David Roh1, Amelia Boehme2, Codi Young2, William Roth2, Jose Gutierrez2, Matthew Flaherty2, Jonathan Rosand2, Fernando Testai2, Daniel Woo2, Mitchell S V Elkind2. 1. From the Department of Neurology (D.R., A.B., W.R., J.G., M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (A.B., C.Y., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (M.F., D.W.), University of Cincinnati Academic Health Center, OH; Department of Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Neurology (F.T.), University of Illinois Hospital & Health Sciences System, Chicago. dr2753@cumc.columbia.edu. 2. From the Department of Neurology (D.R., A.B., W.R., J.G., M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology (A.B., C.Y., M.S.V.E.), Mailman School of Public Health, Columbia University, New York, NY; Department of Neurology (M.F., D.W.), University of Cincinnati Academic Health Center, OH; Department of Neurology (J.R.), Massachusetts General Hospital, Harvard Medical School, Boston; and Department of Neurology (F.T.), University of Illinois Hospital & Health Sciences System, Chicago.
Abstract
OBJECTIVE: To test the hypothesis that patients with deep intracerebral hemorrhage (ICH) would encounter hematoma expansion (HE) more frequently compared to patients with lobar ICH. METHODS: Patients with ICH with neuroimaging to calculate HE were analyzed from the multicenter Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) cohort. Patients with laboratory coagulopathy or preceding anticoagulant use were excluded to assess relationships of ICH location alone (deep vs lobar) with HE, defined as >33% relative growth. Odds ratios (ORs) and 95% confidence intervals (CIs) for these relationships were estimated with logistic regression. Sensitivity and specificity determined HE thresholds best associated with poor 3-month outcomes (modified Rankin score 4-6) stratified by location. RESULTS: There were 1,049 patients with deep and 408 patients with lobar ICH analyzed. Deep ICH locations were more likely to have HE (adjusted OR 1.57, 95% CI 1.08-2.29) after adjustment for age, sex, race, baseline hematoma size, and intraventricular hemorrhage. However, this difference was nonsignificant (adjusted OR 1.35, 95% CI 0.81-2.24) after controlling for time from symptom onset to admission CT in a subgroup analysis of 729 patients with these data. Yet, the threshold of HE best associated with poor outcomes was smaller in deep (30%) compared to lobar (50%) ICH. CONCLUSIONS: While HE was more frequent in deep than lobar ICH, this could be due to differences in symptom onset to admission CT times in our cohort. However, patients with deep ICH appear particularly vulnerable to the deleterious effects of small volumes of HE. Further studies should clarify whether ICH location needs to be considered in HE treatment paradigms.
OBJECTIVE: To test the hypothesis that patients with deep intracerebral hemorrhage (ICH) would encounter hematoma expansion (HE) more frequently compared to patients with lobar ICH. METHODS: Patients with ICH with neuroimaging to calculate HE were analyzed from the multicenter Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) cohort. Patients with laboratory coagulopathy or preceding anticoagulant use were excluded to assess relationships of ICH location alone (deep vs lobar) with HE, defined as >33% relative growth. Odds ratios (ORs) and 95% confidence intervals (CIs) for these relationships were estimated with logistic regression. Sensitivity and specificity determined HE thresholds best associated with poor 3-month outcomes (modified Rankin score 4-6) stratified by location. RESULTS: There were 1,049 patients with deep and 408 patients with lobar ICH analyzed. Deep ICH locations were more likely to have HE (adjusted OR 1.57, 95% CI 1.08-2.29) after adjustment for age, sex, race, baseline hematoma size, and intraventricular hemorrhage. However, this difference was nonsignificant (adjusted OR 1.35, 95% CI 0.81-2.24) after controlling for time from symptom onset to admission CT in a subgroup analysis of 729 patients with these data. Yet, the threshold of HE best associated with poor outcomes was smaller in deep (30%) compared to lobar (50%) ICH. CONCLUSIONS: While HE was more frequent in deep than lobar ICH, this could be due to differences in symptom onset to admission CT times in our cohort. However, patients with deep ICH appear particularly vulnerable to the deleterious effects of small volumes of HE. Further studies should clarify whether ICH location needs to be considered in HE treatment paradigms.
