Early Quantification of Hematoma Hounsfield Units on Noncontrast CT in Acute Intraventricular Hemorrhage Predicts Ventricular Clearance after Intraventricular Thrombolysis

Kornbluth, Joshua; Nekoovaght-Tak, Saman; Ullman, Natalie; Carhuapoma, J. Ricardo; Hanley, Daniel F.; Ziai, Wendy

doi:10.3174/ajnr.a4393

Cited by 9 publications

(9 citation statements)

References 24 publications

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“…2,6,25,34 Furthermore, the clearance of IVH with tissue plasminogen activator has been the target of ongoing studies. 11,12 Although qualitative scores (original and modified Fisher grade, 3 LeRoux score, 15 and original and modified Graeb scores 1,6,21 ) have been established for evaluating SAH and IVH, assessment of hemorrhage qualitatively can be inconsistent and imprecise. 27 A recent study positively correlated the radiodensity of intracerebral hemorrhage to perihemorrhagic edema, suggesting that radiodensity may play a role in evaluating brain irritation/injury and predict clinical outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, elevated levels of several CSF proteins have been linked with poorer prognosis in aneurysmal SAH patients. 4,5,[9][10][11][16][17][18]22,24,26,28,29,33,38,39 This study had several limitations, including the small sample size and its retrospective nature. Moreover, the proposed method to calculate ventricular density involves manual selection of the ventricular system.…”

Section: Discussionmentioning

confidence: 99%

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Radiodensity of intraventricular hemorrhage associated with aneurysmal subarachnoid hemorrhage may be a negative predictor of outcome

Nguyen¹,

Li²,

Patel³

et al. 2018

Journal of Neurosurgery

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OBJECTIVE The presence, extent, and distribution of intraventricular hemorrhage (IVH) have been associated with negative outcomes in aneurysmal subarachnoid hemorrhage (SAH). Several qualitative scores (Fisher grade, LeRoux score, and Graeb score) have been established for evaluating SAH and IVH. However, no study has assessed the radiodensity within the ventricular system in aneurysmal SAH patients with IVH. Prior studies have suggested that hemorrhage with a higher radiodensity, as measured by CT Hounsfield units, can cause more irritation to brain parenchyma. Therefore, the authors set out to investigate the relationship between the overall radiodensity of the ventricular system in aneurysmal SAH patients with IVH and their clinical outcome scores. METHODS The authors reviewed the records of 101 patients who were admitted to their institution with aneurysmal SAH and IVH between January 2011 and July 2015. The following data were collected: age, sex, Glasgow Coma Scale (GCS) score, Hunt and Hess grade, extent of SAH (none, thin, or thick/localized), aneurysm location, and Glasgow Outcome Scale (GOS) score. To evaluate the ventricular radiodensity, the initial head CT scan was loaded into OsiriX MD. The ventricular system was manually selected as the region of interest (ROI) through all pertinent axial slices. After this, an averaged ventricular radiodensity was calculated from the ROI by the software. GOS scores were dichotomized as 1-3 and 4-5 subgroups for analysis. RESULTS On univariate analysis, younger age, higher GCS score, lower Hunt and Hess grade, and lower ventricular radiodensity significantly correlated with better GOS scores (all p < 0.05). Subsequent multivariate analysis yielded age (OR 0.936, 95% CI 0.895-0.979), GCS score (OR 3.422, 95% CI 1.9-6.164), and ventricular density (OR 0.937, 95% CI 0.878-0.999) as significant independent predictors (p < 0.05). A receiver operating characteristic curve yielded 12.7 HU (area under the curve 0.625, p = 0.032, sensitivity = 0.591, specificity = 0.596) as threshold between GOS scores of 1-3 and 4-5. CONCLUSIONS This study suggests that the ventricular radiodensity in aneurysmal SAH patients with IVH, along with GCS score and age, may serve as a predictor of clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radiodensity of intraventricular hemorrhage associated with aneurysmal subarachnoid hemorrhage may be a negative predictor of outcome

Nguyen¹,

Li²,

Patel³

et al. 2018

Journal of Neurosurgery

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“…Further, Hounsfield units (HU) of the mass measured +60 HU, a density measurement supporting the diagnosis of a hematoma, with no mention of heterogeneous fluid. 7 Consultation by the plastic surgery service on hospital day 2 revealed a clinical picture consistent with OCS despite high-normal tonometry readings including vision changes, pain, proptosis, and total external ophthalmoplegia. The patient was taken to the operating room for a lateral canthotomy and cantholysis.…”

