial hematoma mass, ICH causes blood-brain barrier disruption and parenchymal cell swelling, which result in brain edema and intracranial hypertension affecting patient prognosis. Reducing brain edema is a critical part of post-ICH care. However, there are limited effective treatment methods for reducing perihematomal cerebral edema and intracranial pressure in ICH. This review discusses the mechanisms underlying perihematomal brain edema formation, the effects of sex and age, as well as how edema is resolved. It examines progress in pharmacotherapy, particularly focusing on drugs which have been or are currently being investigated in clinical trials.
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Affiliation(s)
- Yingfeng Wan
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Ya Hua
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Richard F Keep
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
| | - Guohua Xi
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
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A machine learning approach for predicting perihematomal edema expansion in patients with intracerebral hemorrhage. Eur Radiol 2022; 33:4052-4062. [PMID: 36472694 DOI: 10.1007/s00330-022-09311-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/06/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Preventing the expansion of perihematomal edema (PHE) represents a novel strategy for the improvement of neurological outcomes in intracerebral hemorrhage (ICH) patients. Our goal was to predict early and delayed PHE expansion using a machine learning approach. METHODS We enrolled 550 patients with spontaneous ICH to study early PHE expansion, and 389 patients to study delayed expansion. Two imaging researchers rated the shape and density of hematoma in non-contrast computed tomography (NCCT). We trained a radiological machine learning (ML) model, a radiomics ML model, and a combined ML model, using data from radiomics, traditional imaging, and clinical indicators. We then validated these models on an independent dataset by using a nested 4-fold cross-validation approach. We compared models with respect to their predictive performance, which was assessed using the receiver operating characteristic curve. RESULTS For both early and delayed PHE expansion, the combined ML model was most predictive (early/delayed AUC values were 0.840/0.705), followed by the radiomics ML model (0.799/0.663), the radiological ML model (0.779/0.631), and the imaging readers (reader 1: 0.668/0.565, reader 2: 0.700/0.617). CONCLUSION We validated a machine learning approach with high interpretability for the prediction of early and delayed PHE expansion. This new technique may assist clinical practice for the management of neurocritical patients with ICH. KEY POINTS • This is the first study to use artificial intelligence technology for the prediction of perihematomal edema expansion. • A combined machine learning model, trained on data from radiomics, clinical indicators, and imaging features associated with hematoma expansion, outperformed all other methods.
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Zhou P, Sun Q, Song G, Liu Z, Qi J, Yuan X, Wang X, Yan S, Du J, Dai Z, Wang J, Hu S. Radiomics features from perihematomal edema for prediction of prognosis in the patients with basal ganglia hemorrhage. Front Neurol 2022; 13:982928. [DOI: 10.3389/fneur.2022.982928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022] Open
Abstract
ObjectiveWe developed and validated a clinical-radiomics nomogram to predict the prognosis of basal ganglia hemorrhage patients.MethodsRetrospective analyses were conducted in 197 patients with basal ganglia hemorrhage (training cohort: n = 136, test cohort: n = 61) who were admitted to The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital) and underwent computed tomography (CT) scan. According to different prognoses, patients with basal ganglia hemorrhage were divided into two groups. Independent clinical risk factors were derived with univariate and multivariate regression analysis. Radiomics signatures were obtained using least absolute shrinkage and selection operator. A radiomics score (Rad-score) was generated by 12 radiomics signatures of perihematomal edema (PHE) from CT images that were correlated with the prognosis of basal ganglia hemorrhage patients. A clinical-radiomics nomogram was conducted by combing the Rad-score and clinical risk factors using logistic regression analysis. The prediction performance of the nomogram was tested in the training cohort and verified in the test cohort.ResultsThe clinical model conducted by four clinical risk factors and 12 radiomcis features were used to establish the Rad-score. The clinical-radiomics nomogram outperformed the clinical model in the training cohort [area under the curve (AUC), 0.92 vs. 0.85] and the test cohort (AUC, 0.91 vs 0.85). The clinical-radiomics nomogram showed good calibration and clinical benefit in both the training and test cohorts.ConclusionRadiomics features of PHE in patients with basal ganglia hemorrhage could contribute to the outcome prediction. The clinical-radiomics nomogram may help first-line clinicians to make individual clinical treatment decisions for patients with basal ganglia hemorrhage.
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He J, Fu F, Zhang W, Zhan Z, Cheng Z. Prognostic significance of the clinical and radiological haemorrhagic transformation subtypes in acute ischaemic stroke: A systematic review and meta-analysis. Eur J Neurol 2022; 29:3449-3459. [PMID: 35789517 DOI: 10.1111/ene.15482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to investigate the associations of haemorrhagic transformation (HT) and its clinical and radiological subtypes with functional outcome, mortality, early neurological deterioration (END) and neurological complications in patients with acute ischaemic stroke (AIS). METHODS A systematic review and meta-analysis of observational studies on the associations of overall HT, clinical HT subtypes (asymptomatic intracerebral haemorrhage [aICH] and symptomatic intracerebral haemorrhage [sICH]) or radiological HT subtypes (haemorrhagic infarction [HI-1 or HI-2] and parenchymal haemorrhage [PH-1 or PH-2]) with prognosis in patients with AIS was performed. PubMed, Web of Science and Embase were systematically searched. Random effects models were used to calculate pooled estimates. RESULTS Fifty-one studies with 100,510 patients were pooled in the meta-analysis. Overall HT was associated with worse functional outcome (odds ratio [OR] 2.12, 95% confidence interval [CI] 1.55-2.90), increased mortality (OR 1.87, 95% CI 1.52-2.30), END (OR 2.35, 95% CI 1.46-3.77), early-onset seizures (OR 2.58, 95% CI 1.63-4.10) and post-stroke epilepsy (OR 2.23, 95% CI 1.11-4.49). For clinical subtypes, sICH remained significantly associated with the aforementioned poor prognoses except post-stroke epilepsy, and aICH was associated with worse functional outcome but was unrelated to mortality. For radiological subtypes, PH (especially PH-2) was strongly associated with poor prognosis. HI-2 was associated with worse functional outcome, and HI-1 was associated with a lower risk of mortality and END. CONCLUSIONS Regardless of whether AIS patients undergo thrombolysis or thrombectomy, overall HT, sICH and PH (especially PH-2) are associated with a substantially increased risk of worse functional outcome, mortality, END or neurological complications. The presence of aICH is related to worse functional outcome but is independent of increased mortality. HI-2 impairs functional independence, and HI-1 does not cause neurological impairment.
