Early Hemorrhage Growth in Patients With Intracerebral Hemorrhage

Brott, Thomas G.; Broderick, Joseph P.; Kothari, Rashmi; Barsan, William G.; Tomsick, Thomas A.; Sauerbeck, Laura; Spilker, Judith; Duldner, John E.; Khoury, Jane

doi:10.1161/01.str.28.1.1

Cited by 1,334 publications

(949 citation statements)

References 21 publications

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“…Most intracerebral hematomas that expand do so within the first 24 h, with the majority occurring in the first 6 h of the initial bleed [2]. On noncontrast head CT, fluid levels within the hematoma are associated with coagulopathy and an increased risk of expansion [3].…”

Section: Discussionmentioning

confidence: 99%

Fluid levels in the bleeding brain: a marker for coagulopathy and hematoma expansion

et al. 2017

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A 72-year-old man with baseline vascular dementia was admitted for 3 days of confusion, unintelligible speech, and incontinence. His past medical history was notable for a right middle cerebral artery territory infarction 4 years prior, coronary artery disease treated with angioplasty and stenting, hypertension, and diabetes. Upon evaluation in our emergency department, his examination was notable for expressive aphasia and confusion. He was moving all extremities spontaneously against gravity. A noncontrast head CT was performed that showed a subacute infarct in the left frontal lobe, subsequently confirmed on MRI (panel A). Since he was outside the window for thrombolysis and intervention, he was given one full-dose aspirin (325 mg tablet), and admitted to our hospital for a stroke evaluation.During the course of his stroke work-up, he was found to have an apical left ventricular thrombus, presumably the etiology of his subacute left frontal lobe infarct. Given his increased risk of further ischemic strokes, he was started on anticoagulation 7 days after his stroke using intravenous heparin and then switched to an oral vitamin K antagonist (warfarin).

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Section: Discussionmentioning

confidence: 99%

Fluid levels in the bleeding brain: a marker for coagulopathy and hematoma expansion

et al. 2017

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“…Every patient underwent follow‐up head CT in the first 6 to 24 hours. Hematoma expansion was defined as a proportional increase of more than 33% or an absolute increase greater than 6 cc (if baseline ICH volume ≤15 cc) from the initial ICH volume 23. Hydrocephalus was defined as rounding of the frontal horns with increased radius or decreased ventricular angle, increased width of the temporal horns, rounding and enlargement of the atrium with sulcal effacement, increased width of the third ventricle, or ballooning of the fourth ventricle 24.…”

Section: Methodsmentioning

confidence: 99%

Race‐Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and Whites

Faigle

Marsh

Llinás

et al. 2016

JAHA

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BackgroundIntracerebral hemorrhage (ICH) carries high risk for short‐term mortality. We sought to identify race‐specific predictors of mortality in ICH patients.Methods and ResultsWe used 2 databases, the Johns Hopkins clinical stroke database and the Nationwide Inpatient Sample (NIS). We included 226 patients with the primary diagnosis of spontaneous ICH from our stroke database between 2010 and 2013; in the NIS, 42 077 patients met inclusion criteria. Logistic regression was used to assess differences in predictors of mortality in blacks compared to whites. In our clinical stroke database, Glasgow Coma Scale (GCS; P=0.016), ICH volume (P=0.013), intraventricular haemorrhage (IVH; P=0.023), and diabetes mellitus (P=0.037) were predictors of mortality in blacks, whereas GCS (P=0.007), ICH volume (P=0.005), age (P=0.002), chronic kidney disease (P=0.003), and smoking (P=0.010) predicted mortality in whites. Among patients with IVH, blacks had over 7 times higher odds of mortality compared to whites (odds ratio [OR], 7.27; P value for interaction, 0.017) and were more likely to present with hydrocephalus (OR, 2.76; P=0.026). In the NIS, black ICH patients had higher rates of external ventricular drain (EVD) placement compared to whites (9.7% vs 5.0%; P<0.001) and were more likely to develop hydrocephalus (OR, 1.32; 95% CI, 1.20–1.46). Comparison of a race‐specific ICH score to the original ICH score showed that the various ICH score components have differential relevance for ICH score performance by race.Conclusions IVH and age differentially predict mortality among blacks and whites. Blacks have higher rates of obstructive hydrocephalus and more frequently require EVD placement compared to their white counterparts.

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“…Other studies also showed increased risks of poor functional outcome and death [16,30,33]. The occurrence of hematoma expansion is related to initial hematoma size; smaller hematomas are less likely to expand [16,34,35].…”

Section: Hematoma Expansionmentioning

confidence: 97%

“…Seventy three percent of patients express some degree of expansion, and 30 to 40% of patients expand more than 33% from baseline volume [13,18,30,31]. The pathophysiological mechanism by which hematoma expansion occurs remains unclear.…”

Section: Hematoma Expansionmentioning

confidence: 99%