Imaging and clinical prognostic indicators for early hematoma enlargement after spontaneous intracerebral hemorrhage

Ji, Nan; Lu, Jing; Zhao, Yuan Li; Wang, Shuo; Zhao, Jizhong

doi:10.1179/174313209x444035

Cited by 20 publications

(15 citation statements)

References 8 publications

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“…Additional studies have later confirmed this observation (51, 69). The presence of heterogeneity is further linked to mortality and poor functional outcome (68).…”

Section: Non-contrast Computed Tomographymentioning

confidence: 57%

“…The hypothesis behind this observation is that the irregularity could result from multiple leaking vessels feeding the hematoma and hence a higher probability of hematoma expansion (70). Even though the observation that irregularity of the hematoma shape should facilitate hematoma expansion is validated in a large study elaborated by Fujii et al (71), other studies have not been able to confirm this finding – thus making irregular shaping of the hematoma an uncertain predictor of hematoma expansion (48, 51, 69). …”

Section: Non-contrast Computed Tomographymentioning

confidence: 98%

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Prediction and Observation of Post-Admission Hematoma Expansion in Patients with Intracerebral Hemorrhage

et al. 2014

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Post-admission hematoma expansion in patients with intracerebral hemorrhage (ICH) comprises a simultaneous major clinical problem and a possible target for medical intervention. In any case, the ability to predict and observe hematoma expansion is of great clinical importance. We review radiological concepts in predicting and observing post-admission hematoma expansion. Hematoma expansion can be observed within the first 24 h after symptom onset, but predominantly occurs in the early hours. Thus capturing markers of on-going bleeding on imaging techniques could predict hematoma expansion. The spot sign observed on computed tomography angiography is believed to represent on-going bleeding and is to date the most well investigated and reliable radiological predictor of hematoma expansion as well as functional outcome and mortality. On non-contrast CT, the presence of foci of hypoattenuation within the hematoma along with the hematoma-size is reported to be predictive of hematoma expansion and outcome. Because patients tend to arrive earlier to the hospital, a larger fraction of acute ICH-patients must be expected to undergo hematoma expansion. This renders observation and radiological follow-up investigations increasingly relevant. Transcranial duplex sonography has in recent years proven to be able to estimate hematoma volume with good precision and could be a valuable tool in bedside serial observation of acute ICH-patients. Future studies will elucidate, if better prediction and observation of post-admission hematoma expansion can help select patients, who will benefit from hemostatic treatment.

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“…Additional studies have later confirmed this observation (51, 69). The presence of heterogeneity is further linked to mortality and poor functional outcome (68).…”

Section: Non-contrast Computed Tomographymentioning

confidence: 57%

Section: Non-contrast Computed Tomographymentioning

confidence: 98%

Prediction and Observation of Post-Admission Hematoma Expansion in Patients with Intracerebral Hemorrhage

et al. 2014

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“…As well, the occurrence of hematoma growth, which occurs in up to one-third of all ICH patients, is another predictor of poor outcome (Fujii et al, 1994;Ji et al, 2009). On-going bleeding appears to be minimal in the autologous blood infusion model (MacLellan et al, 2008) whereas collagenase infusion causes bleeding that starts within minutes to last for several hours (MacLellan et al, 2008;Rosenberg et al, 1990).…”