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Affiliation(s)
- Jinfeng He
- Department of Neurology, Taizhou Municipal Hospital, Taizhou, China
| | - Fangwang Fu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenyuan Zhang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Department of Neurology, Affiliated Yueqing Hospital, Wenzhou Medical University, Yueqing, China
| | - Zhenxiang Zhan
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zicheng Cheng
- Department of Neurology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
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Huang X, Wang D, Zhang Q, Ma Y, Zhao H, Li S, Deng J, Ren J, Yang J, Zhao Z, Xu M, Zhou Q, Zhou J. Radiomics for prediction of intracerebral hemorrhage outcomes: A retrospective multicenter study. Neuroimage Clin 2022; 36:103242. [PMID: 36279754 PMCID: PMC9668657 DOI: 10.1016/j.nicl.2022.103242] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/15/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Accurate risk stratification of patients with intracerebral hemorrhage (ICH) could help refine adjuvant therapy selection and better understand the clinical course. We aimed to evaluate the value of radiomics features from hematomal and perihematomal edema areas for prognosis prediction and to develop a model combining clinical and radiomic features for accurate outcome prediction of patients with ICH. METHODS This multicenter study enrolled patients with ICH from January 2016 to November 2021. Their outcomes at 3 months were recorded based on the modified Rankin Scale (good, 0-3; poor, 4-6). Independent clinical and radiomic risk factors for poor outcome were identified through multivariate logistic regression analysis, and predictive models were developed. Model performance and clinical utility were evaluated in both internal and external cohorts. RESULTS Among the 1098 ICH patients evaluated (mean age, 60 ± 13 years), 703 (64 %) had poor outcomes. Age, hemorrhage volume and location, and Glasgow Coma Scale (GCS) were independently associated with outcomes. The area under the receiver operating characteristic curve (AUC) of the clinical model was 0.881 in the external validation cohort. Addition of the Rad-score (combined hematoma and perihematomal edema area) improved predictive accuracy and model performance (AUC, 0.893), net reclassification improvement, 0.140 (P < 0.001), and integrated discrimination improvement, 0.050 (P < 0.001). CONCLUSIONS The radiomics features of hematomal and perihematomal edema area have additional value in prognostic prediction; moreover, addition of radiomic features significantly improves model accuracy.
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Affiliation(s)
- Xiaoyu Huang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China; Second Clinical School, Lanzhou University, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | - Dan Wang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China
| | - Qiaoying Zhang
- Department of Radiology, Xi'an Central Hospital, Xi An 710000, China
| | - Yaqiong Ma
- Second Clinical School, Lanzhou University, Lanzhou 730030, China; Department of Radiology, Gansu Provincial Hospital, Lanzhou 730030, China
| | - Hui Zhao
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China; Second Clinical School, Lanzhou University, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | - Shenglin Li
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China; Second Clinical School, Lanzhou University, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | - Juan Deng
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China; Second Clinical School, Lanzhou University, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | | | - Jingjing Yang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China; Second Clinical School, Lanzhou University, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | - Zhiyong Zhao
- Department of Radiology, Gansu Provincial Hospital, Lanzhou 730030, China
| | - Min Xu
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China; Second Clinical School, Lanzhou University, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | - Qing Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China; Second Clinical School, Lanzhou University, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou 730030, China; Department of Neurosurgery, Lanzhou University Second Hospital Lanzhou 730030, China.
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Molecular, Pathological, Clinical, and Therapeutic Aspects of Perihematomal Edema in Different Stages of Intracerebral Hemorrhage. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:3948921. [PMID: 36164392 PMCID: PMC9509250 DOI: 10.1155/2022/3948921] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/17/2022] [Accepted: 09/03/2022] [Indexed: 02/07/2023]
Abstract
Acute intracerebral hemorrhage (ICH) is a devastating type of stroke worldwide. Neuronal destruction involved in the brain damage process caused by ICH includes a primary injury formed by the mass effect of the hematoma and a secondary injury induced by the degradation products of a blood clot. Additionally, factors in the coagulation cascade and complement activation process also contribute to secondary brain injury by promoting the disruption of the blood-brain barrier and neuronal cell degeneration by enhancing the inflammatory response, oxidative stress, etc. Although treatment options for direct damage are limited, various strategies have been proposed to treat secondary injury post-ICH. Perihematomal edema (PHE) is a potential surrogate marker for secondary injury and may contribute to poor outcomes after ICH. Therefore, it is essential to investigate the underlying pathological mechanism, evolution, and potential therapeutic strategies to treat PHE. Here, we review the pathophysiology and imaging characteristics of PHE at different stages after acute ICH. As illustrated in preclinical and clinical studies, we discussed the merits and limitations of varying PHE quantification protocols, including absolute PHE volume, relative PHE volume, and extension distance calculated with images and other techniques. Importantly, this review summarizes the factors that affect PHE by focusing on traditional variables, the cerebral venous drainage system, and the brain lymphatic drainage system. Finally, to facilitate translational research, we analyze why the relationship between PHE and the functional outcome of ICH is currently controversial. We also emphasize promising therapeutic approaches that modulate multiple targets to alleviate PHE and promote neurologic recovery after acute ICH.
