Temporal Pattern of Cytotoxic Edema in the Perihematomal Region After Intracerebral Hemorrhage

Abstract

Background and Purpose-Knowledge about cytotoxic edema (CE) in intracerebral hemorrhage is still limited. We aimed to analyze its presence, temporal pattern, and prognostic meaning. Methods-Twenty-one patients with primary intracerebral hemorrhage underwent magnetic resonance imaging at days 1, 3, and 7 after symptom onset. CE was identified using diffusion-weighted imaging. Hematoma and perihematomal edema volumes were measured on fluid-attenuated inversion recovery images. National Institutes of Health Stroke Scale score was assessed at admission and with each magnetic resonance imaging. Clinical outcome was assessed by modified Rankin scale at 90 days. Results-CE appeared in half of the patients within the first 24 hours. The apparent diffusion coefficient values decreased until day 3 and were significantly reversed from days 3 through 7 (P<0.01). Patients with CE showed significantly faster perihematomal edema growth from day 0 to 1 (P=0.036) than those without. Larger 3-day perihematomal edema volume (P=0.02) and presence of CE on day 3 (P=0.07) were associated with poor clinical outcome. Conclusions-CE is associated with stroke severity, perihematomal edema volume, and poor outcome. It is considered to indicate ongoing neuronal injury and, thus, might emerge as new treatment target. (Stroke. 2013;44:1144-1146.)

Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data

“…We screened 4191 studies identified by our searches, assessed 167 for eligibility, invited 77 eligible cohorts to share data, and obtained patient-level data from 36 (47%) cohorts18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51 involving 6428 patients with repeat brain imaging after intracerebral haemorrhage between 1985 and 2015 (no data up to 1984 were obtained; figure 1; appendix). 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55 Countries classified as high income by the World Bank contributed to 26 (72%) of 36 collaborating cohorts versus 30 (73%) of 41 eligible cohorts that did not collaborate.…”

Prognostic Significance of Perihematomal Edema in Acute Intracerebral Hemorrhage

“…Although we confirmed the prognostic importance of the underlying hematoma volume, 12,21 the findings also indicate that the PHE is important in its own right where potential mechanisms-hydrostatic pressure and clot retraction-may be amendable to treatment. 9,22 Data are conflicting about the independent significance of PHE on clinical outcomes. Some 23,24 but not all 12,17,22 observational studies have shown a relationship between PHE and clinical outcome.…”

“…Despite its importance clinically, there is ongoing controversy as to whether PHE has independent prognostic significance in acute ICH. [8][9][10][11][12][13][14][15][16][17] In our previous analysis of 270 patients with ICH from the pilot phase Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT1), neither the degree of growth from baseline or absolute volume at 24 hours of PHE was associated with 90-day outcomes independent of hematoma volume. 12 This result may have been because of limited statistical power to detect modest associations.…”

Perihematomal Diffusion Restriction in Intracerebral Hemorrhage Depends on Hematoma Volume, But Does Not Predict Outcome

“…The temporal pattern of ADC properties of the perihematomal zone was previously shown to be highly variable. In particular, one study reported a decrease in frequency of PDR from 45% on day 1 after symptom onset to 32% on day 7 [11] . This observation may account for the relatively high frequency of PDR in our sample compared to previous studies, since only patients with MRI obtained within 24 h after symptom onset were included in our sample, whereas previous studies included patients with MRI scans up to 14 days after symptom onset [13] .…”

“…PDR has been repeatedly suggested as a prognostic and therapeutic target in ICH [9][10][11] . In our cohort, well known risk factors, that is, hematoma volume, ventricular extension of hemorrhage and higher age were independent predictors of mortality and severe disability at hospital discharge [3] .…”