Natalie L Ullman1, Pouya Tahsili-Fahadan2,3, Carol B Thompson4, Wendy C Ziai2, Daniel F Hanley5. 1. Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA. nlullman@gmail.com. 2. Division of Neurosciences Critical Care, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 3. Neuroscience Intensive Care Unit, Department of Medicine, Virginia Commonwealth University, INOVA campus, Falls Church, VA, USA. 4. Biotstatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 5. Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Abstract
INTRODUCTION: The Clot Lysis: Evaluating Accelerated Resolution of IVH trial examined whether irrigating the ventricular system with alteplase improved functional outcomes in patients with small intracerebral hemorrhage (ICH) and large intraventricular hemorrhage (IVH). Thalamic ICH location was common and was associated with poor outcome. One possible explanation is thalamic ICH-associated mass effect obstructing the third ventricle. We hypothesized that patients with thalamic ICH obstructing the third ventricle would have worse functional outcomes compared to patients without obstructing lesions. METHODS: ICH obstruction of third ventricle was defined as third ventricle compression on 1 or more axial computed tomography slices visually impeding cerebral spinal fluid flow. If the third ventricle was casted with IVH, it was scored as such. Multivariable logistic regression analyses were used to determine whether obstruction of the third ventricle predicts poor functional outcomes defined as modified Rankin score (mRS) 4-6, higher mRS, and mortality at 180 days. Models were adjusted for thalamic ICH location, ICH volume, IVH volume, age, hydrocephalus, baseline Glasgow coma scale, and percentage of low cerebral perfusion pressures during treatment. RESULTS: Among saline-treated patients, obstruction of the third ventricle by IVH was a significant predictor of higher mRS at 180 days (OR 1.87, CI 1.01-3.47) and mortality at 180 days (OR 2.73, CI 1.27-5.87) while obstruction by ICH was not. In contrast, among alteplase-treated patients, obstruction by ICH was a significant predictor of mRS 4-6 (OR 3.20, CI 1.30-7.88) and higher mRS at 180 days (OR 2.33, CI 1.24-4.35), while obstruction by IVH was not. CONCLUSIONS: Poor outcomes were associated with mass-related obstruction of the third ventricle from thalamic ICH in alteplase-treated patients and from IVH in saline-treated patients. Once the ventricular system is cleared with alteplase, obstruction of cerebral spinal fluid flow from thalamic ICH might become important in functional recovery.
INTRODUCTION: The Clot Lysis: Evaluating Accelerated Resolution of IVH trial examined whether irrigating the ventricular system with alteplase improved functional outcomes in patients with small intracerebral hemorrhage (ICH) and large intraventricular hemorrhage (IVH). Thalamic ICH location was common and was associated with poor outcome. One possible explanation is thalamic ICH-associated mass effect obstructing the third ventricle. We hypothesized that patients with thalamic ICH obstructing the third ventricle would have worse functional outcomes compared to patients without obstructing lesions. METHODS:ICH obstruction of third ventricle was defined as third ventricle compression on 1 or more axial computed tomography slices visually impeding cerebral spinal fluid flow. If the third ventricle was casted with IVH, it was scored as such. Multivariable logistic regression analyses were used to determine whether obstruction of the third ventricle predicts poor functional outcomes defined as modified Rankin score (mRS) 4-6, higher mRS, and mortality at 180 days. Models were adjusted for thalamic ICH location, ICH volume, IVH volume, age, hydrocephalus, baseline Glasgow coma scale, and percentage of low cerebral perfusion pressures during treatment. RESULTS: Among saline-treated patients, obstruction of the third ventricle by IVH was a significant predictor of higher mRS at 180 days (OR 1.87, CI 1.01-3.47) and mortality at 180 days (OR 2.73, CI 1.27-5.87) while obstruction by ICH was not. In contrast, among alteplase-treated patients, obstruction by ICH was a significant predictor of mRS 4-6 (OR 3.20, CI 1.30-7.88) and higher mRS at 180 days (OR 2.33, CI 1.24-4.35), while obstruction by IVH was not. CONCLUSIONS: Poor outcomes were associated with mass-related obstruction of the third ventricle from thalamic ICH in alteplase-treated patients and from IVH in saline-treated patients. Once the ventricular system is cleared with alteplase, obstruction of cerebral spinal fluid flow from thalamic ICH might become important in functional recovery.