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Validation of perihematomal edema expansion as a new imaging biomarker to predict clinical outcome in patients with intracerebral hemorrhage. J Stroke Cerebrovasc Dis 2022; 31:106692. [PMID: 35932542 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/16/2022] [Accepted: 07/26/2022] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVES The use of hematoma expansion (HE) in intracerebral hemorrhage (ICH) patients is limited due to its low sensitivity. Perihematomal edema (PHE) has been considered an important marker of secondary brain injury after ICH. Enrolling PHE expansion to redefine traditional ICH expansion merits exploration. MATERIALS AND METHODS This study analyzed a cohort of patients with spontaneous ICH. The hematoma and PHE were manually segmented. Logistic regression analysis was utilized to identify risk factors for poor outcomes. Receiver operating characteristic curve analysis was performed to calculate the predictive values of PHE expansion and HE. Poor neurological outcome was defined as a modified Rankin Scale score of 4-6 at 90 days. RESULTS Overall, 223 target patients were enrolled in the study. Multivariable analysis showed the larger PHE expansion is the independent risk factors for poor prognosis. The predictive value of absolute PHE expansion (AUC=0.776, sensitivity=67.9%, specificity=77.0%) was higher than that of absolute HE (AUC=0.573, sensitivity=41.7%, specificity=87.1%) and HE (>6 ml) (AUC=0.594, sensitivity=23.8%, specificity=95.0%). The best cutoff for early absolute/relative PHE expansion resulting in a poor outcome was 5.96 ml and 31%. CONCLUSIONS Early PHE expansion was associated with a poor outcome, characterized by a better predictive value than HE.
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3D Island Sign on Computed Tomography Predicts Early Perihematomal Edema Expansion and Poor Outcome in Patients with Intracerebral Hemorrhage. Clin Neurol Neurosurg 2022; 222:107443. [DOI: 10.1016/j.clineuro.2022.107443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/27/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022]
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Cliteur MP, Sondag L, Wolsink A, Rasing I, Meijer FJA, Jolink WMT, Wermer MJH, Klijn CJM, Schreuder FHBM. Cerebral small vessel disease and perihematomal edema formation in spontaneous intracerebral hemorrhage. Front Neurol 2022; 13:949133. [PMID: 35968312 PMCID: PMC9372363 DOI: 10.3389/fneur.2022.949133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/07/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Blood-brain barrier (BBB) dysfunction is implicated in the pathophysiology of cerebral small vessel disease (cSVD)-related intracerebral hemorrhage (ICH). The formation of perihematomal edema (PHE) is presumed to reflect acute BBB permeability following ICH. We aimed to assess the association between cSVD burden and PHE formation in patients with spontaneous ICH. Methods We selected patients with spontaneous ICH who underwent 3T MRI imaging within 21 days after symptom onset from a prospective observational multicenter cohort study. We rated markers of cSVD (white matter hyperintensities, enlarged perivascular spaces, lacunes and cerebral microbleeds) and calculated the composite score as a measure of the total cSVD burden. Perihematomal edema formation was measured using the edema extension distance (EED). We assessed the association between the cSVD burden and the EED using a multivariable linear regression model adjusting for age, (log-transformed) ICH volume, ICH location (lobar vs. non-lobar), and interval between symptom onset and MRI. Results We included 85 patients (mean age 63.5 years, 75.3% male). Median interval between symptom onset and MRI imaging was 6 days (IQR 1–19). Median ICH volume was 17.0 mL (IQR 1.4–88.6), and mean EED was 0.54 cm (SD 0.17). We found no association between the total cSVD burden and EED (B = −0.003, 95% CI −0.003–0.03, p = 0.83), nor for any of the individual radiological cSVD markers. Conclusion We found no association between the cSVD burden and PHE formation. This implies that mechanisms other than BBB dysfunction are involved in the pathophysiology of PHE.
