Diagnosis and Management of Acute Intracerebral Hemorrhage

Morotti, Andrea; Goldstein, Joshua N.

doi:10.1016/j.emc.2016.06.010

Cited by 114 publications

(104 citation statements)

References 90 publications

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“…Intracerebral hemorrhage (ICH) is one of the most devastating subtypes of cerebrovascular diseases with extremely high mortality, severe disability in the surviving patients and little effective treatment ( 1 – 3 ). According to epidemiological reports, ICH remains the second most common form of stroke, accounting for 10–15% of all strokes, with an incidence of 10–30 per 100,000 people each year worldwide ( 4 , 5 ).…”

Section: Introductionmentioning

confidence: 99%

Urokinase vs Tissue-Type Plasminogen Activator for Thrombolytic Evacuation of Spontaneous Intracerebral Hemorrhage in Basal Ganglia

Yang

et al. 2017

Front. Neurol.

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Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke, which leads to a high rate of mortality and poor neurological outcomes worldwide. Thrombolytic evacuation with urokinase-type plasminogen activator (uPA) or tissue-type plasminogen activator (tPA) has been showed to be a hopeful treatment for ICH. However, to the best of our knowledge, no clinical trials were reported to compare the efficacy and safety of these two fibrinolytics administrated following minimally invasive stereotactic puncture (MISP) in patients with spontaneous basal ganglia ICH. Therefore, the authors intended here to evaluate the differential impact of uPA and tPA in a retrospective study. In the present study, a total of 86 patients with spontaneous ICH in basal ganglia using MISP received either uPA (uPA group, n = 45) or tPA (tPA group, n = 41), respectively. The clinical baseline characteristics prior to the operation were collected. In addition, therapeutic responses were assessed by the short-term outcomes within 30 days postoperation, as well as long-term outcomes at 1 year postoperation. Our findings showed that, in comparison with tPA, uPA was able to better promote hematoma evacuation and ameliorate perihematomal edema, but the differences were not statistically significant. Moreover, the long-term functional outcomes of both groups were similar, with no statistical difference. In conclusion, these results provide evidence supporting that uPA and tPA are similar in the efficacy and safety for thrombolytic evacuation in combination with MISP in patients with spontaneous basal ganglia ICH.

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Section: Introductionmentioning

confidence: 99%

Urokinase vs Tissue-Type Plasminogen Activator for Thrombolytic Evacuation of Spontaneous Intracerebral Hemorrhage in Basal Ganglia

Yang

et al. 2017

Front. Neurol.

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“…Hematoma expansion is a common event in the early natural history of ICH and given its influence on outcome represents an appealing target for acute ICH treatment [16]. Rapid and efficient prediction of ICH expansion is therefore crucial in order to select those patients most likely to benefit from anti-expansion therapies.…”

Section: Discussionmentioning

confidence: 99%

Phantom-based standardization of CT angiography images for spot sign detection

et al. 2017

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Purpose The CT angiography (CTA) spot sign is a strong predictor of hematoma expansion in intracerebral hemorrhage (ICH). However, CTA parameters vary widely across centers and may negatively impact spot sign accuracy in predicting ICH expansion. We developed a CT iodine calibration phantom that was scanned at different institutions in a large multicenter ICH clinical trial to determine the effect of image standardization on spot sign detection and performance. Methods A custom phantom containing known concentrations of iodine was designed and scanned using the stroke CT protocol at each institution. Custom software was developed to read the CT volume datasets and calculate the Hounsfield Unit as a function of iodine concentration for each phantom scan. CTA images obtained within 8 h from symptom onset were analyzed by two trained readers comparing the calibrated vs. uncalibrated density cutoffs for spot sign identification. ICH expansion was defined as hematoma volume growth >33%. Results A total of 90 subjects qualified for the study, of whom 17/83 (20.5%) experienced ICH expansion. The number of spot sign positive scans was higher in the calibrated analysis (67.8% vs 38.9% p<0.001). All spot signs identified in the non-calibrated analysis remained positive after calibration. Calibrated CTA images had higher sensitivity for ICH expansion (76% vs 52%) but inferior specificity (35% vs 63%) compared with uncalibrated images. Conclusion Normalization of CTA images using phantom data is a feasible strategy to obtain consistent image quantification for spot sign analysis across different sites and may improve sensitivity for identification of ICH expansion.

