Outcome Predictors and Spectrum of Treatment Eligibility With Prospective Protocolized Management of Intracerebral Hemorrhage

Jaffe, Jennifer; Alkhawam, Lora; Du, Hongyan; Tobin, Kristen; O'Leary, Judith; Pollock, Glen; Batjer, H. Hunt; Awad, Issam A.

doi:10.1227/01.neu.0000330402.20883.1b

Cited by 21 publications

(13 citation statements)

References 53 publications

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“…In logistic regression analysis, after adjusting for potential confounders, we also found that GCS score was independently associated with severity on admission and in‐hospital mortality after PICH, whereby the lower GCS score on admission, the worse severity on admission and greater in‐hospital mortality. These findings correspond with results from many previous studies in which the initial consciousness level evaluated by GCS score was the most important and consistent predictor of ICH outcome and mortality .…”

Section: Discussionsupporting

confidence: 91%

Factors Associated with Severity on Admission and In-Hospital Mortality after Primary Intracerebral Hemorrhage in China

Wong

Wei

et al. 2011

International Journal of Stroke

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Section: Discussionsupporting

confidence: 91%

Factors Associated with Severity on Admission and In-Hospital Mortality after Primary Intracerebral Hemorrhage in China

Wong

Wei

et al. 2011

International Journal of Stroke

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“…Intraventricular hemorrhage (IVH) is frequently associated with intracerebral hemorrhage 1 , and the volume of associated IVH a significant and independent predictor of mortality and disability in this disease 1–8 . An external ventricular drain (EVD) is commonly used to control intracranial pressure, and to divert cerebrospinal fluid in the setting of hydrocephalus, but also to help clear ventricular blood 11–12 .…”

Section: Introductionmentioning

confidence: 99%

Ventricular Catheter Location and the Clearance of Intraventricular Hemorrhage

et al. 2012

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Background There is no consensus regarding optimal position of external ventricular drain (EVD) with regard to clearance of intraventricular hemorrhage (IVH). Objective To assess the hypothesis that EVD laterality may influence the clearance of blood from the ventricular system, with and without administration of thrombolytic agent. Methods The EVD location was assessed in 100 patients in two CLEAR Phase II trials assessing the safety, and dose optimization of thrombolysis through the EVD to accelerate the clearance of obstructive IVH. Laterality of catheter was correlated with clearance rates. Results Clearance of IVH over the first 3 days was significantly greater when thrombolytic was administered as compared to placebo, regardless of catheter laterality (p < 0.005, CI −14.0, −4.14 for contralateral EVD and CI −24.7, −5.44 for ipsilateral EVD, respectively). When thrombolytic was administered, there was a trend of more rapid clearance of total IVH through an EVD placed on the side of dominant intraventricular blood as compared to an EVD on the side with lesser blood (P = 0.09; CI −9.62, 0.69). This was not true when placebo was administered. Clearance of 3rd and 4th ventricular blood was unrelated to EVD laterality. Conclusion It is possible that placement of EVD may be optimized to enhance the clearance of total IVH if lytic agents are used. Catheters on either side can clear the 3rd and 4th ventricles with equal efficiency.

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“…Most notably, with regard to brain edema and factors affecting acute functional outcome, the collagenase model is known to cause far more lasting and severe blood-brain barrier rupture and neurological deficits than autologous blood injection (MacLellan et al, 2008). Neither model mimics clinical conditions perfectly, but both may be necessary since human ICH also presents in a wide spectrum of severity ( Jaffe et al, 2009). Nonetheless, the study of short-term free-radical-mediated pathophysiological mechanisms may yet yield significant results in future studies using the autologous blood infusion model, since melatonin's effects may simply be inadequate to overcome the severity of acute-phase collagenase injury.…”

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confidence: 99%

Protective Effect of Melatonin upon Neuropathology, Striatal Function, and Memory Ability after Intracerebral Hemorrhage in Rats

Lekic

Hartman

Rojas

et al. 2010

Journal of Neurotrauma

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Since free radicals play a role in the mechanisms of brain injury after hemorrhagic stroke, the effect of melatonin (a potent antioxidant and free-radical scavenger) on outcomes was investigated after intracerebral hemorrhage (ICH) in rats. ICH was induced by clostridial collagenase infusion into the right caudate putamen, and several time points and doses of melatonin were studied. Brain edema and neurological function at 24 h were unchanged in comparison with vehicle-treated groups, in spite of oxidative stress reductions. Repeated treatment with the lower dose of melatonin (5 mg=kg) given at 1 h and every 24 h thereafter for 3 days after ICH, led to normalization of striatal function and memory ability over the course of 8 weeks, and less brain atrophy 2 weeks later. These results suggest that melatonin is safe for use after ICH, reduces oxidative stress, provides brain protection, and could be used for future investigations of free radical mechanisms after cerebral hemorrhage.

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Outcome Predictors and Spectrum of Treatment Eligibility With Prospective Protocolized Management of Intracerebral Hemorrhage

Cited by 21 publications

References 53 publications

Factors Associated with Severity on Admission and In-Hospital Mortality after Primary Intracerebral Hemorrhage in China

Factors Associated with Severity on Admission and In-Hospital Mortality after Primary Intracerebral Hemorrhage in China

Ventricular Catheter Location and the Clearance of Intraventricular Hemorrhage

Protective Effect of Melatonin upon Neuropathology, Striatal Function, and Memory Ability after Intracerebral Hemorrhage in Rats

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