Early Perihematomal Edema Expansion: Definition, Significance, and Association with Outcomes after Intracerebral Hemorrhage

Abstract

Objective. To investigate the association between early perihematomal edema (PHE) expansion and functional outcome in patients with intracerebral hemorrhage (ICH). Methods. Patients with ICH who underwent initial computed tomography (CT) scans within 6 hours after the onset of symptoms and follow-up CT scans within 24 ± 12 hours were included. Absolute PHE increase was defined as the absolute increase in PHE volume from baseline to 24 hours. A receiver-operating characteristic (ROC) curve was generated to determine the cutoff value for early PHE expansion, which was operationally defined as an absolute increase in PHE volume of >6 mL. The outcome of interest was 3-month poor outcome defined as modified Rankin scale score of ≥4. A multivariable logistic regression procedure was used to assess the association between early PHE expansion and outcome after ICH. Results. In 233 patients with ICH, 89 (38.2%) patients had poor outcome at 3-month follow-up. Early PHE expansion was observed in 56 of 233 (24.0%) patients. Patients with early PHE expansion were more likely to have poor functional outcome than those without (43.8% vs. 11.8%, p < 0.001 ). After adjusting for age, admission systolic blood pressure, admission Glasgow Coma Scale score, baseline ICH volume and the presence of intraventricular hemorrhage, and time from onset to CT, early PHE expansion was associated with poor outcome (adjusted odds ratio, 4.25; 95% confidence interval, 1.70–10.60; p = 0.002 ). Conclusions. The early PHE expansion was not uncommon in patients with ICH and was correlated with poor outcome following ICH.

The association between perihaematomal oedema and functional outcome after spontaneous intracerebral haemorrhage: A systematic review and meta-analysis

“…17,24 Seven studies (n = 4473 patients) assessed the influence of PHO growth on poor functional outcome. 21,23,25,29,36,41,42 Six out of the seven studies measured aPHO increase while one study assessed increase in OED. 23 There was large variation in the interval between symptom onset, baseline PHO measurement and the timing of the assessment of PHO growth.…”

“…37 Combining these two studies 28,37 with the studies included the primary analysis, 22,24,30,38 we found a pooled OR of 1.02 (95% CI 1.00-1.04, p = 0.1, I 2 = 76%) for the association between PHO and mRS 3 and 6 at any time of follow-up. Seven studies (n = 2793 patients) 25,27,29,31,36,39,42 reported on the influence of PHO and mRS score 4-6 at 3 months. Three of these studies (n = 1398) 25,36,42 assessed PHO growth as their primary analysis, the other four (n = 1395) 27,29,31,39 measured aPHO.…”

Defining Delayed Perihematomal Edema Expansion in Intracerebral Hemorrhage: Segmentation, Time Course, Risk Factors and Clinical Outcome

“…The pre-clinical research on magnetic resonance spectroscopy revealed that the recovery of N-acetylaspartate, choline, and creatine was faster in the PHE area than in the non-PHE area ( 31 ), suggesting that the PHE may provide a protective buffer against irreversible impairment. Nevertheless, real-world research showed that patients with absolute ( 15 , 32 , 33 ) and relative PHE expansion ( 5 , 16 ) have a higher risk of developing poor neurological outcomes. Compared to the well-established research for hematoma expansion, we believe the PHE expansion is worthy of further investigation based on its good sensitivity for prognosis prediction, and a more comprehensive prediction model for PHE expansion is needed.…”

Molecular, Pathological, Clinical, and Therapeutic Aspects of Perihematomal Edema in Different Stages of Intracerebral Hemorrhage

“…The growth of PHE measured by PHE expansion and EED was also used to evaluate the severity of brain edema after ICH in patients. Two clinical studies have found that an increase in absolute PHE volume from baseline to day 3 was correlated with a poor outcome 3 months after ICH [ 116 , 179 ]. A study with 115 patients also found that the PHE expansion rate from baseline to 72 hours was associated with poor functional outcomes after deep ICH [ 180 ].…”