Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage

Tuhrim, Stanley; Horowitz, Deborah R.; Sacher, Michael; Godbold, James

doi:10.1097/00003246-199903000-00045

Cited by 411 publications

(296 citation statements)

References 22 publications

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“…Intraventricular blood is associated with a high mortality rate. 123 Ventriculostomy, rather than fiberoptic ICP devices, should be used in patients with hydrocephalus or intraventricular hemorrhage (Fig. 8).…”

Section: Neurosurg Focus / Volume 15 / October 2003mentioning

confidence: 99%

Spontaneous intracerebral hemorrhage: a review

Fewel¹,

Thompson²,

Hoff³

2003

FOC

149

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Spontaneous intracerebral hemorrhage (SICH) is a blood clot that arises in the brain parenchyma in the absence of trauma or surgery. This entity accounts for 10 to 15% of all strokes and is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage. Common causes include hypertension, amyloid angiopathy, coagulopathy, vascular anomalies, tumors, and various drugs. Hypertension, however, remains the single greatest modifiable risk factor for SICH. Computerized tomography scanning is the initial diagnostic modality of choice in SICH, and angiography should be considered in all cases except those involving older patients with preexisting hypertension in thalamic, putaminal, or cerebellar hemorrhage. Medical management includes venous thrombosis prophylaxis, gastric cytoprotection, and aggressive rehabilitation. Anticonvulsant agents should be prescribed in supratentorial SICH, whereas the management of hypertension is controversial. To date, nine prospective randomized controlled studies have been conducted to compare surgical and medical management of SICH. Although definitive evidence favoring surgical intervention is lacking, there is good theoretical rationale for early surgical intervention. Surgery should be considered in patients with moderate to large lobar or basal ganglia hemorrhages and those suffering progressive neurological deterioration. Elderly patients in whom the Glasgow Coma Scale score is less than 5, those with brainstem hemorrhages, and those with small hemorrhages do not typically benefit from surgery. Patients with cerebellar hemorrhages larger than 3 cm, those with brainstem compression and hydrocephalus, or those exhibiting neurological deterioration should undergo surgical evacuation of the clot. It is hoped that the forthcoming results of the International Surgical Trial in IntraCerebral Hemorrhage will help formulate evidence-based recommendations regarding the role of surgery in SICH.

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Section: Neurosurg Focus / Volume 15 / October 2003mentioning

confidence: 99%

Spontaneous intracerebral hemorrhage: a review

Fewel¹,

Thompson²,

Hoff³

2003

FOC

149

View full text Add to dashboard Cite

show abstract

“…Chung et al demonstrated that the mortality was 81% when thalamic hemorrhage presented the entire area of the thalamus: global type 13 . The volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage, as shown by Tuhrim et al 14 .…”

Section: Discussionmentioning

confidence: 89%

Stereotactic fibrinolysis of spontaneous intracerebral hematoma using infusion of recombinant tissue plasminogen activator

Nasser

Falavigna

Bezerra

et al. 2002

Arq. Neuro-Psiquiatr.

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-Purpose: The authors present a prospective study on 10 patients with stereotactic infusion of tissue plasminogen activator (rtPA) intraparenchimal hemorrhage. Methods: Between 1999 and 2000, 10 patients with deep seated hematomas in the basal ganglia were selected for stereotactic infusion of rtPA and spontaneous clot drainage. Results: All cases had about 80% reduction of the hematoma volume in the CT scan at the third day. The intracranial pressure was normalized by the third day too. There were no local or systemic complications with the use of this trombolitic. The results were shown by the Glasgow Outcome Scale with six patients in V, three in IV and one in III after 3 months. Conclusion: Early treatment and drainage with minimally invasive neurosurgery , can make these patients with deep-seated hematomas recover the consciousness and they can be rehabilitated earlier avoiding secondary complications.

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“…In these studies, IVH tends to occur in patients with larger parenchymal hemorrhages, which is itself of adverse prognostic significance. Tuhrim et al (4) suggested that the volume of intraventricular blood is an independent predictor of outcome and a more important contributor to mortality after ICH than the mere presence of an IVH. We did not evaluate the volume of IVH, but the rate of IVH is significantly higher in patients with contrast extravasation, as compared to patients without extravasation.…”

Section: Discussionmentioning

confidence: 99%

Contrast Extravasation into an Acute Spontaneous Intracerebral Hematoma: Multidetector CT Angiographic Findings and Clinical Implications

Kim

Baik

et al. 2007

J Korean Radiol Soc

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Spontaneous intracerebral hemorrhage (ICH) is one of the most devastating forms of stroke (1). Spontaneous ICH is a type of stroke that arises in the brain parenchyma in the absence of trauma or surgery. Common causes include hypertension, amyloid angiopathy, coagulopathy, vascular anomalies, tumors, and treatment with various drugs. However, hypertension is the single most important risk factor for spontaneous ICH. Spontaneous ICH accounts for 10 15% of all strokes and is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage (SAH) (2). Purpose: The purpose of this study was to evaluate multidetector row CT (MDCT) angiographic findings and their clinical significance for contrast extravasation into a spontaneous intracerebral hematoma (ICH). Materials and Methods: MDCT angiographic studies and clinical records of 115 patients with spontaneous ICH were retrospectively reviewed. Cases were divided into two groups according to the presence or absence of contrast extravasation. The cases in the two groups were compared to determine the differences in radiological and clinical findings. The contrast extravasation group was divided into two subgroups according to radiological findings as follows: single or multiple dot-like contrast extravasation (Type A) and beaded-tubular (with or without dot-like extravasation) contrast extravasation (Type B). Results: Contrast extravasation was seen in 38 patients (33%). It was associated with a larger hematoma volume, more frequent intraventricular hemorrhage (IVH) and subarachnoid hemorrhage (SAH), a shorter time interval from onset to the time of the CT scan, lower Glasgow coma scale (GCS), and a higher mortality rate. Type A and B contrast extravasation were observed in 16 (42%) and 22 (58%) patients, respectively. The rate of IVH and the clinical outcome of patients with Type B showed a significant correlation. Conclusion: Two types of contrast extravasation into an ICH show a significant difference in the rate of IVH and in clinical outcome. Detecting the presence of contrast extravasation and classifying them according to the morphologic patterns are important in predicting a prognosis.

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Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage

Abstract: Volume of intraventricular hemorrhage is an important determinant of outcome in supratentorial intracerebral hemorrhage.

Cited by 411 publications

References 22 publications

Spontaneous intracerebral hemorrhage: a review

Spontaneous intracerebral hemorrhage: a review

Stereotactic fibrinolysis of spontaneous intracerebral hematoma using infusion of recombinant tissue plasminogen activator

Contrast Extravasation into an Acute Spontaneous Intracerebral Hematoma: Multidetector CT Angiographic Findings and Clinical Implications

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