Targeting secondary injury in intracerebral haemorrhage—perihaematomal oedema

Urday, Sebastian; Kimberly, W. Taylor; Beslow, Lauren A.; Vortmeyer, Alexander O.; Selim, Magdy; Rosand, Jonathan; Simard, J. Marc; Sheth, Kevin N

doi:10.1038/nrneurol.2014.264

Cited by 229 publications

(237 citation statements)

References 109 publications

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“…Exclusion of patients who underwent surgery is also a strength of this analysis, since decompression alters edema volume measurements and often obscures the association of edema and poor outcome. 2 However, this exclusion limits the results of the present study to patients with ICH who do not have surgical intervention. This study has some important limitations.…”

Section: Discussionmentioning

confidence: 94%

“…1 PHE is hypothesised to occur following the activation of inflammatory pathways by haeme products. 2 Studies assessing the association between PHE and ICH outcomes have yielded conflicting results, perhaps due to small sample sizes, retrospective design and selection bias, and heterogeneity in the measurement techniques and timing of imaging. For instance, the relative edema volume, a ratio obtained by dividing PHE by the baseline haematoma volume (HV), 3 is limited by strong collinearity between PHE and HV and the tendency to be disproportionately higher in small haematomas compared with larger ones.…”

Section: Introductionmentioning

confidence: 99%

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Rate of perihaematomal oedema expansion is associated with poor clinical outcomes in intracerebral haemorrhage

Murthy

Urday

Beslow

et al. 2016

J Neurol Neurosurg Psychiatry

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Background Perihaematomal oedema (PHE) expansion rate may be a predictor of outcome after intracerebral haemorrhage (ICH). We determined whether PHE expansion rate in the first 72 hours after ICH predicts outcome, and how it compares against other PHE measures. Methods We included patients from the Virtual International Stroke Trials Archive. We calculated PHE expansion rate using the equation: (PHE at 72 hours- PHE at baseline)/(Time to 72 hour computerized tomography scan – Time to baseline computerized tomography scan). Outcomes of interest were mortality and poor 90-day outcome (modified Rankin Scale score of ≥ 3). Logistic regression was used to assess relationships with outcome. Results A total of 596 patients with ICH were included. At baseline, median haematoma volume was 15.0 mL (IQR: 7.9–29.2) with median PHE volume of 8.7 mL (IQR: 4.5–15.5). Median PHE expansion rate was 0.31 mL/hr (IQR: 0.12–0.55). The odds of mortality were greater with increasing PHE expansion rate (OR: 2.63, CI: 1.10–6.25), while the odds of poor outcome also increased with greater PHE growth (OR: 1.67, CI: 1.28–2.39). Female sex had an inverse relationship with PHE growth, but baseline hematoma volume had a direct correlation. Among other PHE measures, only interval increase in PHE correlated with poor outcome. There was no significant difference between the two measures of PHE volume expansion. Conclusions Rate of PHE growth over 72 hours was an independent predictor of mortality and poor functional outcomes following intracerebral haemorrhage. Baseline haematoma volume and gender appear to influence PHE growth.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Rate of perihaematomal oedema expansion is associated with poor clinical outcomes in intracerebral haemorrhage

Murthy

Urday

Beslow

et al. 2016

J Neurol Neurosurg Psychiatry

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“…Although often related to sepsis, fever can also relate to an inflammatory reaction around the haematoma, as well as associated IVH or subarachnoid extension of the ICH 29. Animal studies suggest that induced hypothermia mitigates perihaematomal oedema by reducing several mediators of secondary brain injury, such as thrombin and the proinflammatory cytokines;30 preliminary clinical studies further support this action on perihaematomal oedema,31 an independent prognostic factor in ICH 32. It seems reasonable, therefore, that early treatment of fever should be safe and provide benefits to patients, but the results of several ongoing phase II trials, such as the Targeted Temperature Management after Intracerebral Hemorrhage (TTM-ICH)33 and Paracetamol (Acetaminophen) In Stroke 2 (PAIS 2)34 are awaited (table 2).…”

Section: Control Of Bp and Other Physiological Variablesmentioning

confidence: 99%

Medical management of intracerebral haemorrhage

Schreuder¹,

Sato

Klijn³

et al. 2016

J Neurol Neurosurg Psychiatry

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The global burden of intracerebral haemorrhage (ICH) is enormous. Developing evidence-based management strategies for ICH has been hampered by its diverse aetiology, high case fatality and variable cooperative organisation of medical and surgical care. Progress is being made through the conduct of collaborative multicentre studies with the large sample sizes necessary to evaluate therapies with realistically modest treatment effects. This narrative review describes the major consequences of ICH and provides evidence-based recommendations to support decision-making in medical management.

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“…(1) A better understanding of ICH pathophysiology has led to interest in therapies that ameliorate secondary injury such as peri-hematomal edema (PHE). (2–4)…”

Section: Introductionmentioning

confidence: 99%

Rate of Perihematomal Edema Expansion Predicts Outcome After Intracerebral Hemorrhage

Urday

Beslow

Dai

et al. 2016

Critical Care Medicine

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Objective Intracerebral hemorrhage (ICH) is a devastating disorder with no current treatment. Whether peri-hematomal edema (PHE) is an independent predictor of neurologic outcome is controversial. We sought to determine whether PHE expansion rate predicts outcome after ICH. Design Retrospective cohort study Setting Tertiary medical center Patients 139 consecutive supratentorial spontaneous ICH patients >18 years admitted between 2000–2013. Interventions None Measurements and Main Results ICH, intraventricular hemorrhage (IVH), and PHE volumes were measured from computed tomography (CT) scans obtained at presentation, 24 hours, and 72 hours post-ICH. PHE expansion rate was the difference between initial and follow-up PHE volumes divided by the time interval. Logistic regression was performed to evaluate the relationship between 1) PHE expansion rate at 24 hours and 90-day mortality and 2) PHE expansion rate at 24 hours and 90-day modified Rankin Scale score (mRS). PHE expansion rate between admission and 24-hours post-ICH was a significant predictor of 90-day mortality (OR 2.97, 95%CI 1.48–5.99, p=0.002). This association persisted after adjusting for all components of the ICH score (OR 2.21, 95% CI 1.05–4.64, p=0.04). Similarly, higher 24-hour PHE expansion rate was associated with poorer mRS in an ordinal shift analysis (OR 2.40, 95% CI 1.37–4.21, p=.002), even after adjustment for all ICH score components (OR 2.07, 95% CI 1.12–3.83, p=0.02). Conclusions Faster PHE expansion rate 24 hours post-ICH is associated with worse outcome. PHE may represent an attractive translational target for secondary injury after ICH.

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Targeting secondary injury in intracerebral haemorrhage—perihaematomal oedema

Cited by 229 publications

References 109 publications

Rate of perihaematomal oedema expansion is associated with poor clinical outcomes in intracerebral haemorrhage

Rate of perihaematomal oedema expansion is associated with poor clinical outcomes in intracerebral haemorrhage

Medical management of intracerebral haemorrhage

Rate of Perihematomal Edema Expansion Predicts Outcome After Intracerebral Hemorrhage

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