Bastian Volbers1, Wolfgang Willfarth2, Joji B Kuramatsu2, Tobias Struffert3, Arnd Dörfler3, Hagen B Huttner2, Stefan Schwab2, Dimitre Staykov2,4. 1. Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany. bastian.volbers@uk-erlangen.de. 2. Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany. 3. Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany. 4. Department of Neurology, Hospital of the Brothers of St. John, Eisenstadt, Austria.
Abstract
BACKGROUND: Intracerebral hemorrhage (ICH) is a devastating disease with ICH volume being the main predictor of poor outcome. The prognostic role of perihemorrhagic edema (PHE) is still unclear; however, available data are mainly derived from analyses during the first days after symptom onset. As PHE growth may continue up to 14 days after ICH, we evaluated PHE over a longer period of time and investigated its impact on short-term clinical outcome. METHODS: In this monocentric retrospective cohort study, patients with spontaneous supratentorial ICH were identified from our institutional data base. Different time points of CT scans were merged to time clusters for better comparison (day 1, 2-3, 4-6, 7-9, 10-12). Absolute volumes of ICH and PHE were obtained using a validated semiautomatic volumetric algorithm. Clinical outcome at discharge was assessed using the modified Rankin Scale (0-3 = favorable, 4-6 = poor). RESULTS: 220 patients (83 with favorable, 137 with poor outcome) were included in the final analysis. Mean ICH volume on admission was 22.8 [standard deviation (SD) 24.6] cm(3). Mean absolute PHE volume on admission was 22.5 (SD 20.8) cm(3) and increased to a mean peak volume of 38.1 (SD 31.4) cm(3) during 6.7 (SD 4.1) days on average. Besides GCS on admission, functional status before ICH, peak hematoma volume, lobar localization and fever burden, and high peak PHE volume predicted poor outcome at discharge [OR 0.977 (95 % CI 0.957-0.998)] in the multivariable analysis. CONCLUSIONS: PHE may have a negative impact on short-term functional outcome after ICH and therefore represent a possible treatment target.
BACKGROUND:Intracerebral hemorrhage (ICH) is a devastating disease with ICH volume being the main predictor of poor outcome. The prognostic role of perihemorrhagic edema (PHE) is still unclear; however, available data are mainly derived from analyses during the first days after symptom onset. As PHE growth may continue up to 14 days after ICH, we evaluated PHE over a longer period of time and investigated its impact on short-term clinical outcome. METHODS: In this monocentric retrospective cohort study, patients with spontaneous supratentorial ICH were identified from our institutional data base. Different time points of CT scans were merged to time clusters for better comparison (day 1, 2-3, 4-6, 7-9, 10-12). Absolute volumes of ICH and PHE were obtained using a validated semiautomatic volumetric algorithm. Clinical outcome at discharge was assessed using the modified Rankin Scale (0-3 = favorable, 4-6 = poor). RESULTS: 220 patients (83 with favorable, 137 with poor outcome) were included in the final analysis. Mean ICH volume on admission was 22.8 [standard deviation (SD) 24.6] cm(3). Mean absolute PHE volume on admission was 22.5 (SD 20.8) cm(3) and increased to a mean peak volume of 38.1 (SD 31.4) cm(3) during 6.7 (SD 4.1) days on average. Besides GCS on admission, functional status before ICH, peak hematoma volume, lobar localization and fever burden, and high peak PHE volume predicted poor outcome at discharge [OR 0.977 (95 % CI 0.957-0.998)] in the multivariable analysis. CONCLUSIONS:PHE may have a negative impact on short-term functional outcome after ICH and therefore represent a possible treatment target.