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Affiliation(s)
- Maaike P. Cliteur
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Lotte Sondag
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Axel Wolsink
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Ingeborg Rasing
- Department of Neurology & Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
| | - F. J. A. Meijer
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, Netherlands
| | | | - Marieke J. H. Wermer
- Department of Neurology & Neurosurgery, Leiden University Medical Center, Leiden, Netherlands
| | - Catharina J. M. Klijn
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Floris H. B. M. Schreuder
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
- *Correspondence: Floris H. B. M. Schreuder
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Ironside N, Patrie J, Ng S, Ding D, Rizvi T, Kumar JS, Mastorakos P, Hussein MZ, Naamani KE, Abbas R, Harrison Snyder M, Zhuang Y, Kearns KN, Doan KT, Shabo LM, Marfatiah S, Roh D, Lignelli-Dipple A, Claassen J, Worrall BB, Johnston KC, Jabbour P, Park MS, Sander Connolly E, Mukherjee S, Southerland AM, Chen CJ. Quantification of hematoma and perihematomal edema volumes in intracerebral hemorrhage study: Design considerations in an artificial intelligence validation (QUANTUM) study. Clin Trials 2022; 19:534-544. [PMID: 35786006 DOI: 10.1177/17407745221105886] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hematoma and perihematomal edema volumes are important radiographic markers in spontaneous intracerebral hemorrhage. Accurate, reliable, and efficient quantification of these volumes will be paramount to their utility as measures of treatment effect in future clinical studies. Both manual and semi-automated quantification methods of hematoma and perihematomal edema volumetry are time-consuming and susceptible to inter-rater variability. Efforts are now underway to develop a fully automated algorithm that can replace them. A (QUANTUM) study to establish inter-quantification method measurement equivalency, which deviates from the traditional use of measures of agreement and a comparison hypothesis testing paradigm to indirectly infer quantification method measurement equivalence, is described in this article. The Quantification of Hematoma and Perihematomal Edema Volumes in Intracerebral Hemorrhage study aims to determine whether a fully automated quantification method and a semi-automated quantification method for quantification of hematoma and perihematomal edema volumes are equivalent to the hematoma and perihematomal edema volumes of the manual quantification method. METHODS/DESIGN Hematoma and perihematomal edema volumes of supratentorial intracerebral hemorrhage on 252 computed tomography scans will be prospectively quantified in random order by six raters using the fully automated, semi-automated, and manual quantification methods. Primary outcome measures for hematoma and perihematomal edema volumes will be quantified via computed tomography scan on admission (<24 h from symptom onset) and on day 3 (72 ± 12 h from symptom onset), respectively. Equivalence hypothesis testing will be conducted to determine if the hematoma and perihematomal edema volume measurements of the fully automated and semi-automated quantification methods are within 7.5% of the hematoma and perihematomal edema volume measurements of the manual quantification reference method. DISCUSSION By allowing direct equivalence hypothesis testing, the Quantification of Hematoma and Perihematomal Edema Volumes in Intracerebral Hemorrhage study offers advantages over radiology validation studies which utilize measures of agreement to indirectly infer measurement equivalence and studies which mistakenly try to infer measurement equivalence based on the failure of a comparison two-sided null hypothesis test to reach the significance level for rejection. The equivalence hypothesis testing paradigm applied to artificial intelligence application validation is relatively uncharted and warrants further investigation. The challenges encountered in the design of this study may influence future studies seeking to translate artificial intelligence medical technology into clinical practice.
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Affiliation(s)
- Natasha Ironside
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - James Patrie
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Sherman Ng
- Department of Software Engineering, Microsoft Corporation, Redmond, WA, USA
| | - Dale Ding
- Department of Neurosurgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Tanvir Rizvi
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jeyan S Kumar
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Panagiotis Mastorakos
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Mohamed Z Hussein
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Rawad Abbas
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | - Yan Zhuang
- Department of Biomedical Engineering and Electrical and Computer Engineering, University of Virginia, Charlottesville, VA, USA
| | - Kathryn N Kearns
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kevin T Doan
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Leah M Shabo
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Saurabh Marfatiah
- Department of Radiology, Columbia University School of Medicine, New York, NY, USA
| | - David Roh
- Department of Neurology, Columbia University School of Medicine, New York, NY, USA
| | | | - Jan Claassen
- Department of Neurology, Columbia University School of Medicine, New York, NY, USA
| | - Bradford B Worrall
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.,Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Karen C Johnston
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.,Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Min S Park
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - E Sander Connolly
- Department of Neurosurgery, Columbia University School of Medicine, New York, NY, USA
| | - Sugoto Mukherjee
- Department of Radiology and Medical Imaging, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Andrew M Southerland
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA.,Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Ching-Jen Chen
- Department of Neurosurgery, The University of Texas Health Science Center, Houston, TX, USA
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Chen Y, Qin C, Chang J, Liu Y, Zhang Q, Ye Z, Li Z, Tian F, Ma W, Wei J, Feng M, Chen S, Yao J, Wang R. Defining Delayed Perihematomal Edema Expansion in Intracerebral Hemorrhage: Segmentation, Time Course, Risk Factors and Clinical Outcome. Front Immunol 2022; 13:911207. [PMID: 35615357 PMCID: PMC9125313 DOI: 10.3389/fimmu.2022.911207] [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: 04/02/2022] [Accepted: 04/15/2022] [Indexed: 11/30/2022] Open
Abstract
We attempt to generate a definition of delayed perihematomal edema expansion (DPE) and analyze its time course, risk factors, and clinical outcomes. A multi-cohort data was derived from the Chinese Intracranial Hemorrhage Image Database (CICHID). A non-contrast computed tomography (NCCT) -based deep learning model was constructed for fully automated segmentation hematoma and perihematomal edema (PHE). Time course of hematoma and PHE evolution correlated to initial hematoma volume was volumetrically assessed. Predictive values for DPE were calculated through receiver operating characteristic curve analysis and were tested in an independent cohort. Logistic regression analysis was utilized to identify risk factors for DPE formation and poor outcomes. The test cohort’s Dice scores of lesion segmentation were 0.877 and 0.642 for hematoma and PHE, respectively. Overall, 1201 patients were enrolled for time-course analysis of ICH evolution. A total of 312 patients were further selected for DPE analysis. Time course analysis showed the growth peak of PHE approximately concentrates in 14 days after onset. The best cutoff for DPE to predict poor outcome was 3.34 mL of absolute PHE expansion from 4-7 days to 8-14 days (AUC=0.784, sensitivity=72.2%, specificity=81.2%), and 3.78 mL of absolute PHE expansion from 8-14 days to 15-21 days (AUC=0.682, sensitivity=59.3%, specificity=92.1%) in the derivation sample. Patients with DPE was associated with worse outcome (OR: 12.340, 95%CI: 6.378-23.873, P<0.01), and the larger initial hematoma volume (OR: 1.021, 95%CI: 1.000-1.043, P=0.049) was the significant risk factor for DPE formation. This study constructed a well-performance deep learning model for automatic segmentations of hematoma and PHE. A new definition of DPE was generated and is confirmed to be related to poor outcomes in ICH. Patients with larger initial hematoma volume have a higher risk of developing DPE formation.
