Predisposing Factors to Enlargement of Spontaneous Intracerebral Hematoma

Kazui, Seiji; Minematsu, Kazuo; Yamamoto, Haruko; Sawada, Tohru; Yamaguchi, Takami

doi:10.1161/01.str.28.12.2370

Cited by 324 publications

(259 citation statements)

References 24 publications

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“…For example, the relation between BP and rebleeding in PICH is probably mostly explained by an interaction between timing of BP measurement and severity. 39,40 Likewise, high premorbid BP contributes to elevated BP in acute stroke and could contribute, in part, to poor outcome through previous cerebral vascular damage. Third, the strategy of dichotomizing BP, though clinically relevant, might create artificial strata for the analysis.…”

Section: Willmot Et Al High Blood Pressure Acute Stroke and Outcomementioning

confidence: 99%

High Blood Pressure in Acute Stroke and Subsequent Outcome

2004

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Abstract-High blood pressure (BP) is common in acute stroke and might be associated with a poor outcome, although observational studies have given varying results. In a systematic review, articles were sought that reported both admission BP and outcome (death, death or dependency, death or deterioration, stroke recurrence, and hematoma expansion) in acute stroke. Data were analyzed by the Cochrane Review Manager software and are given as odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs Key Words: stroke, thrombotic Ⅲ stroke, hemorrhagic Ⅲ blood pressure Ⅲ morbidity Ⅲ mortality H igh blood pressure (BP Ͼ140/90 mm Hg, as defined by the World Health Organization) occurs in acute stroke in up to 75% of cases. 1,2 Subsequently, BP settles over a period of about a week, although Ϸ40% of patients remain hypertensive. The causes of this pathophysiologic response are multifactorial and are related to preexisting high BP, activation of the neuroendocrine systems (sympathetic nervous system, renin-angiotensin axis, and glucocorticoid system), increased cardiac output, and "white coat hypertension." [3][4][5][6][7] It has been suggested that high BP is associated with a poor outcome after acute stroke, although the results of observational studies have given conflicting results. Some authors have even demonstrated better outcomes in patients with high initial BP. 8,9 Data from the International Stroke Trial (IST) confirmed that the risk of early death and late death or dependency was independently associated with increasing systolic BP (SBP) in 17 398 patients. 10 We report here a systematic review of observational studies of BP and outcome and assess the relation between the two. Methods Study IdentificationPublished observational studies that reported baseline BP and outcome (death, death or dependency, or death or deterioration) or mechanisms for poor outcome (recurrent stroke, hemorrhagic transformation, development of cerebral edema, or hematoma expansion) in acute (Ͻ7 days) stroke were sought. Systematic searches of EMBASE and PUBMED were made by M.W. The search strategy used 10 key words: blood pressure, hypertension, outcome, prognosis, death, mortality, recovery, stroke, cerebr*, and acute. Additional studies were found from reference lists of identified articles and reviews. 11-13 Disability or dependency was typically measured with the Barthel Index or Rankin Scale; deterioration was defined as worsening on a stroke neurologic impairment scale, eg, National Institutes of Health stroke scale, or where an ordinal scale (eg, "improved," "unchanged," or "worse") was used. Publications were excluded if they were a randomized trial (these tend not to enroll consecutive patients and might therefore have a biased sample), gave insufficient data, used other outcomes, or were duplicate articles. Decisions on inclusion and exclusion of studies were made by M.W. and P.M.W.B. Data ExtractionTwo authors (M.W. and J.L.-B.) independently extracted data; discrepancies were resolved by P.M.W...

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Section: Willmot Et Al High Blood Pressure Acute Stroke and Outcomementioning

confidence: 99%

High Blood Pressure in Acute Stroke and Subsequent Outcome

2004

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“…Kazui, et al, 67 used multiple logistic regression analysis of data obtained in 186 patients with SICH to identify factors related to the risk of hematoma enlargement. They identified four factors predisposing to hematoma enlargement: history of brain infarction, liver disease, fasting glucose level greater than 141 mg/dl with SBP greater than 200 mm Hg, and HgbA1c greater than 5.1% with SBP greater than 200 mm Hg.…”

