The physiopathology of spontaneous hemorrhagic stroke: a systematic review

Filho, Alcivan Batista de Morais; Rego, Thiago Luis de Holanda; Mendonça, Letícia de Lima; Almeida, Sulyanne Saraiva de; Nóbrega, Mariana Lima da; Palmieri, Thais de Oliveira; Giustina, Gabriela Zanotto Della; Melo, Jáderson Pimenta; Pinheiro, Francisco Irochima; Gúzen, Fausto Pierdoná

doi:10.1515/revneuro-2020-0131

Cited by 9 publications

(5 citation statements)

References 119 publications

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“…Firstly, we were unable to carry out further subgroup comparison of hemorrhagic stroke because the corresponding data were not available in the original articles. The mechanisms and risk factors for subarachnoid hemorrhage and intracerebral hemorrhage are different in important ways, as are treatment and outcomes ( 58 ). More clinical and mechanistic studies deserve further research.…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Elevated Serum Uric Acid and Risk of Stroke in Adult: An Updated and Dose–Response Meta-Analysis

Qiao

Peng

2021

Front. Neurol.

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Background: Uric acid (UA) is proposed as a potential risk factor for stroke in adult, yet the results from published studies are not generally accordant.Method: We included prospective studies that explored the relationship between serum UA (SUA) and strokes. In this study, strokes include ischemic stroke and hemorrhagic stroke, which consists of intracerebral hemorrhage and subarachnoid hemorrhage. The effect-size estimates were expressed as hazard ratio (HR) and 95% confidence interval (CI). Sensitivity and subgroup analyses were performed to assess the robustness of the pooled estimation and potential sources of heterogeneity between studies.Results: We meta-analyzed 19 prospective cohort articles, which involve 37,386 males and 31,163 females. Overall analyses results showed a significant association between a 1 mg/dl increase in high levels of SUA and the risk of total stroke (HR = 1.13; 95% CI: 1.09–1.18; P < 0.001), ischemic stroke (HR = 1.15; 95% CI: 1.10–1.21; P < 0.001), and hemorrhagic stroke (HR = 1.07; 95% CI: 1.00 to 1.15; P = 0.046). No significant difference was found between ischemic stroke and hemorrhagic stroke. In the subgroup analyses, the association of high SUA levels and the risk of total stroke was statistically significant in females (HR = 1.19; 95% CI: 1.12–1.26; P < 0.001) and males (HR = 1.11; 95% CI: 1.05–1.17; P < 0.001). Coincidentally, the association was also statistically significant for ischemic stroke, both in females (HR = 1.26; 95% CI: 1.17–1.36; P < 0.001) and in males (HR = 1.12; 95% CI: 1.06–1.19; P < 0.001). However, for hemorrhagic stroke, it was only statistically significant in females (HR = 1.19; 95% CI: 1.04–1.35; P = 0.01). Our dose–response research indicated the J-shaped trend between the ascending SUA levels and the higher risk of suffering from a stroke.Conclusions: Our findings indicate that elevated SUA is a significant risk factor for adult stroke, both for ischemic stroke and hemorrhagic stroke, and especially in females.

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Section: Discussionmentioning

confidence: 99%

The Relationship Between Elevated Serum Uric Acid and Risk of Stroke in Adult: An Updated and Dose–Response Meta-Analysis

Qiao

Peng

2021

Front. Neurol.

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“…They also found foci of contrast enhancement in 91% of expanded hematomas [16] . Although the precise pathophysiological mechanism underlying the formation of the spot sign remains unclear, some scholars propose that the spot sign's development may be linked to persistent bleeding around the hematoma, with consensus that the spot sign signi es contrast media leakage [17][18][19] . Prior studies have indicated that the spot sign exhibits greater reliability in predicting an unfavorable prognosis compared to other markers such as the black hole sign, blend sign, and island sign [20] .…”

Section: Discussionmentioning

confidence: 99%

Is the hyperdensity areas of the CT blend sign associated with the fresh bleeding in intracerebral hemorrhage?