Section: Case Reportmentioning

confidence: 97%

“…Further, Hounsfield units (HU) of the mass measured +60 HU, a density measurement supporting the diagnosis of a hematoma, with no mention of heterogeneous fluid. 7…”

Section: Case Reportmentioning

confidence: 99%

Lateral Canthotomy and Cantholysis for Spontaneous Retrobulbar Hemorrhage With Normal Intraocular Pressures: Case Report and Review of the Literature

Lem

Oyur

LaBove

et al. 2022

FACE

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Spontaneous retrobulbar hemorrhage (RBH) is uncommon and typically occurs secondary to vascular malformations, coagulopathies, hypertension, or strenuous activities in the setting of elevated intraocular pressure (IOP). RBH can cause orbital compartment syndrome (OCS) with resultant permanent vision loss. We present a case of spontaneous RBH in an 18-year-old male with a history of acute lymphoblastic leukemia (ALL) and sepsis. While IOPs were normal, the patient exhibited symptoms of OCS in which a lateral canthotomy and cantholysis were performed. This case highlights the importance of the clinical exam when treating a patient with suspected OCS and demonstrates that intraocular pressures need not be elevated for both diagnosis and intervention.

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“…72,73 At this time, individualized dosing for IVF has not been studied. Variations in response to IVF with alteplase is a subject of future research and has been identified in related cohorts with radiographic features 74 and clot-related factors. 75 Additionally, genetic factors modulating the response to intravenous alteplase for revascularization after acute ischemic stroke have been characterized, including Apo E2 phenyotype, 76 polymorphisms at loci of the factor XIII gene, 77 thrombin-activatable fibrinolysis inhibitor gene, 78 interleukin 1B gene, and von Willebrand factor genes.…”

Section: Enhancing Clot Lysis and Removalmentioning

confidence: 99%

Spontaneous Intraventricular Hemorrhage: When Should Intraventricular tPA Be Considered?

Abdelmalik

Ziai

2017

Semin Respir Crit Care Med

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Spontaneous intracerebral hemorrhage (ICH) is the most common cause of intraventricular hemorrhage (IVH) in adults. Complicating approximately 40% of ICH cases, IVH adds to the morbidity and mortality of this often fatal form of stroke. It is also a severity factor that complicates subarachnoid hemorrhage and traumatic brain injury, along with other less common causes of intracranial bleeding. Medical and surgical interventions to date have focused on limiting ICH and IVH expansion, controlling intracranial pressure, and relieving obstructive hydrocephalus. The placement of an external ventricular drain (EVD) can achieve the latter two goals but has not demonstrated improvement in clinical outcomes beyond mortality reduction. More recently, intraventricular fibrinolysis, utilizing the EVD, has gained interest as a safe and potentially effective method to maintain catheter patency and facilitate hematoma removal. A recent phase III clinical trial evaluating the efficacy of intraventricular alteplase versus intraventricular saline showed a mortality benefit, but failed to meet the primary endpoint of significant functional improvement. However, planned subgroup analysis focusing on patients with IVH volume > 20 mL, and those with IVH removal > 85% suggest that significant functional benefits may be attainable with this therapy. The practice of intraventricular fibrinolysis for spontaneous IVH is not the standard of care; however, based on 20 years of experience, it meets thresholds as a safe intervention, and in those patients with a high burden of intraventricular blood, aggressive clearance may lead to improved quality of life in survivors of this morbid syndrome.

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Early Quantification of Hematoma Hounsfield Units on Noncontrast CT in Acute Intraventricular Hemorrhage Predicts Ventricular Clearance after Intraventricular Thrombolysis

Abstract: BACKGROUND AND PURPOSE: Thrombolytic efficacy of intraventricular rtPA for acute intraventricular hemorrhage may depend on hematoma composition. We assessed whether hematoma Hounsfield unit quantification informs intraventricular hemorrhage clearance after intraventricular rtPA.

Cited by 9 publications

References 24 publications

Radiodensity of intraventricular hemorrhage associated with aneurysmal subarachnoid hemorrhage may be a negative predictor of outcome

Radiodensity of intraventricular hemorrhage associated with aneurysmal subarachnoid hemorrhage may be a negative predictor of outcome

Lateral Canthotomy and Cantholysis for Spontaneous Retrobulbar Hemorrhage With Normal Intraocular Pressures: Case Report and Review of the Literature

Spontaneous Intraventricular Hemorrhage: When Should Intraventricular tPA Be Considered?

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