Authors: Daniel F Hanley; Karen Lane; Nichol McBee; Wendy Ziai; Stanley Tuhrim; Kennedy R Lees; Jesse Dawson; Dheeraj Gandhi; Natalie Ullman; W Andrew Mould; Steven W Mayo; A David Mendelow; Barbara Gregson; Kenneth Butcher; Paul Vespa; David W Wright; Carlos S Kase; J Ricardo Carhuapoma; Penelope M Keyl; Marie Diener-West; John Muschelli; Joshua F Betz; Carol B Thompson; Elizabeth A Sugar; Gayane Yenokyan; Scott Janis; Sayona John; Sagi Harnof; George A Lopez; E Francois Aldrich; Mark R Harrigan; Safdar Ansari; Jack Jallo; Jean-Louis Caron; David LeDoux; Opeolu Adeoye; Mario Zuccarello; Harold P Adams; Michael Rosenblum; Richard E Thompson; Issam A Awad Journal: Lancet Date: 2017-01-10 Impact factor: 79.321
Authors: Neal Naff; Michael A Williams; Penelope M Keyl; Stanley Tuhrim; M Ross Bullock; Stephan A Mayer; William Coplin; Raj Narayan; Stephen Haines; Salvador Cruz-Flores; Mario Zuccarello; David Brock; Issam Awad; Wendy C Ziai; Anthony Marmarou; Denise Rhoney; Nichol McBee; Karen Lane; Daniel F Hanley Journal: Stroke Date: 2011-08-25 Impact factor: 7.914
Authors: Brad E Zacharia; Kerry A Vaughan; Zachary L Hickman; Samuel S Bruce; Amanda M Carpenter; Nils H Petersen; Stacie Deiner; Neeraj Badjatia; E Sander Connolly Journal: Neurosurg Focus Date: 2012-04 Impact factor: 4.047
Authors: H Hallevi; K C Albright; J Aronowski; A D Barreto; S Martin-Schild; A M Khaja; N R Gonzales; K Illoh; E A Noser; J C Grotta Journal: Neurology Date: 2008-03-11 Impact factor: 9.910
Authors: Candice Delcourt; Shoichiro Sato; Shihong Zhang; Else Charlotte Sandset; Danni Zheng; Xiaoying Chen; Maree L Hackett; Hisatomi Arima; Jun Hata; Emma Heeley; Rustam Al-Shahi Salman; Thompson Robinson; Leo Davies; Pablo M Lavados; Richard I Lindley; Christian Stapf; John Chalmers; Craig S Anderson Journal: Neurology Date: 2017-02-24 Impact factor: 9.910
Authors: Wendy C Ziai; Stanley Tuhrim; Karen Lane; Nichol McBee; Kennedy Lees; Jesse Dawson; Kenneth Butcher; Paul Vespa; David W Wright; Penelope M Keyl; A David Mendelow; Carlos Kase; Christine Wijman; Marc Lapointe; Sayona John; Richard Thompson; Carol Thompson; Steven Mayo; Pat Reilly; Scott Janis; Issam Awad; Daniel F Hanley Journal: Int J Stroke Date: 2013-08-28 Impact factor: 5.266
Authors: Jens Witsch; Guido J Falcone; Audrey C Leasure; Charles Matouk; Matthias Endres; Lauren Sansing; Daniel Woo; Kevin N Sheth Journal: Neurocrit Care Date: 2021-01-21 Impact factor: 3.210