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Affiliation(s)
- Yihao Chen
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Jianbo Chang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Qinghua Zhang
- Department of Neurosurgery, Shenzhen Nanshan Hospital, Shenzhen, China
| | - Zeju Ye
- Department of Neurosurgery, Dongguan People's Hospital, Dongguan, China
| | - Zhaojian Li
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao, China.,Department of Medicine, Qingdao University, Qingdao, China
| | - Fengxuan Tian
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, China
| | - Wenbin Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Junji Wei
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengpan Chen
- Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangzhou, China
| | | | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Marchina S, Trevino-Calderon JA, Hassani S, Massaro JM, Lioutas VA, Carvalho F, Selim M. Perihematomal Edema and Clinical Outcome After Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis. Neurocrit Care 2022; 37:351-362. [PMID: 35578090 DOI: 10.1007/s12028-022-01512-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 04/05/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Perihematomal edema (PHE) has been proposed as a radiological marker of secondary injury and therapeutic target in intracerebral hemorrhage (ICH). We conducted a systematic review and meta-analysis to assess the prognostic impact of PHE on functional outcome and mortality in patients with ICH. METHODS We searched major databases through December 2020 using predefined keywords. Any study using logistic regression to examine the association between PHE or its growth and functional outcome was included. We examined the overall pooled effect and conducted secondary analyses to explore the impact of individual PHE measures on various outcomes separately. Study quality was assessed by three independent raters using the Newcastle-Ottawa Scale. Odds ratios (per 1-unit increase in PHE) and their confidence intervals (CIs) were log transformed and entered into a DerSimonian-Laird random-effects meta-analysis to obtain pooled estimates of the effect. RESULTS Twenty studies (n = 6633 patients) were included in the analysis. The pooled effect size for overall outcome was 1.05 (95% CI 1.02-1.08; p < 0.00). For the following secondary analyses, the effect size was weak: mortality (1.01; 95% CI 0.90-1.14), functional outcome (1.04; 95% CI 1.02-1.07), both 90-day (1.06; 95% CI 1.02-1.11), and in-hospital assessments (1.04; 95% CI 1.00-1.08). The effect sizes for PHE volume and PHE growth were 1.04 (95% CI 1.01-1.07) and 1.14 (95% CI 1.04-1.25), respectively. Heterogeneity across studies was substantial except for PHE growth. CONCLUSIONS This meta-analysis demonstrates that PHE volume within the first 72 h after ictus has a weak effect on functional outcome and mortality after ICH, whereas PHE growth might have a slightly larger impact during this time frame. Definitive conclusions are limited by the large variability of PHE measures, heterogeneity, and different evaluation time points between studies.
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Affiliation(s)
- Sarah Marchina
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Jorge A Trevino-Calderon
- Division of Child Neurology, Children's Medical Center, University of Texas Southwestern, Dallas, TX, USA
| | - Sara Hassani
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Joseph M Massaro
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Vasileios-Arsenios Lioutas
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Filipa Carvalho
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Magdy Selim
- Stroke Division, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Palmer 127, 330 Brookline Ave, Boston, MA, 02215, USA
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40
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Rabinstein AA. Monitoring ICP In ICH: Is It Worth It? Neurology 2022; 99:45-46. [PMID: 35508392 DOI: 10.1212/wnl.0000000000200802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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41
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Advances in computed tomography-based prognostic methods for intracerebral hemorrhage. Neurosurg Rev 2022; 45:2041-2050. [DOI: 10.1007/s10143-022-01760-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/18/2022] [Accepted: 02/18/2022] [Indexed: 10/19/2022]
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42
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Zhang Z, Li Y, Shi J, Zhu L, Dai Y, Fu P, Liu S, Hong M, Zhang J, Wang J, Jiang C. Lymphocyte-Related Immunomodulatory Therapy with Siponimod (BAF-312) Improves Outcomes in Mice with Acute Intracerebral Hemorrhage. Aging Dis 2022; 14:966-991. [PMID: 37191423 DOI: 10.14336/ad.2022.1102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022] Open
Abstract
Modulators of the sphingosine-1-phosphate receptor (S1PR) have been proposed as a promising strategy for treating stroke. However, the detailed mechanisms and the potential translational value of S1PR modulators for intracerebral hemorrhage (ICH) therapy warrant exploration. Using collagenase VII-S-induced ICH in the left striatum of mice, we investigated the effects of siponimod on cellular and molecular immunoinflammatory responses in the hemorrhagic brain in the presence or absence of anti-CD3 monoclonal antibodies (Abs). We also assessed the severity of short- and long-term brain injury and evaluated the efficacy of siponimod in long-term neurologic function. Siponimod treatment significantly decreased brain lesion volume and brain water content on day 3 and the volume of the residual lesion and brain atrophy on day 28. It also inhibited neuronal degeneration on day 3 and improved long-term neurologic function. These protective effects may be associated with a reduction in the expression of lymphotactin (XCL1) and T-helper 1 (Th1)-type cytokines (interleukin 1β and interferon-γ). It may also be associated with inhibition of neutrophil and lymphocyte infiltration and alleviation of T lymphocyte activation in perihematomal tissues on day 3. However, siponimod did not affect the infiltration of natural killer cells (NK) or the activation of CD3-negative immunocytes in perihematomal tissues. Furthermore, it did not influence the activation or proliferation of microglia or astrocytes around the hematoma on day 3. Siponimod appears to have a profound impact on infiltration and activation of T lymphocytes after ICH. The effects of neutralized anti-CD3 Abs-induced T-lymphocyte tolerance on siponimod immunomodulation further confirmed that siponimod alleviated the cellular and molecular Th1 response in the hemorrhagic brain. This study provides preclinical evidence that encourages future investigation of immunomodulators, including siponimod, which target the lymphocyte-related immunoinflammatory reaction in ICH therapy.
