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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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Dong X, Liu Y, Chu X, Yu E, Jia X, Wu C. Mirror Image of Spontaneous Intracranial Hemorrhage. Diagnostics (Basel) 2024; 14:357. [PMID: 38396395 PMCID: PMC10887743 DOI: 10.3390/diagnostics14040357] [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: 12/02/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
In this paper, we reported the first case of mirrored spontaneous intracranial hemorrhage with almost identical hematoma morphological characteristics. This patient's first symptom was loss of consciousness, without any local neurological symptoms. This clinical presentation fits well with the atypical computed tomography (CT) image showing bilateral hematomas, and indicates that the distribution of hypertensive vascular damage may be symmetric and that the degree of the bilateral lesions may be similar.
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Affiliation(s)
| | | | | | | | | | - Chuanjie Wu
- Xuanwu Hospital, Capital Medical University, Beijing 100053, China; (X.D.); (Y.L.); (X.C.); (E.Y.); (X.J.)
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Munakomi S, Chaulagain D. Demographical domains and clinico-radiological characteristics of study cohorts with spontaneous simultaneous multiple intracerebral hemorrhages in a tertiary neurosurgical center in Nepal: a cross-sectional study. F1000Res 2022; 11:154. [PMID: 36519009 PMCID: PMC9716112 DOI: 10.12688/f1000research.108816.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Spontaneous simultaneous multiple intra-cerebral hemorrhages (SMICHs) and its occurrences in different territories of arterial disposition has been viewed as uncommon clinical occurrences, since the pathophysiological and predisposing factors as mechanisms aren't vividly defined. This research primarily aims for demographic stratification and dichotomization pertaining to risk factors, etiological classifications, anatomical distributions and outcome analysis by focusing on management strategies and pertinent stroke care. Methods: 40 patients presenting to the College of Medical Sciences, Chitwan, Nepal in the last two years were included in the study. The patients with two or more spontaneous SMICHs with affected arterial territories with similar tomographic density based profiling were chosen as samples. Regression analysis was chosen to test three hypotheses. Results: Among our study cohorts, cortical and cortical territory (60%) was the major anatomical patterns of involvement. A conservative approach was undertaken in nine patients (22.5%), whereas surgical intervention was needed in five others (12.5%). A total of 14(35%) patients leaving against medical advice and a further seven (17.5%) patients were referred for adjuvant oncologic care. Mortality was observed among five (12.5%) patients. Hypertension was seen as a significant variable in its pathogenesis. Male patients were more affected. Age groups comprising 36-45years and 56-65 years were involved in 32.5% and 30% of cases respectively. Conclusion: This study proves the need for a national stroke data bank pertaining to spontaneous SMICHs. This will help foster effective patient education during preoperative counseling; as well as formatting a management algorithm combating them.
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Affiliation(s)
- Sunil Munakomi
- Neurosurgery, College of Medical Sciences, Chitwan, Nepal,
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Li J, Shen D, Zhou Y, Jin Y, Jin L, Ye X, Tong L, Gao F. Underlying microangiopathy and functional outcome of simultaneous multiple intracerebral hemorrhage. Front Aging Neurosci 2022; 14:1000573. [PMID: 36425320 PMCID: PMC9679501 DOI: 10.3389/fnagi.2022.1000573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
Objective To identify the predominant type of cerebral small vessel disease (SVD) and outcomes in patients with simultaneous multiple intracerebral hemorrhages (SMICH). Methods Consecutive patients with intracerebral hemorrhage (ICH) from a single-center prospective cohort were retrospectively reviewed. Presumed etiology was classified according to the SMASH-U criteria. Demographics, clinical and laboratory variables, and neuroimaging data were compared between patients with primary SMICH and those with single ICH. Functional outcomes were assessed using the modified Rankin scale 90 days after ICH. Results Of the 598 enrolled patients, 37 (6.2%) met the criteria for SMICH. Risk factors for SMICH included a high burden of deep cerebral microbleeds (CMBs) (odds ratio [OR] 1.06, 95% confidence interval [CI], 1.00–1.12; p = 0.040), white matter hyperintensity scores (OR 1.27, 95% CI 1.04–1.57; p = 0.021), history of ICH (OR 3.38, 95% CI 1.31–8.05; p = 0.008), and low serum magnesium levels (OR 0.01, 95% CI 0.00–0.25; p = 0.007). Based on the SMASH-U classification, 15(40.5%) SMICH were classified as hypertension, whereas 17 (45.9%) as undetermined-etiology. To further explore the potential microangiopathy underlying undetermined-SMICH, these patients with undetermined-etiology were compared to those with cerebral amyloid angiopathy-ICH, and were associated with a higher burden of deep CMBs but less severe centrum semiovale enlarged perivascular spaces. Likewise, compared with hypertension-ICH patients, those with undetermined SMICH were consistently associated with a higher deep CMB counts. Moreover, multivariate analysis revealed that SMICH was independently associated with poor outcomes (OR 2.23, 95%CI 1.03–4.76; p = 0.038). Conclusion Our results suggest that most patients with primary SMICH harbor hypertensive-SVD as principal angiopathy. Patients with SMICH are at a high risk of poor outcomes. (ClinicalTrials.gov Identifier: NCT 04803292).
