Progression of Traumatic Intracerebral Hemorrhage: A Prospective Observational Study

Abstract

Preliminary evidence has shown that intracerebral hemorrhages, either spontaneous (sICH) or traumatic (tICH) often expand over time. An association between hemorrhage expansion and clinical outcomes has been described for sICH. The intent of this prospective, observational study was to characterize the temporal profile of hemorrhage progression, as measured by serial computed tomography (CT) scanning, with the aim of better understanding the natural course of hemorrhage progression in tICH. There was also a desire to document the baseline adverse event (AE) profile in this patient group. An important motive for performing this study was to set the stage for subsequent studies that will examine the role of a new systemic hemostatic agent in tICH. Subjects were enrolled if they had tICH lesions of at least 2 mL on a baseline CT scan obtained within 6 h of a head injury. CT scans were repeated at 24 and 72 h. Clinical outcomes and pre-defined AEs were documented. The data showed that 51% of the subjects demonstrated an increase in tICH volume, and that most of the increase occurred early. In addition, larger hematomas exhibited the greatest expansion. Thromboembolic complications were identified in 13% of subjects. This study demonstrates that tICH expansion between the baseline and 24-h CT scans occurred in approximately half of the subjects. The earlier after injury that the initial CT scan is obtained, the greater is the likelihood that the hematoma will expand on subsequent scans. The time frame during which hemorrhagic expansion occurs provides an opportunity for early intervention to limit a process with adverse prognostic implications.

Traumatic Intracranial Hematomas: Prognostic Value of Contrast Extravasation

“…32 Initial hematoma volume 2,3,6,9,42,43 and midline shift 35,36,[42][43][44] are potent predictors of intracranial hematoma progression and poor outcome but have also been shown to be collinear. 42,45 Contrast extravasation could, therefore, potentially offer additional information not provided by NCCT, though this would need to be assessed by directly comparing NCCT with CTA/PCCT.…”

“…In the presence of acute intracranial hematomas, management options include emergent surgical evacuation or close observation including imaging surveillance. Sixteen percent to 65% of the patients in the latter group will show hematoma progression, [2][3][4][5][6][7][8] and 13%-19% will require delayed surgery [2][3][4] ; hematoma expansion is also associated with increased morbidity and mortality. 6,7 Despite previous identification of multiple NCCT predictors of hematoma expansion, 2,3,5,6,9 this modality remains inherently limited for the detection of active hemorrhage.…”

Endogenous plasminogen activators mediate progressive intracerebral hemorrhage after traumatic brain injury in mice

“…1,2 Delayed intracerebral hemorrhage (ICH) is a strong predictor of morbidity and mortality. [3][4][5] Serial computed tomography scans reveal expansion of ICH in ;50% of patients post-TBI, [6][7][8] but intervention based on the current presumptive pathophysiology is often futile.…”

Profilaxia de tromboembolismo venoso em pacientes com lesão cerebral traumática

“…Studies by Narayan et al 7 and Allard et al 8 found a 50% progression of contusion volume at 24 hours compared to baseline CT.…”