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: Daniel Woo; Jonathan Rosand; Chelsea Kidwell; Jacob L McCauley; Jennifer Osborne; Mark W Brown; Sandra E West; Eric W Rademacher; Salina Waddy; Jamie N Roberts; Sebastian Koch; Nicole R Gonzales; Gene Sung; Steven J Kittner; Lee Birnbaum; Michael Frankel; Fernando Daniel Testai; Christiana E Hall; Mitchell S V Elkind; Matthew Flaherty; Bruce Coull; Ji Y Chong; Tanya Warwick; Marc Malkoff; Michael L James; Latisha K Ali; Bradford B Worrall; Floyd Jones; Tiffany Watson; Anne Leonard; Rebecca Martinez; Ralph I Sacco; Carl D Langefeld Journal: Stroke Date: 2013-09-10 Impact factor: 7.914
Authors: Anirudh Sreekrishnan; Jennifer L Dearborn; David M Greer; Fu-Dong Shi; David Y Hwang; Audrey C Leasure; Sonya E Zhou; Emily J Gilmore; Charles C Matouk; Nils H Petersen; Lauren H Sansing; Kevin N Sheth Journal: Neurocrit Care Date: 2016-12 Impact factor: 3.210
Authors: David Roh; Glenda L Torres; Chunyan Cai; Christopher Zammit; Alexandra S Reynolds; Amanda Mitchell; E Sander Connolly; Jan Claassen; James C Grotta; Huimahn A Choi; Tiffany R Chang Journal: Neurosurgery Date: 2020-10-15 Impact factor: 4.654
Authors: H Bart Brouwers; Yuchiao Chang; Guido J Falcone; Xuemei Cai; Alison M Ayres; Thomas W K Battey; Anastasia Vashkevich; Kristen A McNamara; Valerie Valant; Kristin Schwab; Susannah C Orzell; Linda M Bresette; Steven K Feske; Natalia S Rost; Javier M Romero; Anand Viswanathan; Sherry H-Y Chou; Steven M Greenberg; Jonathan Rosand; Joshua N Goldstein Journal: JAMA Neurol Date: 2014-02 Impact factor: 18.302
Authors: David Roh; Tiffany Chang; Christopher Zammit; Gebhard Wagener; Alexandra S Reynolds; Nina Yoh; Mitchell S V Elkind; Kevin Doyle; Amelia Boehme; Andrew Eisenberger; Richard O Francis; Soojin Park; Sachin Agarwal; E Sander Connolly; Jan Claassen; Eldad Hod Journal: Neurocrit Care Date: 2019-08 Impact factor: 3.210
Authors: David Roh; Chung-Huan Sun; Santosh Murthy; Mitchell S V Elkind; Samuel S Bruce; Kara Melmed; Natasha Ironside; Amelia Boehme; Kevin Doyle; Daniel Woo; Hooman Kamel; Soojin Park; Sachin Agarwal; E Sander Connolly; Jan Claassen Journal: Neurocrit Care Date: 2019-08 Impact factor: 3.210
Authors: M Irem Baharoglu; Charlotte Cordonnier; Rustam Al-Shahi Salman; Koen de Gans; Maria M Koopman; Anneke Brand; Charles B Majoie; Ludo F Beenen; Henk A Marquering; Marinus Vermeulen; Paul J Nederkoorn; Rob J de Haan; Yvo B Roos Journal: Lancet Date: 2016-05-10 Impact factor: 79.321
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; Santosh B Murthy; David J Roh; Ifeyinwa S Asonye; Fernanda Carvalho Poyraz; Jessica R Magid-Bernstein; Evan F Joiner; Radhika Avadhani; Issam Awad; Daniel F Hanley Journal: Stroke Date: 2022-01-28 Impact factor: 10.170
Authors: Andrea Morotti; Gregoire Boulouis; Andreas Charidimou; Qi Li; Loris Poli; Paolo Costa; Valeria De Giuli; Eleonora Leuci; Federico Mazzacane; Giorgio Busto; Francesco Arba; Laura Brancaleoni; Sebastiano Giacomozzi; Luigi Simonetti; Michele Laudisi; Giuseppe Micieli; Anna Cavallini; Elisa Candeloro; Massimo Gamba; Mauro Magoni; Andrew D Warren; Christopher D Anderson; M Edip Gurol; Alessandro Biffi; Anand Viswanathan; Ilaria Casetta; Enrico Fainardi; Andrea Zini; Alessandro Pezzini; Alessandro Padovani; Steven M Greenberg; Jonathan Rosand; Joshua N Goldstein Journal: Neurology Date: 2021-04-01 Impact factor: 9.910