The etiologic subtype of intracerebral hemorrhage may influence the risk of significant hematoma expansion

Cappellari, Manuel; Zivelonghi, Cecilia; Moretto, Giuseppe; Micheletti, Nicola; Carletti, Monica; Tomelleri, Giampaolo; Bovi, Paolo

doi:10.1016/j.jns.2015.11.024

Cited by 21 publications

(18 citation statements)

References 29 publications

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“…At the same time, HTN, systemic diseases, and medication-induced ICH carried the same risk of HE. These results are in accordance with the work of Cappellari and colleagues [22] who declared that certain etiologic S-ICH subtypes are more prone to risk of HE including HTN, systemic diseases related, and medication induced. They also stated that large volume lobar supratentorial hematomas are more liable for re-bleeding than infratentorial ones.…”

Section: Discussionsupporting

confidence: 92%

Early hematoma expansion in primary intracerebral hemorrhage: incidence and predictors

Helal

Bahnasy

Ghali

et al. 2019

Egypt J Neurol Psychiatry Neurosurg

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Background: Hematoma expansion (HE) is the leading cause of early neurological deterioration, poor functional outcome, and increased mortality in patients with spontaneous intracerebral hemorrhage (S-ICH). The study aimed to estimate the risks and predictors of early HE in patients with S-ICH and the effect of this HE on patient's survival and functional outcome. Methods: This study was carried out on 72 patients with S-ICH submitted to baseline non-contrast brain CT (NCCT) and CT angiography for determination of hematoma site, size, border irregularity, blend sign, and spot sign score (SSS). Rescan was done 48 h after stroke onset or on clinical deterioration to resize the HV and diagnose HE. Modified Rankin Scale (MRS) was done 3 months after stroke onset to assess the effect of HE on patients' physical dependence. Results: HE occurred in 28/72 (38.9%) of included patients. Risks of HE included old age, smoking, elevated baseline mean arterial blood pressure, and high admission modified National Institute of Health stroke scale. NCCT predictors of HE included large volume, irregular border, and presence of blend sign. The presence of spot sign in early CTA is more accurate than NCCT predictors with 54%, 91%, 79%, and 75% for sensitivity, specificity, positive predictive value, and negative predictive value, respectively. Conclusions: HE is a major cause of early clinical deterioration, increased mortality, and poor functional outcome. Early CTA for detection of spot sign is indicated in patients with large volume, irregular border, and/or blend sign in NCCT.

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Section: Discussionsupporting

confidence: 92%

Early hematoma expansion in primary intracerebral hemorrhage: incidence and predictors

Helal

Bahnasy

Ghali

et al. 2019

Egypt J Neurol Psychiatry Neurosurg

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“…Previous study reports that approximately one‐third of ICH patients had significant change in hematoma volume (Brott et al., ), suggesting that not all patients had the risk of change in hematoma volume or hematoma expansion. The CT spot sign, hematoma morphologic appearance (Blacquiere et al., ), and the etiologic subtype (Cappellari et al., ) also had great influence on change in hematoma volume.…”

Section: Discussionmentioning

confidence: 99%

Cardiac troponin and cerebral herniation in acute intracerebral hemorrhage

Lin

Wang

et al. 2017

Brain and Behavior

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ObjectivesTo explore the association, if any, between the relationship between cardiac troponin and cerebral herniation after intracerebral hemorrhage (ICH).MethodsSix hundred and eighty‐seven consecutive ICH patients admitted to West China Hospital from May 1, 2014 to September 1, 2015 were retrospectively reviewed. Data on demographics, etiology, laboratory examinations at admission including serum cardiac troponin, computed tomography (CT) scans at admission and follow‐up, and clinical outcomes were obtained. Using multiple logistic regression to identify the relationship of troponin and herniation. The association between troponin and hematoma volume was assessed using bivariate correlation and linear regression.ResultsAmong 188 (27.4%) patients who underwent the test of serum cardiac troponin at admission, 16 (8.5%) demonstrated cerebral herniation. The median time from symptom onset to CT at admission and follow‐up was 4 and 30.25 hr, respectively. In multivariate analysis, elevated troponin was independently associated with cerebral herniation (adjusted odds ratio [OR] 5.19; 95% confidence interval [CI], 1.08–24.93). And those with elevated troponin had larger hematoma volume at follow‐up in bivariate correlation (correlation coefficient, .375, p = .003) and linear regression (β, .370, 95% CI, 0.062–0.320, p = .005), higher National Institutes of Health Stroke Scale score (adjusted OR 2.06; 95% CI, 1.06–4.01, p = .033) and lower Glasgow Coma Scale score (adjusted OR 2.34; 95% CI, 1.17–4.68, p = .016) than those without.ConclusionsElevated cardiac troponin was associated with an almost five‐fold increased risk of cerebral herniation, but not in‐hospital mortality. The possibility of cerebral herniation should be considered when ICH patients with large hematoma volume and elevated troponin.

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“…Differentiation between HA and CAA is traditionally based on hemorrhage location34. CAA-related hemorrhage is typically located in the lobar region and hypertensive ICH is usually located in the deep region56. However, because hypertension also causes lobar hemorrhage7, and the possibility of concomitant HA and CAA48, the pathogenesis of ICH is sometimes difficult to ascertain.…”

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confidence: 99%

Correlation of Cerebral Microbleed Distribution to Amyloid Burden in Patients with Primary Intracerebral Hemorrhage

Tsai

Chen

et al. 2017

Sci Rep

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The underlying pathology of cerebral microbleeds (CMBs) with mixed lobar and deep distribution remains contentious. The aim of this study was to correlate CMBs distribution to β-amyloid burden in patients with primary intracerebral hemorrhage (ICH). Fourty-seven ICH patients underwent magnetic resonance susceptibility-weighted imaging and 11C-Pittsburgh Compound B positron emission tomography. The amyloid burden was expressed as standardized uptake value ratio with reference to cerebellum, and presented as median (interquartile range). Patients were categorized into the lobar, mixed (both lobar and deep regions), and deep types of CMB. Comparing the lobar (17%), mixed (59.6%) and deep (23.4%) CMB types, the global amyloid burden was significantly higher in the mixed type than the deep type (1.10 [1.03–1.25] vs 1.00 [0.97–1.09], p = 0.011), but lower than in the lobar type (1.48 [1.18–1.50], p = 0.048). On multivariable analysis, the ratio of lobar to deep CMB number was positively correlated with global (p = 0.028) and occipital (p = 0.031) amyloid burden. In primary ICH, patients with lobar and mixed CMB types are associated with increased amyloid burden than patients with deep type. The ratio of lobar to deep CMB number is an independent indicator of cerebral β-amyloid deposition.

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The etiologic subtype of intracerebral hemorrhage may influence the risk of significant hematoma expansion

Cited by 21 publications

References 29 publications

Early hematoma expansion in primary intracerebral hemorrhage: incidence and predictors

Early hematoma expansion in primary intracerebral hemorrhage: incidence and predictors

Cardiac troponin and cerebral herniation in acute intracerebral hemorrhage

Correlation of Cerebral Microbleed Distribution to Amyloid Burden in Patients with Primary Intracerebral Hemorrhage

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