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43
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Chen Y, Chang J, Wei J, Feng M, Wang R. Assessing the Evolution of Intracranial Hematomas by using Animal Models: A Review of the Progress and the Challenges. Metab Brain Dis 2021; 36:2205-2214. [PMID: 34417943 DOI: 10.1007/s11011-021-00828-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/14/2021] [Indexed: 01/07/2023]
Abstract
Stroke has become the second leading cause of death in people aged higher than 60 years, with cancer being the first. Intracerebral hemorrhage (ICH) is the most lethal type of stroke. Using imaging techniques to evaluate the evolution of intracranial hematomas in patients with hemorrhagic stroke is worthy of ongoing research. The difficulty in obtaining ultra-early imaging data and conducting intensive dynamic radiographic imaging in actual clinical settings has led to the application of experimental animal models to assess the evolution of intracranial hematomas. Herein, we review the current knowledge on primary intracerebral hemorrhage mechanisms, focus on the progress of animal studies related to hematoma development and secondary brain injury, introduce preclinical therapies, and summarize related challenges and future directions.
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Affiliation(s)
- Yihao Chen
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jianbo Chang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Junji Wei
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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44
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Chen Y, Chen S, Chang J, Wei J, Feng M, Wang R. Perihematomal Edema After Intracerebral Hemorrhage: An Update on Pathogenesis, Risk Factors, and Therapeutic Advances. Front Immunol 2021; 12:740632. [PMID: 34737745 PMCID: PMC8560684 DOI: 10.3389/fimmu.2021.740632] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022] Open
Abstract
Intracerebral hemorrhage (ICH) has one of the worst prognoses among patients with stroke. Surgical measures have been adopted to relieve the mass effect of the hematoma, and developing targeted therapy against secondary brain injury (SBI) after ICH is equally essential. Numerous preclinical and clinical studies have demonstrated that perihematomal edema (PHE) is a quantifiable marker of SBI after ICH and is associated with a poor prognosis. Thus, PHE has been considered a promising therapeutic target for ICH. However, the findings derived from existing studies on PHE are disparate and unclear. Therefore, it is necessary to classify, compare, and summarize the existing studies on PHE. In this review, we describe the growth characteristics and relevant underlying mechanism of PHE, analyze the contributions of different risk factors to PHE, present the potential impact of PHE on patient outcomes, and discuss the currently available therapeutic strategies.
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Affiliation(s)
- Yihao Chen
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengpan Chen
- Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Jianbo Chang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Junji Wei
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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45
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Jeon H, Kim M, Park W, Lim JS, Lee E, Cha H, Ahn JS, Kim JH, Hong SH, Park JE, Lee EJ, Woo CW, Lee S. Upregulation of AQP4 Improves Blood-Brain Barrier Integrity and Perihematomal Edema Following Intracerebral Hemorrhage. Neurotherapeutics 2021; 18:2692-2706. [PMID: 34545550 PMCID: PMC8804112 DOI: 10.1007/s13311-021-01126-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 01/08/2023] Open
Abstract
In intracerebral hemorrhage (ICH), delayed secondary neural damages largely occur from perihematomal edema (PHE) resulting from the disruption of the blood-brain barrier (BBB). PHE is often considered the principal cause of morbidity and mortality in patients with ICH. Nevertheless, the main cellular mechanism as well as the specific BBB component involved in the formation of PHE after ICH remains elusive. Herein, we evaluated the role of AQP4, a water channel expressed on the astrocytes of the BBB, in the formation of PHE in ICH. The static and dynamic functions of the BBB were evaluated by analyzing the microstructure and leakage assay. Protein changes in the PHE lesion were analyzed and the control mechanism of AQP4 expression by reactive oxygen species was also investigated. Delayed PHE formation due to BBB disruption after ICH was confirmed by the decreased coverage of multiple BBB components and increased dynamic leakages. Microstructure assay showed that among the BBB components, AQP4 showed a markedly decreased expression in the PHE lesions. The decrease in AQP4 was due to microenvironmental ROS derived from the hemorrhage and was restored by treatment with ROS scavenger. AQP4-deficient mice had significantly larger PHE lesions and unfavorable survival outcomes compared with wild-type mice. Our data identify AQP4 as a specific BBB-modulating target for alleviating PHE in ICH. Further comprehensive studies are needed to form the preclinical basis for the use of AQP4 enhancers as BBB modulators for preventing delayed cerebral edema after ICH.