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Wang ZJ, Zhao R, Hu X, Yang WS, Deng L, Lv XN, Li ZQ, Cheng J, Pu MJ, Tang ZP, Wu GF, Zhao LB, Xie P, Li Q. Higher Cerebral Small Vessel Disease Burden in Patients With Small Intracerebral Hemorrhage. Front Neurosci 2022; 16:888198. [PMID: 35645707 PMCID: PMC9133886 DOI: 10.3389/fnins.2022.888198] [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: 03/02/2022] [Accepted: 04/14/2022] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate the association between cerebral small vessel disease (SVD) and hematoma volume in primary intracerebral hemorrhage (ICH). Methods Patients from a prospective ICH cohort were enrolled. Admission and follow-up CT scan within 72 h after onset were reviewed to calculate the final hematoma volume. We evaluated cortical superficial siderosis and the global SVD score, including white matter hyperintensities, lacunes, enlarged perivascular space, and cerebral microbleeds on MRI. We conducted the multivariate logistic regression analyses to explore the association between SVD markers and small ICH, as well as hematoma volume. Hematoma location was stratified into lobar and non-lobar for subgroup analysis. Results A total of 187 patients with primary ICH (mean age 62.4 ± 13.4 years, 67.9% male) were enrolled. 94 (50.2%) patients had small ICH. The multivariate logistic regression analysis showed an association between global SVD score and small ICH [adjusted odds ratio (aOR) 1.27, 95% CI 1.03–1.57, p = 0.027] and a trend of higher global SVD score towards non-lobar small ICH (aOR 1.23, 95% CI 0.95–1.58, p = 0.122). In the multivariate linear regression analysis, global SVD score was inversely related to hematoma volume of all ICH (β = −0.084, 95% CI −0.142 to −0.025, p = 0.005) and non-lobar ICH (β = −0.112, 95% CI −0.186 to −0.037, p = 0.004). Lacune (β = −0.245, 95% CI −0.487 to −0.004, p = 0.046) was associated with lower non-lobar ICH volume. Conclusion Global SVD score is associated with small ICH and inversely correlated with hematoma volume. This finding predominantly exists in non-lobar ICH.
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Affiliation(s)
- Zi-Jie Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Zhao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao Hu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wen-Song Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- National Health Commission (NHC) Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lan Deng
- Department of Neurology, 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
| | - Zuo-Qiao Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Cheng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ming-Jun Pu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhou-Ping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guo-Feng Wu
- Emergency Department, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Li-Bo Zhao
- Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Xie
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- National Health Commission (NHC) Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- National Health Commission (NHC) Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
- *Correspondence: Qi Li,
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Alhashim A, Hadhiah K, Al-Dandan H, Aljaman M, Alabdali M, Alshurem M, Aljaafari D, AlQarni M. Spontaneous Simultaneous Bilateral Basal Ganglia Hemorrhage (SSBBGH): Systematic Review and Data Analysis on Epidemiology, Clinical Feature, Location of Bleeding, Etiology, Therapeutic Intervention and Outcome. Vasc Health Risk Manag 2022; 18:267-276. [PMID: 35444424 PMCID: PMC9015104 DOI: 10.2147/vhrm.s349912] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Spontaneous simultaneous bilateral basal ganglia hemorrhage (SSBBGH) is an extremely rare condition with only a few published case reports and series. However, there is no systematic review that has been published yet. Objective The study aims to conduct a systematic review on spontaneous simultaneous bilateral basal ganglion bleeding and a descriptive statistical analysis of collected data on epidemiology, clinical features, etiology, therapeutic approach and prognosis. This review aims to be a clinical reference for busy clinicians when they are faced with such a rare condition. Methodology This review has been carried out in accordance with recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results Review of 60 cases showed that SSBBGH affected predominantly male patients (70%) with an average age of 50.8 ± 15.33 years and the male-to-female ratio was 2.5:1. The female patients tend to be older with an average age of 54.22 ± 16.67 years. Location of SSBBGHwas more common in the putamen (90% vs 10% non-putaminal). SSBBGH posed a significant mortality rate (33.33%). Among patients who survived, only 40.6% (13/32 report) have had favorable outcomes (mRS ≤2) and the remaining 59.4% (19/32) ended up with poor functional status (mRS ≥3-5). The most common implicated etiologies were hypertension followed by alcohol intoxication. Conclusion SSBBGH is a rare clinical entity with significant morbidity and mortality. Systemic approach can lead to early recognition of etiology and prompt treatment. Hypertension and the putamen are the most common etiology and location of SSBBGH, respectively. History of hypertension and age can help narrow differential diagnosis and limit unnecessary testing or intervention.
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Affiliation(s)
- Ali Alhashim
- Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
- Correspondence: Ali Alhashim, Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia, Tel +966509444833, Email
| | - Kawther Hadhiah
- Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
| | - Hassan Al-Dandan
- Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
| | - Mugbil Aljaman
- Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
| | - Majed Alabdali
- Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
| | - Mohammed Alshurem
- Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
| | - Danah Aljaafari
- Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
| | - Mustafa AlQarni
- Neurology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, 34212, Saudi Arabia
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Schmidbauer ML, Ferse C, Salih F, Klingner C, Musleh R, Kunst S, Wittstock M, Neumann B, Schebesch KM, Bösel J, Godau J, Lochner P, Adam EH, Jahnke K, Knier B, Schirotzek I, Müllges W, Notz Q, Dengl M, Güldner A, Onur OA, Garcia Borrega J, Dimitriadis K, Günther A. COVID-19 and Intracranial Hemorrhage: A Multicenter Case Series, Systematic Review and Pooled Analysis. J Clin Med 2022; 11:jcm11030605. [PMID: 35160057 PMCID: PMC8836638 DOI: 10.3390/jcm11030605] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/16/2022] [Accepted: 01/21/2022] [Indexed: 12/27/2022] Open
Abstract
Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) profoundly impacts hemostasis and microvasculature. In the light of the dilemma between thromboembolic and hemorrhagic complications, in the present paper, we systematically investigate the prevalence, mortality, radiological subtypes, and clinical characteristics of intracranial hemorrhage (ICH) in coronavirus disease (COVID-19) patients. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we performed a systematic review of the literature by screening the PubMed database and included patients diagnosed with COVID-19 and concomitant ICH. We performed a pooled analysis, including a prospectively collected cohort of critically ill COVID-19 patients with ICH, as part of the PANDEMIC registry (Pooled Analysis of Neurologic Disorders Manifesting in Intensive Care of COVID-19). Results: Our literature review revealed a total of 217 citations. After the selection process, 79 studies and a total of 477 patients were included. The median age was 58.8 years. A total of 23.3% of patients experienced the critical stage of COVID-19, 62.7% of patients were on anticoagulation and 27.5% of the patients received ECMO. The prevalence of ICH was at 0.85% and the mortality at 52.18%, respectively. Conclusion: ICH in COVID-19 patients is rare, but it has a very poor prognosis. Different subtypes of ICH seen in COVID-19, support the assumption of heterogeneous and multifaceted pathomechanisms contributing to ICH in COVID-19. Further clinical and pathophysiological investigations are warranted to resolve the conflict between thromboembolic and hemorrhagic complications in the future.