Section: Risk Of Hematoma Enlargementmentioning

confidence: 99%

Spontaneous intracerebral hemorrhage: a review

Fewel¹,

Thompson²,

Hoff³

2003

FOC

148

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Spontaneous intracerebral hemorrhage (SICH) is a blood clot that arises in the brain parenchyma in the absence of trauma or surgery. This entity accounts for 10 to 15% of all strokes and is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage. Common causes include hypertension, amyloid angiopathy, coagulopathy, vascular anomalies, tumors, and various drugs. Hypertension, however, remains the single greatest modifiable risk factor for SICH. Computerized tomography scanning is the initial diagnostic modality of choice in SICH, and angiography should be considered in all cases except those involving older patients with preexisting hypertension in thalamic, putaminal, or cerebellar hemorrhage. Medical management includes venous thrombosis prophylaxis, gastric cytoprotection, and aggressive rehabilitation. Anticonvulsant agents should be prescribed in supratentorial SICH, whereas the management of hypertension is controversial. To date, nine prospective randomized controlled studies have been conducted to compare surgical and medical management of SICH. Although definitive evidence favoring surgical intervention is lacking, there is good theoretical rationale for early surgical intervention. Surgery should be considered in patients with moderate to large lobar or basal ganglia hemorrhages and those suffering progressive neurological deterioration. Elderly patients in whom the Glasgow Coma Scale score is less than 5, those with brainstem hemorrhages, and those with small hemorrhages do not typically benefit from surgery. Patients with cerebellar hemorrhages larger than 3 cm, those with brainstem compression and hydrocephalus, or those exhibiting neurological deterioration should undergo surgical evacuation of the clot. It is hoped that the forthcoming results of the International Surgical Trial in IntraCerebral Hemorrhage will help formulate evidence-based recommendations regarding the role of surgery in SICH.

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“…Acute high BP might enhance active intracranial bleeding and hematoma growth, which could be a determinant of poor clinical outcome. [8][9][10][11][12] In contrast, some investigators insist that high BP might work to maintain normal cerebral blood flow and prevent peri-hematomal ischemic damage. 13,14 However, pharmacologically mediated BP reduction apparently has no adverse effects on cerebral blood flow in humans or other animals.…”

Section: Introductionmentioning

confidence: 99%

Nationwide survey of antihypertensive treatment for acute intracerebral hemorrhage in Japan

et al. 2009

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Acute hypertension is associated with hematoma enlargement and poor clinical outcomes in patients with intracerebral hemorrhage (ICH). However, the method of controlling blood pressure (BP) during the acute phase of ICH remains unknown. The aim of this study is to show current strategies about this issue in Japan. Questionnaires regarding antihypertensive treatment (AHT) strategies were sent to neurosurgeons, neurologists and others responsible for ICH management in 1424 hospitals. Of 600 respondents, 550 (92%) worked at hospitals wherein acute ICH patients are managed and 548 (99.6%) of them agreed with the application of AHT within 24 h of ICH onset. Most answered that the systolic BP threshold for starting AHT was 180 mm Hg (36%) or 160 mm Hg (31%), which differed significantly between neurosurgeons (median, 160 mm Hg) and neurologists/others (180 mm Hg, Po0.001). The goal of lowering systolic BP was to reach a maximum of 140, 150 or 160 mm Hg according to 448 respondents (82%) and 209 (38%) intensively lowered systolic BP to p140 mm Hg. Nicardipine was the first choice of intravenous drug for 313 (57%) and the second choice for 146 respondents (27%). However, 141 (26%) thought that nicardipine is inappropriate mainly because of a conflict with a description of contraindications on the official Japanese label for this drug. In conclusion, the present Japanese respondents, especially neurosurgeons, lower BP more aggressively than recommended in domestic and Western guidelines for managing acute ICH patients. Nicardipine was the most frequent choice of antihypertensive agent.

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Predisposing Factors to Enlargement of Spontaneous Intracerebral Hematoma

Cited by 324 publications

References 24 publications

High Blood Pressure in Acute Stroke and Subsequent Outcome

High Blood Pressure in Acute Stroke and Subsequent Outcome

Spontaneous intracerebral hemorrhage: a review

Nationwide survey of antihypertensive treatment for acute intracerebral hemorrhage in Japan

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