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“…Результати. Значення сумарного бала ≥2 за шкалою Hemphill-ICH та ≥8 по ICH-GS асоційовані з підвищенням ризику летального результату відповідно в 7,1 [2,[8][9][10][11][12][13][14][15][16][17][18],0] (р < 0,01) і 4,4 [2,2-9,3] раза (р < 0,01). Шкала Hemphill-ICH характеризується вищою інформативністю для прогнозування вітального прогнозу виходу гострого періоду МГСІ (AUC = 0,84) порівняно зі шкалою ICH-GS (AUC = 0,78, p < 0,05).…”

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“…One of the ways to improve the effectiveness of treatment activities in this contingent of patients is a differentiated definition of optimal therapeutic tactics with regard to individual vital and functional prognosis of the disease acute period outcome [4,5,10].…”

Section: Introductionmentioning

confidence: 99%

Possibilities of clinical neuroimaging assessment scales using for patient severity in the onset of cerebral hemorrhagic supratentorial stroke to predict the outcome of the disease acute period

Kuznietsov

2018

ZMJ

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The main purpose of the study was to determine the criteria for the vital and functional prognosis of the cerebral hemorrhagic supratentorial stroke (CHSS) acute period outcome based on the Hemphill Intracerebral Hemorrhage (Hemphill-ICH) Scale and ICH-Grading Scale (ICH-GS) in the onset of the disease. Materials and methods. A prospective, cohort, complex clinical and paraclinical study was conducted in 124 patients (72 men and 52 women, mean age 64.7 ± 1.1 years) with CHSS. This study included clinical assessment using National Institute of Health Stroke Scale and Glasgow Coma Scale, visualization of cerebral structures and integrated assessment of health state severity using the Hemphill-ICH Scale and ICH-GS. The functional outcome of the acute period was determined by the modified Rankin Scale. Results. The Hemphill-ICH Scale score ≥2 and ICH-GS score ≥8 are associated with an increased risk of CHSS acute period lethal outcome, at 7.1 [2.8-18.0] (P < 0.01) and 4.4 [2.2-9.3] times (P < 0.01), respectively. The Hemphill-ICH Scale is characterized by a higher informative value for CHSS acute period lethal outcome prediction (AUC = 0.84) in comparison with the ICH-GS (AUC = 0.78, P < 0.05). The ICH-GS is characterized by a higher informative value for the functional prognosis of CHSS acute period outcome (AUC = 0.69) in comparison with the Hemphill-ICH Scale (AUC = 0.61, P < 0.05). Conclusions. Predictors of CHSS acute period lethal outcome are Hemphill-ICH Scale score ≥ 2 and ICH-GS score ≥8. The Hemphill-ICH Scale score = 0 and ICH-GS score = 5 are the criteria for the favourable functional outcome of CHSS acute period (mRS score ≤3 on the 21st day). The informative value of the Hemphill-ICH Scale and ICH-GS is higher for the vital prognosis than for the functional prognosis of CHSS acute period outcome verification.

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Diagnosis and Management of Acute Intracerebral Hemorrhage

Cited by 114 publications

References 90 publications

Urokinase vs Tissue-Type Plasminogen Activator for Thrombolytic Evacuation of Spontaneous Intracerebral Hemorrhage in Basal Ganglia

Urokinase vs Tissue-Type Plasminogen Activator for Thrombolytic Evacuation of Spontaneous Intracerebral Hemorrhage in Basal Ganglia

Phantom-based standardization of CT angiography images for spot sign detection

Possibilities of clinical neuroimaging assessment scales using for patient severity in the onset of cerebral hemorrhagic supratentorial stroke to predict the outcome of the disease acute period

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