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Affiliation(s)
- Moritz L. Schmidbauer
- Department of Neurology, University Hospital LMU Munich, 81377 Munich, Germany; (M.L.S.); (S.K.)
| | - Caroline Ferse
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany;
| | - Farid Salih
- Department of Neurology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany;
| | - Carsten Klingner
- Hans-Berger-Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (C.K.); (R.M.)
| | - Rita Musleh
- Hans-Berger-Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (C.K.); (R.M.)
| | - Stefan Kunst
- Department of Neurology, University Hospital LMU Munich, 81377 Munich, Germany; (M.L.S.); (S.K.)
| | - Matthias Wittstock
- Department of Neurology, Rostock University Hospital, 18147 Rostock, Germany;
| | - Bernhard Neumann
- Department of Neurology, Regensburg University, 93040 Regensburg, Germany;
- Department of Neurology, Donau-Isar-Klinikum Deggendorf, 94469 Deggendorf, Germany
| | - Karl-Michael Schebesch
- Medical Center, Department of Neurosurgery, University of Regensburg, 93053 Regensburg, Germany;
| | - Julian Bösel
- Department of Neurology, Klinikum Kassel, 34125 Kassel, Germany; (J.B.); (J.G.)
| | - Jana Godau
- Department of Neurology, Klinikum Kassel, 34125 Kassel, Germany; (J.B.); (J.G.)
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, 66421 Homburg, Germany;
| | - Elisabeth H. Adam
- Department of Anesthesiology, University Hospital Frankfurt, 60590 Frankfurt, Germany;
| | - Kolja Jahnke
- Department of Neurology, University Hospital Frankfurt, 60590 Frankfurt, Germany;
| | - Benjamin Knier
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
| | - Ingo Schirotzek
- Department of Neurology, Klinikum Darmstadt, 64283 Darmstadt, Germany;
| | - Wolfgang Müllges
- Department of Neurology, University Hospital Würzburg, 97070 Würzburg, Germany;
| | - Quirin Notz
- Department of Neurology, University Hospital Würzburg, 97070 Würzburg, Germany;
| | - Markus Dengl
- Department of Neurosurgery, Carl Gustav Carus Medical University of Dresden, 01307 Dresden, Germany;
| | - Andreas Güldner
- Department of Anesthesiology, Carl Gustav Carus Medical University of Dresden, 01307 Dresden, Germany;
| | - Oezguer A. Onur
- Department of Neurology, University of Cologne, 50937 Cologne, Germany;
| | | | - Konstantinos Dimitriadis
- Department of Neurology, University Hospital LMU Munich, 81377 Munich, Germany; (M.L.S.); (S.K.)
- Institute for Stroke and Dementia Research (ISD), Ludwig-Maximilians-Universität (LMU), 81377 Munich, Germany
- Correspondence: (K.D.); (A.G.)
| | - Albrecht Günther
- Hans-Berger-Department of Neurology, Jena University Hospital, 07747 Jena, Germany; (C.K.); (R.M.)
- Correspondence: (K.D.); (A.G.)
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Imaging features and ultraearly hematoma growth in intracerebral hemorrhage associated with COVID-19. Neuroradiology 2022; 64:1367-1372. [PMID: 35034151 PMCID: PMC8761086 DOI: 10.1007/s00234-021-02861-1] [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: 10/21/2021] [Accepted: 11/11/2021] [Indexed: 11/21/2022]
Abstract
Purpose Intracerebral hemorrhage (ICH) is an uncommon but deadly event in patients with COVID-19 and its imaging features remain poorly characterized. We aimed to describe the clinical and imaging features of COVID-19-associated ICH. Methods Multicenter, retrospective, case–control analysis comparing ICH in COVID-19 patients (COV19 +) versus controls without COVID-19 (COV19 −). Clinical presentation, laboratory markers, and severity of COVID-19 disease were recorded. Non-contrast computed tomography (NCCT) markers (intrahematoma hypodensity, heterogeneous density, blend sign, irregular shape fluid level), ICH location, and hematoma volume (ABC/2 method) were analyzed. The outcome of interest was ultraearly hematoma growth (uHG) (defined as NCCT baseline ICH volume/onset-to-imaging time), whose predictors were explored with multivariable linear regression. Results A total of 33 COV19 + patients and 321 COV19 − controls with ICH were included. Demographic characteristics and vascular risk factors were similar in the two groups. Multifocal ICH and NCCT markers were significantly more common in the COV19 + population. uHG was significantly higher among COV19 + patients (median 6.2 mL/h vs 3.1 mL/h, p = 0.027), and this finding remained significant after adjustment for confounding factors (systolic blood pressure, antiplatelet and anticoagulant therapy), in linear regression (B(SE) = 0.31 (0.11), p = 0.005). This association remained consistent also after the exclusion of patients under anticoagulant treatment (B(SE) = 0.29 (0.13), p = 0.026). Conclusions ICH in COV19 + patients has distinct NCCT imaging features and a higher speed of bleeding. This association is not mediated by antithrombotic therapy and deserves further research to characterize the underlying biological mechanisms.