Authors: S M Davis; J Broderick; M Hennerici; N C Brun; M N Diringer; S A Mayer; K Begtrup; T Steiner Journal: Neurology Date: 2006-04-25 Impact factor: 9.910
Authors: Sebastian Urday; Lauren A Beslow; David W Goldstein; Anastasia Vashkevich; Alison M Ayres; Thomas W K Battey; Magdy H Selim; W Taylor Kimberly; Jonathan Rosand; Kevin N Sheth Journal: Stroke Date: 2015-02-26 Impact factor: 7.914
Authors: H Arima; J G Wang; Y Huang; E Heeley; C Skulina; M W Parsons; B Peng; Q Li; S Su; Q L Tao; Y C Li; J D Jiang; L W Tai; J L Zhang; E Xu; Y Cheng; L B Morgenstern; J Chalmers; C S Anderson Journal: Neurology Date: 2009-12-08 Impact factor: 9.910
Authors: Chitra Venkatasubramanian; Michael Mlynash; Anna Finley-Caulfield; Irina Eyngorn; Rajalakshmi Kalimuthu; R W Snider; Christine Anne Wijman Journal: Stroke Date: 2010-12-16 Impact factor: 7.914
Authors: Geoffrey Appelboom; Samuel S Bruce; Zachary L Hickman; Brad E Zacharia; Amanda M Carpenter; Kerry A Vaughan; Andrew Duren; Richard Yeup Hwang; Matthew Piazza; Kiwon Lee; Jan Claassen; Stephan Mayer; Neeraj Badjatia; E Sander Connolly Journal: J Neurol Neurosurg Psychiatry Date: 2013-01-23 Impact factor: 10.154
Authors: W Andrew Mould; J Ricardo Carhuapoma; John Muschelli; Karen Lane; Timothy C Morgan; Nichol A McBee; Amanda J Bistran-Hall; Natalie L Ullman; Paul Vespa; Neil A Martin; Issam Awad; Mario Zuccarello; Daniel F Hanley Journal: Stroke Date: 2013-02-07 Impact factor: 7.914
Authors: Audrey C Leasure; Adnan I Qureshi; Santosh B Murthy; Hooman Kamel; Joshua N Goldstein; Kyle B Walsh; Daniel Woo; Fu-Dong Shi; Hagen B Huttner; Wendy C Ziai; Daniel F Hanley; Charles C Matouk; Lauren H Sansing; Guido J Falcone; Kevin N Sheth Journal: Stroke Date: 2019-07-05 Impact factor: 7.914
Authors: Sarah Marchina; Jorge A Trevino-Calderon; Sara Hassani; Joseph M Massaro; Vasileios-Arsenios Lioutas; Filipa Carvalho; Magdy Selim Journal: Neurocrit Care Date: 2022-05-16 Impact factor: 3.532
Authors: Alois J Schiefecker; Mario Kofler; Max Gaasch; Ronny Beer; Iris Unterberger; Bettina Pfausler; Gregor Broessner; Peter Lackner; Paul Rhomberg; Elke Gizewski; Werner O Hackl; Miriam Mulino; Martin Ortler; Claudius Thome; Erich Schmutzhard; Raimund Helbok Journal: J Cereb Blood Flow Metab Date: 2017-04-24 Impact factor: 6.200
Authors: Teddy Y Wu; Oluwaseun Sobowale; Robert Hurford; Gagan Sharma; Søren Christensen; Nawaf Yassi; Turgut Tatlisumak; Patricia M Desmond; Bruce C V Campbell; Stephen M Davis; Adrian R Parry-Jones; Atte Meretoja Journal: Neuroradiology Date: 2016-07-05 Impact factor: 2.804
Authors: Teddy Y Wu; Bruce Cv Campbell; Daniel Strbian; Nawaf Yassi; Jukka Putaala; Turgut Tatlisumak; Stephen M Davis; Atte Meretoja Journal: Eur Stroke J Date: 2016-08-26
Authors: Rustam Al-Shahi Salman; Joseph Frantzias; Robert J Lee; Patrick D Lyden; Thomas W K Battey; Alison M Ayres; Joshua N Goldstein; Stephan A Mayer; Thorsten Steiner; Xia Wang; Hisatomi Arima; Hitoshi Hasegawa; Makoto Oishi; Daniel A Godoy; Luca Masotti; Dar Dowlatshahi; David Rodriguez-Luna; Carlos A Molina; Dong-Kyu Jang; Antonio Davalos; José Castillo; Xiaoying Yao; Jan Claassen; Bastian Volbers; Seiji Kazui; Yasushi Okada; Shigeru Fujimoto; Kazunori Toyoda; Qi Li; Jane Khoury; Pilar Delgado; José Álvarez Sabín; Mar Hernández-Guillamon; Luis Prats-Sánchez; Chunyan Cai; Mahesh P Kate; Rebecca McCourt; Chitra Venkatasubramanian; Michael N Diringer; Yukio Ikeda; Hans Worthmann; Wendy C Ziai; Christopher D d'Esterre; Richard I Aviv; Peter Raab; Yasuo Murai; Allyson R Zazulia; Kenneth S Butcher; Seyed Mohammad Seyedsaadat; James C Grotta; Joan Martí-Fàbregas; Joan Montaner; Joseph Broderick; Haruko Yamamoto; Dimitre Staykov; E Sander Connolly; Magdy Selim; Rogelio Leira; Byung Hoo Moon; Andrew M Demchuk; Mario Di Napoli; Yukihiko Fujii; Craig S Anderson; Jonathan Rosand Journal: Lancet Neurol Date: 2018-08-14 Impact factor: 44.182
Authors: Pablo Hervella; Manuel Rodríguez-Yáñez; José Manuel Pumar; Paulo Ávila-Gómez; Andrés da Silva-Candal; Ignacio López-Loureiro; Elena Rodríguez-Maqueda; Clara Correa-Paz; José Castillo; Tomás Sobrino; Francisco Campos; Ramón Iglesias-Rey Journal: Neurology Date: 2020-03-27 Impact factor: 9.910