Wu,

Che,

Chen

et al. 2023

Preprint

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Background and purpose Controversies still exist regarding the mechanism behind the formation of the CT blend sign in intracerebral hemorrhage (ICH). This study was undertaken to observe the relationship between the spot sign and the blend sign to gain insights into the blend sign's formation. Methods We collected patient data, including the spot sign's distribution, clinical information, and radiographic data. Patients were categorized based on the spot sign's location within the blend sign. We divided the cohort into two groups: (1) subjects with spot sign in the relatively hypodensity region of the blend sign(Hypo-spot sign group), (2) subjects with spot sign in the relatively hyperdensity region of blend sign(Hyper-spot sign group). Subsequently, based on hematoma expansion (HE), patients were grouped into either the hematoma expansion group (Expander group) or the no hematoma expansion group (No Expander group). After grouping, we analyzed the relationship between the spot sign and the blend sign, as well as the association between the blend sign and HE. Results A total of 205 patients were included in the study. Among them, 190 patients (92.7%) had the spot sign observed in the Hyper-spot sign group, while 55 patients (7.3%) had the spot sign identified in the Hypo-spot sign group. Significant hematoma growth was observed in 60 patients (29.3%) with HE, of which 59 patients (98.3%) had the spot sign detected in the Hyper-spot sign group, and only 1 patient (1.7%) had the spot sign found in the Hypo-spot sign group. Univariate logistic regression analysis revealed that Hyper-spot sign group (6.305, 1.810–49.072; p < 0.05) was an independent predictor of ICH growth. The sensitivity, specificity, positive predictive value, and negative predictive value of Hyper-spot sign group for predicting hematoma growth were 0.983, 0.096, 0.010, and 0.01, respectively. Conclusions In patients presenting both the blend sign and the spot sign, the spot sign was predominantly found in the denser region of the blend sign, indicating active bleeding in the denser part of the blend sign. Trial registration: ClinicalTrials.gov, NCT05548530. Registered September 21, 2022, Prognostic Analysis of Different Treatment Options for Cerebral Hemorrhage - Full Text View - ClinicalTrials.gov

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“…Though the strength of the association between LWH and stroke was moderate compared with other occupational exposures, the high prevalence of LWH lead to an estimated 400 000 deaths by stroke in 2016, with a population attributable fraction close to 7% 1. Stroke, however, is a broad term that conflates two different types of disease with different pathophysiology: ischaemic stroke is caused mainly by the clotting of a cerebral artery and haemorrhagic stroke is caused by the rupture of a cerebral artery 4 5. The WHO/ILO systematic review did not report enough information to differentiate the effect of LWH on risk of stroke subtypes.…”

Section: Introductionmentioning

confidence: 99%

Association between prolonged exposure to long working hours and stroke subtypes in the CONSTANCES cohort

Fadel

Sembajwe

et al. 2023

Occup Environ Med

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BackgroundThough there is increasing evidence on the effect of long working hours (LWH) and stroke, few studies have distinguished stroke subtypes. We examined the associations between LWH and ischaemic or haemorrhagic stroke after adjusting for cardiovascular risk factors.MethodsFrom a national population-based cohort CONSTANCES, baseline questionnaires and initial health examinations were used to retrieve sociodemographic and cardiovascular risk factors from 2012 to 2018. LWH were defined as self-reported working time≥10 hours daily for at least 50 days per year. Incident cases of stroke were collected using International Classification of Disease codes recorded in the National Health Data System. Associations between LWH and stroke were investigated using multinomial models adjusted for cardiovascular risk factors.ResultsAmong the 160 751 participants who were free from stroke at baseline, exposure to LWH≥10 years was reported by 20 723 participants, and 190 incident cases of stroke were identified, including 134 ischaemic and 56 haemorrhagic. Exposure to LWH was associated with an elevated odds of ischaemic stroke (OR=1.61 (1.04–2.49)) and haemorrhagic stroke (OR=2.50 (1.38–4.53)) in unadjusted models. In adjusted multivariable models, only the LWH association with haemorrhagic stroke remained significant (aOR=1.92 (1.01–3.09)).ConclusionsLWH were associated with stroke, though it remained significant for haemorrhagic stroke only after adjustments. Differences in direct and indirect biological pathways and lack of power in the ischaemic subgroup may explain these results and further studies on the impact of mediating and effect measure modifying factors are needed. Nevertheless, policies that attenuate effects of both LWH and cardiovascular risks factor are warranted.

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The physiopathology of spontaneous hemorrhagic stroke: a systematic review

Cited by 9 publications

References 119 publications

The Relationship Between Elevated Serum Uric Acid and Risk of Stroke in Adult: An Updated and Dose–Response Meta-Analysis

The Relationship Between Elevated Serum Uric Acid and Risk of Stroke in Adult: An Updated and Dose–Response Meta-Analysis

Is the hyperdensity areas of the CT blend sign associated with the fresh bleeding in intracerebral hemorrhage?

Association between prolonged exposure to long working hours and stroke subtypes in the CONSTANCES cohort

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