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Jia Y, Li G, Song G, Ye X, Yang Y, Lu K, Huang S, Zhu S. SMASH-U aetiological classification: A predictor of long-term functional outcome after intracerebral haemorrhage. Eur J Neurol 2021; 29:178-187. [PMID: 34534389 DOI: 10.1111/ene.15111] [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: 08/25/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND SMASH-U is a systematic aetiological classification system for intracerebral haemorrhage (ICH) proven to be a predictor of post-ICH haematoma expansion and mortality. However, its role in predicting functional outcome remains elusive. Therefore, we aimed to investigate whether SMASH-U is associated with long-term functional outcome after ICH and improves the accuracy of prediction when added to max-ICH score. METHODS Consecutive acute ICH patients from 2012 to 2018 from the neurology department of Tongji Hospital were enrolled. ICH aetiology was classified according to the SMASH-U system. The association of SMASH-U with 12-month functional outcome after ICH and the predictive value were evaluated. RESULTS Of 1938 ICH patients, the aetiology of 1295 (66.8%) patients were classified as hypertension, followed by amyloid angiopathy (n = 250, 12.9%), undetermined (n = 159, 8.2%), structural lesions (n = 149, 7.7%), systemic disease (n = 74, 3.8%) and medication (n = 11, 0.6%). The baseline characteristics were different among the six aetiologies. In multivariate analysis, SMASH-U was proven to be a predictor of 12-month unfavourable functional outcome. When adding the SMASH-U system, the predictive performance of max-ICH score was improved (area under the receiver operating characteristic curve from 0.802 to 0.812, p = 0.010) and the predictive accuracy was enhanced (integrated discrimination improvement [IDI]: 1.60%, p < 0.001; continuous net reclassification improvement [NRI]: 28.16%, p < 0.001; categorical NRI: 3.34%, p = 0.004). CONCLUSIONS SMASH-U predicted long-term unfavourable functional outcomes after acute ICH and improved the accuracy of prediction when added to max-ICH score. Integrating the aetiology to a score model to predict the post-ICH outcome may be meaningful and worthy of further exploration.
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Affiliation(s)
- Yuchao Jia
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guo Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guini Song
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaodong Ye
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuyan Yang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Lu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shanshan Huang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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10
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Malhotra K, Zompola C, Theodorou A, Katsanos AH, Shoamanesh A, Gupta H, Beshara S, Goyal N, Chang J, Tayal AH, Boviatsis E, Voumvourakis K, Cordonnier C, Werring DJ, Alexandrov AV, Tsivgoulis G. Prevalence, Characteristics, and Outcomes of Undetermined Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis. Stroke 2021; 52:3602-3612. [PMID: 34344165 DOI: 10.1161/strokeaha.120.031471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE There are scarce data regarding the prevalence, characteristics and outcomes of intracerebral hemorrhage (ICH) of undetermined (unknown or cryptogenic) etiology. We sought to determine the prevalence, radiological characteristics, and clinical outcomes of undetermined ICH. METHODS Systematic review and meta-analysis of studies involving patients with spontaneous ICH was conducted to primarily assess the prevalence and clinical-radiological characteristics of undetermined ICH. Additionally, we assessed the rates for ICH secondary to hypertensive arteriopathy and cerebral amyloid angiopathy. Subgroup analyses were performed based on the use of (1) etiology-oriented ICH classification, (2) detailed neuroimaging, and (3) Boston criteria among patients with cerebral amyloid angiopathy related ICH. We pooled the prevalence rates using random-effects models, and assessed the heterogeneity using Cochran Q and I2 statistics. RESULTS We identified 24 studies comprising 15 828 spontaneous ICH patients (mean age, 64.8 years; men, 60.8%). The pooled prevalences of hypertensive arteriopathy ICH, undetermined ICH, and cerebral amyloid angiopathy ICH were 50% (95% CI, 43%-58%), 18% (95% CI, 13%-23%), and 12% (95% CI, 7%-17% [P<0.001 between subgroups]). The volume of ICH was the largest in cerebral amyloid angiopathy ICH (24.7 [95% CI, 19.7-29.8] mL), followed by hypertensive arteriopathy ICH (16.2 [95% CI, 10.9-21.5] mL) and undetermined ICH (15.4 [95% CI, 6.2-24.5] mL). Among patients with undetermined ICH, the rates of short-term mortality (within 3 months) and concomitant intraventricular hemorrhage were 33% (95% CI, 25%-42%) and 38% (95% CI, 28%-48%), respectively. Subgroup analysis demonstrated a higher rate of undetermined ICH among studies that did not use an etiology-oriented classification (22% [95% CI, 15%-29%]). No difference was observed between studies based on the completion of detailed neuroimaging to assess the rates of undetermined ICH (P=0.62). CONCLUSIONS The etiology of spontaneous ICH remains unknown or cryptogenic among 1 in 7 patients in studies using etiology-oriented classification and among 1 in 4 patients in studies that avoid using etiology-oriented classification. The short-term mortality in undetermined ICH is high despite the relatively small ICH volume.
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Affiliation(s)
- Konark Malhotra
- Department of Neurology, Allegheny Health Network, Pittsburgh, PA (K.M., A.H.T.)
| | - Christina Zompola
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (C.Z., A.T., A.H.K., K.V., G.T.)
| | - Aikaterini Theodorou
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (C.Z., A.T., A.H.K., K.V., G.T.)
| | - Aristeidis H Katsanos
- Department of Neurology, Allegheny Health Network, Pittsburgh, PA (K.M., A.H.T.).,Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (C.Z., A.T., A.H.K., K.V., G.T.).,Department of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., A.S., H.G.)
| | - Ashkan Shoamanesh
- Department of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., A.S., H.G.)
| | - Himanshu Gupta
- Department of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K., A.S., H.G.)
| | - Simon Beshara
- Department of Neurology, Queen's University, Kingston, Ontario (S.B., A.V.A., G.T.)
| | - Nitin Goyal
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN (N.G.)
| | - Jason Chang
- Department of Neurology, MedStar Washington Hospital Center, Washington, DC (J.C.)
| | | | - Efstathios Boviatsis
- Department of Neurosurgery, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (E.B.)
| | - Konstantinos Voumvourakis
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (C.Z., A.T., A.H.K., K.V., G.T.)
| | - Charlotte Cordonnier
- Department of Neurology, Université Lille, Inserm, CHU Lille, U1172, LilNCog, Lille Neuroscience and Cognition, France (C.C.)
| | - David J Werring
- Stroke Research Centre, UCL Queen Square Institute of Neurology, London, United Kingdom (D.J.W.)
| | - Andrei V Alexandrov
- Department of Neurology, Queen's University, Kingston, Ontario (S.B., A.V.A., G.T.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, "Attikon" University Hospital, Greece. (C.Z., A.T., A.H.K., K.V., G.T.).,Department of Neurology, Queen's University, Kingston, Ontario (S.B., A.V.A., G.T.)