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Affiliation(s)
- Hanwool Jeon
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Medical Science, Asan Medical Center, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Moinay Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Wonhyoung Park
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Joon Seo Lim
- Clinical Research Center, Asan Medical Center, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eunyeup Lee
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Medical Science, Asan Medical Center, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyeuk Cha
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Medical Science, Asan Medical Center, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Sung Ahn
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong Hoon Kim
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seok Ho Hong
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ji Eun Park
- University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Neuroradiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun-Jae Lee
- Department of Medical Science, Asan Medical Center, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, Republic of Korea
- University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chul-Woong Woo
- Convergence Medicine Research Center, Asan Medical Center, Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seungjoo Lee
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
- Department of Medical Science, Asan Medical Center, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, Republic of Korea.
- University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Early Perihematomal Edema Expansion: Definition, Significance, and Association with Outcomes after Intracerebral Hemorrhage. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6249509. [PMID: 34552686 PMCID: PMC8452407 DOI: 10.1155/2021/6249509] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/29/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
Objective To investigate the association between early perihematomal edema (PHE) expansion and functional outcome in patients with intracerebral hemorrhage (ICH). Methods Patients with ICH who underwent initial computed tomography (CT) scans within 6 hours after the onset of symptoms and follow-up CT scans within 24 ± 12 hours were included. Absolute PHE increase was defined as the absolute increase in PHE volume from baseline to 24 hours. A receiver-operating characteristic (ROC) curve was generated to determine the cutoff value for early PHE expansion, which was operationally defined as an absolute increase in PHE volume of >6 mL. The outcome of interest was 3-month poor outcome defined as modified Rankin scale score of ≥4. A multivariable logistic regression procedure was used to assess the association between early PHE expansion and outcome after ICH. Results In 233 patients with ICH, 89 (38.2%) patients had poor outcome at 3-month follow-up. Early PHE expansion was observed in 56 of 233 (24.0%) patients. Patients with early PHE expansion were more likely to have poor functional outcome than those without (43.8% vs. 11.8%, p < 0.001). After adjusting for age, admission systolic blood pressure, admission Glasgow Coma Scale score, baseline ICH volume and the presence of intraventricular hemorrhage, and time from onset to CT, early PHE expansion was associated with poor outcome (adjusted odds ratio, 4.25; 95% confidence interval, 1.70–10.60; p = 0.002). Conclusions The early PHE expansion was not uncommon in patients with ICH and was correlated with poor outcome following ICH.
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47
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Cui Z, Liu S, Hou L, Sun Y, Chen H, Mao H, Zhao Y, Qiao L. Effect of Tongfu Xingshen capsule on the endogenous neural stem cells of experimental rats with intracerebral hemorrhage. Mol Med Rep 2021; 24:624. [PMID: 34212980 PMCID: PMC8281109 DOI: 10.3892/mmr.2021.12263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/18/2021] [Indexed: 11/16/2022] Open
Abstract
Intracerebral hemorrhage (ICH) can stimulate neural regeneration, promoting tissue repair and recovery of nerve function. Tongfu Xingshen capsule (TXC) is a Chinese medicinal formula used to treat ICH and has been shown to protect brain tissue and improve nerve function in clinical studies. However, the effect of TXC on endogenous neural stem cells (NSCs) remains elusive. To explore the mechanisms underlying TXC action, a rat model of ICH was established. The effects of TXC on the proliferation and differentiation of NSCs were assessed in the subventricular zone (SVZ). TXC significantly improved nerve function defects, decreased brain water content and restored blood‑brain barrier integrity. Additionally, BrdU labeling showed that both high and low doses of TXC significantly increased the proportion of actively cycling NSCs positive for Nestin and glial fibrillary acidic protein, but did not affect the proliferation rates of NeuN‑positive neurons. Finally, TXC also upregulated the mRNA levels of brain‑derived neurotrophic factor and its receptor, TrκB, in affected brain tissues. Taken together, TXC accelerated neural repair and functional recovery after brain injury by potentially enhancing the proliferation and differentiation of endogenous NSCs into astroglial cells in the SVZ area.
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Affiliation(s)
- Zhizhong Cui
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Shanshan Liu
- Department of Hematology, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong 510630, P.R. China
| | - Lingbo Hou
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Yifan Sun
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Haoxuan Chen
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Hui Mao
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
| | - Yuanqi Zhao
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
| | - Lijun Qiao
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P.R. China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong 510120, P.R. China
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Chen J, Li G, Liang H, Zhao S, Sun J, Qin M. An amplitude-based characteristic parameter extraction algorithm for cerebral edema detection based on electromagnetic induction. Biomed Eng Online 2021; 20:74. [PMID: 34344370 PMCID: PMC8335876 DOI: 10.1186/s12938-021-00913-4] [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: 01/07/2021] [Accepted: 07/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Cerebral edema is a common condition secondary to any type of neurological injury. The early diagnosis and monitoring of cerebral edema is of great importance to improve the prognosis. In this article, a flexible conformal electromagnetic two-coil sensor was employed as the electromagnetic induction sensor, associated with a vector network analyzer (VNA) for signal generation and receiving. Measurement of amplitude data over the frequency range of 1–100 MHz is conducted to evaluate the changes in cerebral edema. We proposed an Amplitude-based Characteristic Parameter Extraction (Ab-CPE) algorithm for multi-frequency characteristic analysis over the frequency range of 1–100 MHz and investigated its performance in electromagnetic induction-based cerebral edema detection and distinction of its acute/chronic phase. Fourteen rabbits were enrolled to establish cerebral edema model and the 24 h real-time monitoring experiments were carried out for algorithm verification. Results The proposed Ab-CPE algorithm was able to detect cerebral edema with a sensitivity of 94.1% and specificity of 95.4%. Also, in the early stage, it can detect cerebral edema with a sensitivity of 85.0% and specificity of 87.5%. Moreover, the Ab-CPE algorithm was able to distinguish between acute and chronic phase of cerebral edema with a sensitivity of 85.0% and specificity of 91.0%. Conclusion The proposed Ab-CPE algorithm is suitable for multi-frequency characteristic analysis. Combined with this algorithm, the electromagnetic induction method has an excellent performance on the detection and monitoring of cerebral edema.