Section: Outcome End Pointsmentioning

confidence: 99%

A Critical Appraisal of Experimental Intracerebral Hemorrhage Research

MacLellan

Paquette

Colbourne

2012

J Cereb Blood Flow Metab

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The likelihood of translating therapeutic interventions for stroke rests on the quality of preclinical science. Given the limited success of putative treatments for ischemic stroke and the reasons put forth to explain it, we sought to determine whether such problems hamper progress for intracerebral hemorrhage (ICH). Approximately 10% to 20% of strokes result from an ICH, which results in considerable disability and high mortality. Several animal models reproduce ICH and its underlying pathophysiology, and these models have been widely used to evaluate treatments. As yet, however, none has successfully translated. In this review, we focus on rodent models of ICH, highlighting differences among them (e.g., pathophysiology), issues with experimental design and analysis, and choice of end points. A Pub Med search for experimental ICH (years: 2007 to 31 July 2011) found 121 papers. Of these, 84% tested neuroprotectants, 11% tested stem cell therapies, and 5% tested rehabilitation therapies. We reviewed these to examine study quality (e.g., use of blinding procedures) and choice of end points (e.g., behavioral testing). Not surprisingly, the problems that have plagued the ischemia field are also prevalent in ICH literature. Based on these data, several recommendations are put forth to facilitate progress in identifying effective treatments for ICH.

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“…Haematoma density heterogeneity could be a substitute for the prediction of haematoma expansion. Haematoma heterogeneity refers to the irregularity of shape and density of the initial haematoma on the CT scan, and researchers have found an association between haematoma heterogeneity and haematoma expansion [13, 81]. Takeda et al [159] concluded that the presence of haematoma volume above 16 mL, haematoma heterogeneity and 1.5 h of a systolic blood pressure above 160 mmHg together increased the likelihood of haematoma expansion to approximately 59 %.…”

Section: Acute Progressing Haemorrhagic Strokementioning

confidence: 99%

“…Takeda et al [159] concluded that the presence of haematoma volume above 16 mL, haematoma heterogeneity and 1.5 h of a systolic blood pressure above 160 mmHg together increased the likelihood of haematoma expansion to approximately 59 %. Although its definition was traditionally arbitrary, Ji et al [81] defined the haematoma heterogeneity as a difference of over 20 HU in CT value between two regions exceeding 10 mm 2 in area. Barras et al used quantitative CT densitometry to measure mean attenuation, square root of variance, coefficient of variation, skewness and kurtosis of the attenuation distribution of the haematoma; they found that the coefficient of variation and the square root of variance, along with the basic haematoma volume, are predictors of greater growth.…”

Section: Acute Progressing Haemorrhagic Strokementioning

confidence: 99%

Progressing haemorrhagic stroke: categories, causes, mechanisms and managements

Chen

Zeng

2014

J Neurol

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Haemorrhagic stroke is a severe stroke subtype with high rates of morbidity and mortality. Although this condition has been recognised for a long time, the progressing haemorrhagic stroke has not received adequate attention, and it accounts for an even worse clinical outcome than the nonprogressing types of haemorrhagic stroke. In this review article, we categorised the progressing haemorrhagic stroke into acute progressing haemorrhagic stroke, subacute haemorrhagic stroke, and chronic progressing haemorrhagic stroke. Haematoma expansion, intraventricular haemorrhage, perihaematomal oedema, and inflammation, can all cause an acute progression of haemorrhagic stroke. Specific ‘second peak’ of perihaematomal oedema after intracerebral haemorrhage and ‘tension haematoma’ are the primary causes of subacute progression. For the chronic progressing haemorrhagic stroke, the occult vascular malformations, trauma, or radiologic brain surgeries can all cause a slowly expanding encapsulated haematoma. The mechanisms to each type of progressing haemorrhagic stroke is different, and the management of these three subtypes differs according to their causes and mechanisms. Conservative treatments are primarily considered in the acute progressing haemorrhagic stroke, whereas surgery is considered in the remaining two types.

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Imaging and clinical prognostic indicators for early hematoma enlargement after spontaneous intracerebral hemorrhage

Cited by 20 publications

References 8 publications

Prediction and Observation of Post-Admission Hematoma Expansion in Patients with Intracerebral Hemorrhage

Prediction and Observation of Post-Admission Hematoma Expansion in Patients with Intracerebral Hemorrhage

A Critical Appraisal of Experimental Intracerebral Hemorrhage Research

Progressing haemorrhagic stroke: categories, causes, mechanisms and managements

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