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11
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Lu Y, Jin H, Zhao Y, Li Y, Xu J, Tian J, Luan X, Chen S, Sun W, Zhang S, Xu S, Zhu F, Chen L, Mima D, Sun Y, Zhuoga C. Impact of Increased Hemoglobin on Spontaneous Intracerebral Hemorrhage. Neurocrit Care 2021; 36:395-403. [PMID: 34313936 PMCID: PMC8964592 DOI: 10.1007/s12028-021-01305-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/16/2021] [Indexed: 11/28/2022]
Abstract
Background Studies of the impact of increased hemoglobin on spontaneous intracerebral hemorrhage (ICH) are limited. The present study aimed to explore the effect of increased hemoglobin on ICH. Methods A retrospective single-center study using medical records from a database processed by univariate and multivariate analyses was performed in the People’s Hospital of Tibet Autonomous Region in Lhasa, Tibet, China. Results The mean hemoglobin level in 211 patients with ICH was 165.03 ± 34.12 g/l, and a median hematoma volume was 18.5 ml. Eighty-eight (41.7%) patients had large hematomas (supratentorial hematoma ≥ 30 ml; infratentorial hematoma ≥ 10 ml). No differences in ICH risk factors between the groups with different hemoglobin levels were detected. Increased hemoglobin was independently associated with large hematomas [odds ratio (OR) 1.013, P = 0.023]. Increased hemoglobin was independently associated with ICH with subarachnoid hemorrhage (OR 1.014, P = 0.016), which was more pronounced in men (OR 1.027, P = 0.002). Increased hemoglobin was independently associated with basal ganglia hemorrhage and lobar hemorrhage in men (OR 0.986, P = 0.022; OR 1.013, P = 0.044, respectively) but not in women (P > 0.1). Conclusions Increased hemoglobin was independently associated with large hemorrhage volume. Increased hemoglobin was independently associated with lobar hemorrhage in men and ICH with subarachnoid hemorrhage, which was more pronounced in men. Additional studies are needed to confirm our findings and explore potential mechanisms.
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Affiliation(s)
- Yuxuan Lu
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Haiqiang Jin
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Yuhua Zhao
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, Tibet, China
| | - Yuxian Li
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Jun Xu
- Department of Cognitive Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiayu Tian
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Xiaoting Luan
- Department of Neurology, The First Hospital of Tsinghua University, Beijing, China
| | - Siwei Chen
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wei Sun
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Shouzi Zhang
- Department of Psychiatry, Beijing Geriatric Hospital, Beijing, China
| | - Shunliang Xu
- Department of Neurology, the Second Hospital, Shandong University, Jinan, Shandong Province, China
| | - Feiqi Zhu
- Cognitive Impairment Ward of Neurology Department, the Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen, China
| | - Luzeng Chen
- Department of Ultrasound, Peking University First Hospital, Beijing, China
| | - Dunzhu Mima
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, Tibet, China
| | - Yongan Sun
- Department of Neurology, Peking University First Hospital, Beijing, China.
| | - Cidan Zhuoga
- Department of Neurology, People's Hospital of Tibet Autonomous Region, Lhasa, Tibet, China.
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12
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Shrestha S, Munakomi S. Do Multiple Brain Lesions Always Connote Worse Outcomes? Appraisal Evidence from a Tertiary Care Center in Koshi/Purbanchal Province of Nepal. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1374:91-103. [PMID: 34061333 DOI: 10.1007/5584_2021_642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Advances in medicine comprising diverse diagnostic and management modalities call for a bundle approach to improve patient care. This study aimed to present diagnostic patterns in patients with multiple intracranial lesions together with connoted survival implications. We retrospectively reviewed medical files of 85 patients with tumor and non-tumor intracranial lesions. Metastatic brain lesions were identified in 23.5% of patients. Neurological pathogenesis underlay 29.4%, infectious 21.2%, and vascular 14.1% of lesions, with the remaining portion comprising less frequent disorders. A favorable prognosis was predicted in 52/85 (61.2%) of the study population despite a variety of pathologies, which speaks for substantial improvements in outcomes of once hardly manageable or mortal brain disorders, comprising both common and rare conditions. The improvements are to the credit of advances in medical radio-imaging enhancing the diagnostic power which enables a precise stratification of brain pathologies. We emphasize the use of an algorithmic evaluation of patients presenting with multiple brain lesions for differential diagnosis and survival prognostication. There seems to be an ongoing transition from imperfect probabilistic prediction models to precision medicine, which determines advantages in disease management and outcome.
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Affiliation(s)
- Sangam Shrestha
- Department of Psychiatry, National Academy of Medical Sciences, Bir Hospital Nursing Campus, Gaushala, Kathmandu, Nepal
| | - Sunil Munakomi
- Department of Neurosurgery, College of Medical Sciences, Bharatpur, Chitwan, Nepal.