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Affiliation(s)
- Jingbo Chen
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Gen Li
- School of Pharmacy and Bioengineering, Chongqing University of Technology, Chongqing, China.
| | - Huayou Liang
- China Aerodynamics Research and Development Center Low Speed Aerodynamic Institute, Mianyang, Sichuan, China
| | - Shuanglin Zhao
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jian Sun
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Mingxin Qin
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China.
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Ye G, Huang S, Chen R, Zheng Y, Huang W, Gao Z, Cai L, Zhao M, Ma K, He Q, Lin F, Lin Y, Wang D, Fang W, Kang D, Wu X. Early Predictors of the Increase in Perihematomal Edema Volume After Intracerebral Hemorrhage: A Retrospective Analysis From the Risa-MIS-ICH Study. Front Neurol 2021; 12:700166. [PMID: 34385972 PMCID: PMC8353085 DOI: 10.3389/fneur.2021.700166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Perihematomal edema (PHE) is associated with poor functional outcomes after intracerebral hemorrhage (ICH). Early identification of risk factors associated with PHE growth may allow for targeted therapeutic interventions. Methods: We used data contained in the risk stratification and minimally invasive surgery in acute intracerebral hemorrhage (Risa-MIS-ICH) patients: a prospective multicenter cohort study. Patients' clinical, laboratory, and radiological data within 24 h of admission were obtained from their medical records. The absolute increase in PHE volume from baseline to day 3 was defined as iPHE volume. Poor outcome was defined as modified Rankin Scale (mRS) of 4 to 6 at 90 days. Binary logistic regression was used to assess the relationship between iPHE volume and poor outcome. The receiver operating characteristic curve was used to find the best cutoff. Linear regression was used to identify variables associated with iPHE volume (ClinicalTrials.gov Identifier: NCT03862729). Results: One hundred ninety-seven patients were included in this study. iPHE volume was significantly associated with poor outcome [P = 0.003, odds ratio (OR) 1.049, 95% confidence interval (CI) 1.016-1.082] after adjustment for hematoma volume. The best cutoff point of iPHE volume was 7.98 mL with a specificity of 71.4% and a sensitivity of 47.5%. Diabetes mellitus (P = 0.043, β = 7.66 95% CI 0.26-15.07), black hole sign (P = 0.002, β = 18.93 95% CI 6.84-31.02), and initial ICH volume (P = 0.018, β = 0.20 95% CI 0.03-0.37) were significantly associated with iPHE volume. After adjusting for hematoma expansion, the black hole sign could still independently predict the increase of PHE (P < 0.001, β = 21.62 95% CI 10.10-33.15). Conclusions: An increase of PHE volume >7.98 mL from baseline to day 3 may lead to poor outcome. Patients with diabetes mellitus, black hole sign, and large initial hematoma volume result in more PHE growth, which should garner attention in the treatment.
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Affiliation(s)
- Gengzhao Ye
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shuna Huang
- Department of Clinical Research and Translation Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Renlong Chen
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yan Zheng
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wei Huang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhuyu Gao
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Lueming Cai
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Mingpei Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ke Ma
- Department of Clinical Research and Translation Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qiu He
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Fuxin Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuanxiang Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Dengliang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wenhua Fang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Dezhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiyue Wu
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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50
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O'Carroll CB, Brown BL, Freeman WD. Intracerebral Hemorrhage: A Common yet Disproportionately Deadly Stroke Subtype. Mayo Clin Proc 2021; 96:1639-1654. [PMID: 33952393 DOI: 10.1016/j.mayocp.2020.10.034] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 10/14/2020] [Accepted: 10/29/2020] [Indexed: 12/29/2022]
Abstract
Spontaneous intracerebral hemorrhage (ICH) is a medical emergency and is disproportionately associated with higher mortality and long-term disability compared with ischemic stroke. The phrase "time is brain" was derived for patients with large vessel occlusion ischemic stroke in which approximately 1.9 million neurons are lost every minute. Similarly, this statement holds true for ICH patients due to a high volume of neurons that are damaged at initial onset and during hematoma expansion. Most cases of spontaneous ICH pathophysiologically stem from chronic hypertension and rupture of small perforating vessels off of larger cerebral arteries supplying deep brain structures, with cerebral amyloid angiopathy being another cause for lobar hemorrhages in older patients. Optimal ICH medical management strategies include timely diagnosis, aggressive blood pressure control, correction of underlying coagulopathy defects if present, treatment of cerebral edema, and continuous assessment for possible surgical intervention. Current strategies in the surgical management of ICH include newly developed minimally invasive techniques for hematoma evacuation, with the goal of mitigating injury to fiber tracts while accessing the clot. We review evidence-based medical and surgical management of spontaneous ICH with the overall goal of reducing neurologic injury and optimizing functional outcome.
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Affiliation(s)
| | - Benjamin L Brown
- Department of Neurologic Surgery, Ochsner Neurosciences Institute, Covington, LA
| | - W David Freeman
- Departments of Critical Care Medicine, Neurologic Surgery, and Neurology, Mayo Clinic, Jacksonville, FL
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