Clinical and Radiographic Predictors of Intracerebral Hemorrhage Outcome

Al‐Mufti, Fawaz; Thabet, Ahmad M.; Singh, Tarundeep; El‐Ghanem, Mohammad; Amuluru, Krishna; Gandhi, Chirag D.

doi:10.1159/000484571

Cited by 67 publications

(65 citation statements)

References 105 publications

(131 reference statements)

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“…The mortality of patients with intracerebral hemorrhage (ICH) is about 30‐40% worldwide and it is mostly due to the occurrence of increased intracranial hypertension (ICP) that may lead to dislocation of midline structure and cerebral herniation . Therefore, the availability of diagnostic and monitoring tools for the estimation of ICP may improve the management of these vulnerable patients.…”

Section: Introductionmentioning

confidence: 99%

“…The mortality of patients with intracerebral hemorrhage (ICH) is about 30-40% worldwide and it is mostly due to the occurrence of increased intracranial hypertension (ICP) that may lead to dislocation of midline structure and cerebral herniation. 1,2 Therefore, the availability of diagnostic and monitoring tools for the estimation of ICP may improve the management of these vulnerable patients. Ultrasonography of the optic nerve sheath diameter (ONSD) is a promising simple, noninvasive, repeatable, and bedside technique for the detection of increased ICP and, thus, particularly suitable in an intensive care or stroke-unit setting.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasonography Monitoring of Optic Nerve Sheath Diameter and Retinal Vessels in Patients with Cerebral Hemorrhage

Naldi

Pivetta

Coppo

et al. 2019

Journal of Neuroimaging

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BACKGROUND AND PURPOSE Evaluation of the diagnostic accuracy of optic nerve sheath diameter (ONSD) and Doppler indices of central retinal arteries and veins for the detection of increased intracranial pressure (ICP) in intracerebral hemorrhage (ICH) and of the usefulness of a second assessment of these variables in the monitoring of ICH. METHODS A total of 46 acute ICH patients with (group 1, n = 25) and without (group 2, n = 21) clinical and radiological computed tomography signs of raised ICP and 40 healthy controls were recruited. The median binocular ONSD and Doppler indices of retinal vessels including resistive index (RI) and retinal venous pulsation (RVP) were compared among groups, both at admission and later during ICH monitoring. RESULTS Median binocular ONSD showed higher accuracy for the detection of increased ICP (sensitivity and specificity 100%), while Doppler indices were less accurate (sensitivity 48% and specificity 95% for RI; 80% and 62% for RVP). In ICH patients, ONSD was significantly elevated in group 1 both at admission (6.40 mm [interquartile range [IQR] = .70] vs. 4.70 [.40]) and at control time (6.00 [.55] vs. 4.55 [.40]; P < .01), as well as RI (.79 [.11] vs. .77 [.03] and .80 [.06] vs. .75 [.35]; P = .01). RVP was significantly increased in group 1 only at admission (3.20 cm/s [1.05] vs. 2.00 [1.55], P = .02). CONCLUSIONS Median binocular ONSD evaluation showed higher accuracy for the estimation of elevated ICP compared with Doppler indices of retinal vessels. The ONSD enlargement detected in the early phase of ICH persists at control time.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ultrasonography Monitoring of Optic Nerve Sheath Diameter and Retinal Vessels in Patients with Cerebral Hemorrhage

Naldi

Pivetta

Coppo

et al. 2019

Journal of Neuroimaging

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“…Al Mufti et al (16) conducted a literature review on various radiological factors, which affected the outcome. Haematoma location, volume, expansion, spot sign, swirl sign, perihaematomal oedema, IVH and hydrocephalus were the most studied radiological predictors.…”

Section: Discussionmentioning

confidence: 99%

Radiological Predictors of Mortality in Patients With Primary Spontaneous Intracerebral Haemorrhage