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13
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Beyrouti R, Best JG, Chandratheva A, Perry RJ, Werring DJ. Characteristics of intracerebral haemorrhage associated with COVID-19: a systematic review and pooled analysis of individual patient and aggregate data. J Neurol 2021; 268:3105-3115. [PMID: 33547527 PMCID: PMC7864476 DOI: 10.1007/s00415-021-10425-9] [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: 12/21/2020] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 02/07/2023]
Abstract
Background and purpose There are very few studies of the characteristics and causes of ICH in COVID-19, yet such data are essential to guide clinicians in clinical management, including challenging anticoagulation decisions. We aimed to describe the characteristics of spontaneous symptomatic intracerebral haemorrhage (ICH) associated with COVID-19. Methods We systematically searched PubMed, Embase and the Cochrane Central Database for data from patients with SARS-CoV-2 detected prior to or within 7 days after symptomatic ICH. We did a pooled analysis of individual patient data, then combined data from this pooled analysis with aggregate-level data. Results We included data from 139 patients (98 with individual data and 41 with aggregate-level data). In our pooled individual data analysis, the median age (IQR) was 60 (53–67) years and 64% (95% CI 54–73.7%) were male; 79% (95% CI 70.0–86.9%) had critically severe COVID-19. The pooled prevalence of lobar ICH was 67% (95% CI 56.3–76.0%), and of multifocal ICH was 36% (95% CI 26.4–47.0%). 71% (95% CI 61.0–80.4%) of patients were treated with anticoagulation (58% (95% CI 48–67.8%) therapeutic). The median NIHSS was 28 (IQR 15–28); mortality was 54% (95% CI 43.7–64.2%). Our combined analysis of individual and aggregate data showed similar findings. The pooled incidence of ICH across 12 cohort studies of inpatients with COVID-19 (n = 63,390) was 0.38% (95% CI 0.22–0.58%). Conclusions Our data suggest that ICH associated with COVID-19 has different characteristics compared to ICH not associated with COVID-19, including frequent lobar location and multifocality, a high rate of anticoagulation, and high mortality. These observations suggest different underlying mechanisms of ICH in COVID-19 with potential implications for clinical treatment and trials. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10425-9.
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Affiliation(s)
- R Beyrouti
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK
| | - J G Best
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, First Floor, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK
| | - A Chandratheva
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK.,Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, First Floor, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK
| | - R J Perry
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK.,Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, First Floor, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK
| | - D J Werring
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK. .,Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, First Floor, Russell Square House, 10-12 Russell Square, London, WC1B 5EH, UK.
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14
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Räty S, Sallinen H, Virtanen P, Haapaniemi E, Wu TY, Putaala J, Meretoja A, Tatlisumak T, Strbian D. Occipital intracerebral hemorrhage-clinical characteristics, outcome, and post-ICH epilepsy. Acta Neurol Scand 2021; 143:71-77. [PMID: 32602110 DOI: 10.1111/ane.13303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/09/2020] [Accepted: 06/21/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Posterior location affects the clinical presentation and outcome of ischemic stroke, but little is known about occipital intracerebral hemorrhage (ICH). We studied non-traumatic occipital ICH phenotype, outcome, and post-ICH epilepsy. MATERIALS AND METHODS Occipital ICH patients were retrospectively identified from the Helsinki ICH Study registry of 1013 consecutive ICH patients treated in our tertiary center in 2005-2010. They were compared to non-occipital ICH patients to evaluate the effect of location on functional outcome at discharge (dichotomized modified Rankin Scale, mRS), 3- and 12-month mortality, and incidence of epilepsy. RESULTS We found 19 occipital ICH patients (5.3% of lobar and 1.9% of all ICH). Compared to non-occipital lobar ICHs, they were younger (median age 63 vs 71 years, P = .007) and had lower National Institutes of Health Stroke Scale on admission (1 vs 8, P < .001), smaller hematoma volume (6.3 vs 17.7 ML, P = .008), and more frequently structural etiology underlying the ICH (26% vs 7%, P = .01). Mortality at both 3 and 12 months was 6%, whereas 84% reached favorable outcome (mRS 0-2) at discharge. Occipital location was associated with favorable outcome at discharge in lobar ICH (OR 11.02, 95% CI 1.55-78.20). Incidence of post-ICH epilepsy (median follow-up 2.7 years) was 18%, equaling to that of non-occipital lobar ICH. CONCLUSIONS Occipital ICH patients are younger, have less severe clinical presentation, smaller hematoma volume, more often structural etiology, and better outcome than other ICH patients. They exhibit a similar risk of epilepsy as non-occipital ICHs.
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Affiliation(s)
- Silja Räty
- Neurology, HUS Neurocenter University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Hanne Sallinen
- Neurology, HUS Neurocenter University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Pekka Virtanen
- Radiology, HUS Medical Imaging Center University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Elena Haapaniemi
- Neurology, HUS Neurocenter University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Teddy Y Wu
- Department of Neurology, Christchurch Hospital New Zealand Brain Research Institute Christchurch New Zealand
| | - Jukka Putaala
- Neurology, HUS Neurocenter University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Atte Meretoja
- Neurology, HUS Neurocenter University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Turgut Tatlisumak
- Department of Clinical Neurosciences/Neurology, Institute of Neurosciences and Physiology Sahlgrenska Academy at University of Gothenburg Gothenburg Sweden
- Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
| | - Daniel Strbian
- Neurology, HUS Neurocenter University of Helsinki and Helsinki University Hospital Helsinki Finland
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15
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Motoie R, Akai M, Kitahara T, Imamura H, Tanabe T, Sarazawa K, Takano S, Toda H, Komatsu K. Coronavirus Disease 2019 Complicated by Multiple Simultaneous Intracerebral Hemorrhages. Intern Med 2020; 59:2597-2600. [PMID: 32893231 PMCID: PMC7662065 DOI: 10.2169/internalmedicine.5697-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The relationship between coronavirus disease 2019 (COVID-19) and intracerebral hemorrhage remains unclear. We herein report a case of severe COVID-19 pneumonia complicated by multiple simultaneous intracerebral hemorrhages (MSICH). The patient died eight days after the episode of MSICH. No apparent coagulopathy was observed; however, extracorporeal membrane oxygenation and anticoagulation might have caused the occurrence of MSICH. Laboratory findings showed hypercoagulability, suggesting that thrombotic etiologies, such as sinus thrombosis or cerebral infarction, might also have caused MSICH. MSICH can occur as a fatal complication of COVID-19, and this should be considered when providing treatment.
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Affiliation(s)
- Ryota Motoie
- Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Japan
| | - Masaya Akai
- Department of Respiratory Medicine, Japanese Red Cross Fukui Hospital, Japan
| | - Takahiro Kitahara
- Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Japan
| | - Hisaji Imamura
- Department of Neurology, Japanese Red Cross Fukui Hospital, Japan
| | - Takeshi Tanabe
- Department of Anesthesiology, Japanese Red Cross Fukui Hospital, Japan
| | | | - Seiichiro Takano
- Department of Neurology, Japanese Red Cross Fukui Hospital, Japan
| | - Hiroki Toda
- Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Japan
| | - Kazuto Komatsu
- Department of Nephrology and Urology, Japanese Red Cross Fukui Hospital, Japan
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16
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Renard D, Castelnovo G, Ion I, Guillamo JS, Thouvenot E. Single and simultaneous multiple intracerebral hemorrhages: a radiological review. Acta Neurol Belg 2020; 120:819-829. [PMID: 32449137 DOI: 10.1007/s13760-020-01385-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/14/2020] [Indexed: 01/11/2023]
Abstract
Simultaneous multiple intracerebral hemorrhage (SMICH) is defined as ICH in two or more discrete noncontiguous acute intraparenchymal locations on initial CT. About 5% of ICH patients present with SMICH. ICH/SMICH etiology is classically divided into disorders of primary or secondary origin. About half of primary SMICH cases are caused by cerebral amyloid angiopathy or hypertensive arteriopathy. In this review, we will discuss the radiological features associated with the different causes of primary and secondary ICH and SMICH. Due to its rarity and the associated high morbidity and mortality, we will focus in particular on SMICH.
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Affiliation(s)
- Dimitri Renard
- Department of Neurology, CHU Nîmes, Hôpital Caremeau, University of Montpellier, 4, Rue Du Pr Debré, 30029, Nîmes Cedex 4, France.
| | - Giovanni Castelnovo
- Department of Neurology, CHU Nîmes, Hôpital Caremeau, University of Montpellier, 4, Rue Du Pr Debré, 30029, Nîmes Cedex 4, France
| | - Ioana Ion
- Department of Neurology, CHU Nîmes, Hôpital Caremeau, University of Montpellier, 4, Rue Du Pr Debré, 30029, Nîmes Cedex 4, France
| | - Jean Sebastien Guillamo
- Department of Neurology, CHU Nîmes, Hôpital Caremeau, University of Montpellier, 4, Rue Du Pr Debré, 30029, Nîmes Cedex 4, France
| | - Eric Thouvenot
- Department of Neurology, CHU Nîmes, Hôpital Caremeau, University of Montpellier, 4, Rue Du Pr Debré, 30029, Nîmes Cedex 4, France
- Institut de Génomique Fonctionnelle, UMR 5203, INSERM 1191, Université Montpellier, Montpellier, France
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17
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Kaiser J, Schebesch KM, Brawanski A, Linker RA, Schlachetzki F, Wagner A. Long-Term Follow-Up of Cerebral Amyloid Angiopathy-Associated Intracranial Hemorrhage Reveals a High Prevalence of Atrial Fibrillation. J Stroke Cerebrovasc Dis 2019; 28:104342. [PMID: 31521517 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104342] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/17/2019] [Accepted: 08/06/2019] [Indexed: 12/13/2022] Open
Abstract
GOAL Cerebral amyloid angiopathy (CAA) is the second-most common cause of nontraumatic intracerebral hemorrhages (ICH), surpassed only by uncontrolled hypertension. We characterized the percentage, risk factors, and comorbidities of patients suffering from CAA-related ICH in relation to long-term outcomes. MATERIAL AND METHODS We performed retrospective analyses and clinical follow-ups of individuals suffering from ICH who were directly admitted to neurosurgery between 2002 and 2016. FINDINGS Seventy-four of 174 (42%) spontaneous nontraumatic lobar ICH cases leastwise satisfied the modified Boston criteria definition for at least "possible CAA." Females suffered a higher risk of CAA-caused ICH (42 of 74, 56.8%, P= .035). Atrial fibrillation as a major comorbidity was observed in 19 patients (25.7%). Recovery (decrease of modified Rankin scale [mRS]) was highest during hospitalization in the acute clinic. One-year mortality was as follows: 14 of 25 patients (56%) with probable CAA without supporting pathology, 6 of 18, and 8 of 31 patients with supporting pathology and possible CAA, respectively. Only 10 of 74 (13.6%) had favorable long-term outcomes (mRS ≤2). Increasing numbers of lobar hemorrhages, low initial Glasgow Coma Scale, and subarachnoid hemorrhage were significantly associated with poor survivability, whereas statins, antithrombotic agents, an intraventricular hemorrhage, and midline shift played seemingly minor roles. CONCLUSIONS Symptomatic ICH is a serious stage in CAA progression with high mortality. The high incidence of concurrent atrial fibrillation in these patients may support data on more widespread vascular pathology in CAA.
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Affiliation(s)
- Johanna Kaiser
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | | | - Alexander Brawanski
- Department of Neurosurgery, University Clinic Regensburg, Regensburg, Germany
| | - Ralf A Linker
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | | | - Andrea Wagner
- Department of Neurology, University of Regensburg, Regensburg, Germany.