Krishnakumar¹,

Bhadran²,

Harrison³

et al. 2018

jemds

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BACKGROUND Primary spontaneous intracerebral haematoma (ICH) is a deadly form of stroke with very high mortality and morbidity. Outcome prediction is mandatory for optimisation of therapeutic efforts. The objective of our prospective study is to identify reliable radiological predictors of mortality from a plain CT study of brain. RESULTSThe mortality in our series was 28.6% (N= 32). Radiological factors associated with poor outcome on bivariate analysis were volume of haemorrhage, Midline Shift (MLS), Intraventricular Haemorrhage (IVH) and hydrocephalus. On multivariate analysis IVH (P= .007), MLS (.008) and volume of haemorrhage (P= .029) were significantly associated with poor outcome. Using ROC curve, we had a cut-off volume of 42.5 cm 3 with an optimum sensitivity of 81.2% and specificity of 90%. CONCLUSIONPlain CT study of brain obtained within 24 hours of the ictus can be reliably used for predicting the prognosis of subjects with primary supratentorial ICH.

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“…Advanced age is in itself a risk factor for ICH (28), as is the use of anticoagulants, particularly in the elderly, where the incidence of anticoagulant-related ICH is increasing steadily (3). Risk factors specifically important in young patients years) include hypertension, diabetes, menopause, current cigarette smoking, high alcohol intake, high caffeine intake, and cocaine use (23).…”

Section: Risk Factorsmentioning

confidence: 99%

“…Factors associated with poor functional outcome include advanced age, depressed level of consciousness at admission, diabetes mellitus (31), and pre-ICH cognitive impairment (28). In addition, >20% of ICH patients will deteriorate ≥2 Glasgow Coma Scale (GCS) points between the initial assessment and arrival at the emergency department, and such deterioration is associated with increased mortality and need for surgical intervention (32).…”

Section: Prognostic Factorsmentioning

confidence: 99%

Surgically Treated Intracerebral Haemorrhage : Pathophysiology and Clinical Aspects

Tobieson

2019

Linköping University Medical Dissertations

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To Ester!If it doesn't challenge you it doesn't change you! /the inside of my Ironman cap  Abstract i ABSTRACT Mortality and morbidity of intracerebral haemorrhage (ICH) is excessively high, and the case fatality rate has not improved in the last decades. Although surgery for ICH can be life-saving, no positive effect on functional outcome has been found in large cohorts of ICH patients. Increased understanding of the pathophysiology of ICH is needed to develop improved treatment strategies. Svensk sammanfattningiii KIRURGISK BEHANDLING AV HJÄRN-BLÖDNINGAR Spontan primär hjärnblödning (ICH), som inte beror på pulsåderbråck, utgör ca 12.5% av alla strokeinsjuknanden per år i Sverige, och står för en ansenlig del av den årliga stroke-relaterade dödligheten och förlusten av funktion. Endast en liten del av patienterna kan rehabiliteras åter till ett självständigt liv. I dagsläget saknas effektiv behandling utöver att förebygga att blödningen ökar i storlek genom snabb korrigering av koagulationsrubbningar och blodtryckssänkande behandling. Ca 5 % av alla ICH i Sverige opereras, men det saknas tydlig evidens för nyttan av kirurgi utöver som livräddande åtgärd.(ii-iii) Mikrodialys är en användbar metod för att studera hjärnskada efter ICH och kan kombineras med proteomik analys men det finns fallgropar och svårigheter med tekniken att ta hänsyn till, såsom att proteiner fastnar på mikrodialysmembranet.(iv) Den nationsövergripande genomgången av kirurgiskt behandlade ICH patienter påvisar likheter avseende patienternas ålder och medvetandegrad, men skillnader i volym och lokalisation av opererade blödningar, samt i den postoperativa vården. Dessa skillnader bör vara fokus för framtida forskningsstudier för att möjliggöra utformningen av bättre riktlinjer för klinisk praxis.

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Clinical and Radiographic Predictors of Intracerebral Hemorrhage Outcome

Cited by 67 publications

References 105 publications

Ultrasonography Monitoring of Optic Nerve Sheath Diameter and Retinal Vessels in Patients with Cerebral Hemorrhage

Ultrasonography Monitoring of Optic Nerve Sheath Diameter and Retinal Vessels in Patients with Cerebral Hemorrhage

Radiological Predictors of Mortality in Patients With Primary Spontaneous Intracerebral Haemorrhage

Surgically Treated Intracerebral Haemorrhage : Pathophysiology and Clinical Aspects

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