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Sallinen H, Wu TY, Meretoja A, Putaala J, Tatlisumak T, Strbian D. Effect of baseline hypocalcaemia on volume of intracerebral haemorrhage in patients presenting within 72 hours from symptom onset. J Neurol Sci 2019; 403:24-29. [DOI: 10.1016/j.jns.2019.05.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 11/30/2022]
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Tatlisumak T, Llinas RH, Martí-Fàbregas J, Seiffge DJ. Deciphering the causes of nontraumatic intracerebral hemorrhage. Neurology 2019; 92:357-359. [PMID: 30674599 DOI: 10.1212/wnl.0000000000006938] [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
Affiliation(s)
- Turgut Tatlisumak
- From the Department of Clinical Neuroscience (T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg; Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (R.H.L.), The Johns Hopkins Hospital, Baltimore, MD; Stroke Unit-Department of Neurology (J.M.-F.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Stroke Center and Neurology (D.J.S.), University Hospital and University Basel, Switzerland; and Stroke Research Group (D.J.S.), UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Rafael H Llinas
- From the Department of Clinical Neuroscience (T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg; Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (R.H.L.), The Johns Hopkins Hospital, Baltimore, MD; Stroke Unit-Department of Neurology (J.M.-F.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Stroke Center and Neurology (D.J.S.), University Hospital and University Basel, Switzerland; and Stroke Research Group (D.J.S.), UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Joan Martí-Fàbregas
- From the Department of Clinical Neuroscience (T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg; Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (R.H.L.), The Johns Hopkins Hospital, Baltimore, MD; Stroke Unit-Department of Neurology (J.M.-F.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Stroke Center and Neurology (D.J.S.), University Hospital and University Basel, Switzerland; and Stroke Research Group (D.J.S.), UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - David J Seiffge
- From the Department of Clinical Neuroscience (T.T.), Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg; Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Neurology (R.H.L.), The Johns Hopkins Hospital, Baltimore, MD; Stroke Unit-Department of Neurology (J.M.-F.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Stroke Center and Neurology (D.J.S.), University Hospital and University Basel, Switzerland; and Stroke Research Group (D.J.S.), UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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He D, Yu Y, Wu S, Tian S, Yu H, Xu S, Chu L. Mixed cerebrovascular disease in an elderly patient with mixed vascular risk factors: a case report. BMC Neurol 2019; 19:26. [PMID: 30755166 PMCID: PMC6371517 DOI: 10.1186/s12883-019-1248-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 01/31/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mixed cerebrovascular disease is a diagnostic entity that presents with hemorrhagic and ischemic stroke clinically and/or subclinically. Here, we report a patient with mixed vascular risk factors, who presented with multiple intracerebral hemorrhages and a simultaneously occurring cerebral infarction with hemorrhagic transformation. CASE PRESENTATION A 63-year-old male with no history of trauma or prior neurological disease presented with a sudden onset of weakness in his right limbs, followed by an episode of focal seizure without impaired awareness. The patient had a 4-year history of deep vein thrombosis in the lower limbs, and a 2-year history of Raynaud's phenomenon in the hands. He also had a family history of hypertension and thrombophilia. Head computed tomography plain scans showed two high densities in the bilateral parietal lobes and one mixed density in the left frontal lobe. The patient was diagnosed with mixed cerebrovascular disease. In this report, we make a systematic clinical reasoning regarding the etiological diagnosis, and discuss the possible pathogenic mechanisms leading to mixed cerebrovascular disease. We exclude coagulopathy, endocarditis, atrial fibrillation, patent foramen ovale, brain tumor, cerebral venous thrombosis, cerebral vascular malformation, cerebral amyloid angiopathy and vasculitis as causative factors. We identify hypertension, hereditary protein S deficiency, hypercholesteremia and hyperhomocysteinemia as contributing etiologies in this case. CONCLUSION This case presents complex underlying mechanisms of mixed cerebrovascular disease, in which hypertension and hyperhomocysteinemia are considered to play a central role.
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Affiliation(s)
- Dian He
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - YunLi Yu
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Shan Wu
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - ShuFen Tian
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Hui Yu
- Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Shu Xu
- Department of Pathology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Lan Chu
- Department of Neurology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China.
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Hussein O, Sawalha K, Hamed M, Abd ElAzim A, Wei L, Torbey MT, Hinduja A. The intraventricular-spot sign: prevalence, significance, and relation to hematoma expansion and outcomes. J Neurol 2018; 265:2201-2210. [DOI: 10.1007/s00415-018-8975-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 12/12/2022]
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Tatlisumak T, Cucchiara B, Kuroda S, Kasner SE, Putaala J. Nontraumatic intracerebral haemorrhage in young adults. Nat Rev Neurol 2018. [PMID: 29521335 DOI: 10.1038/nrneurol.2018.17] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Nontraumatic intracerebral haemorrhage (ICH) is a common subtype of stroke with a poor prognosis, high mortality and long-term morbidity. The incidence of ICH increases with age. ICH has not been widely investigated in young adults (herein defined as aged ∼18-50 years) despite an annual incidence of ∼5 per 100,000 individuals. Furthermore, ICH characteristics differ between young and elderly patients. Risk factors for ICH are surprisingly common in young adults, in whom ICH is often caused by structural lesions or hypertension, and only rarely by anticoagulation therapy and cerebral amyloid angiopathy (which are common predisposing factors in elderly patients). High short-term mortality (17% at 3 months) and long-term mortality (>25% at 10 years) persist even in contemporary series from high-income countries, and long-term disability is very common. Thus, an aggressive approach to identifying treatable underlying conditions and preventing ICH recurrence is indicated in young patients, although treatment strategies have generally not been investigated specifically in this age group. This narrative Review summarizes existing knowledge on the epidemiology, risk factors, causes, diagnosis, treatment and outcomes of ICH in young adults. We provide comparisons with the population of elderly patients with ICH and discuss challenges for future research.
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Affiliation(s)
- Turgut Tatlisumak
- Department of Clinical Neuroscience and Neurology, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Brett Cucchiara
- Comprehensive Stroke Center, Department of Neurology, University of Pennsylvania and University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama Prefecture, Japan
| | - Scott E Kasner
- Comprehensive Stroke Center, Department of Neurology, University of Pennsylvania and University of Pennsylvania Medical Center, Philadelphia, PA, USA
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
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