Abstract
ObjectiveTo establish the relationship between hematoma sites of involvement and hematoma expansion (HE) in patients with deep intracerebral hemorrhage (ICH).MethodsEligible patients with deep ICH admitted to hospital within 6 hours of onset between 2018 and 2020 were included in this retrospective multi-center study. Individuals with secondary ICH were excluded. The volume of HE was evaluated based on admission and follow-up computed tomography scans. Associations between deep ICH sites of involvement and HE were examined using multivariable logistic regression analysis while adjusting for confounding covariates of HE.ResultsWe enrolled 583 individuals from three stroke centers. Data from a final total of 460 patients were used in the analysis; of these patients, 159 (34.6%) had HE. In the crude model without adjustment, external capsule, anterior limb of the internal capsule, and posterior limb of the internal capsule (PLIC) involvement were correlated with HE. After fully adjusted models for sex, age, intraventricular hemorrhage, Glasgow Coma Scale admission score, baseline ICH volume, and time from onset to initial computed tomography, multivariable logistic regression revealed that the PLIC is a robust predictor of HE in patients with deep ICH (adjusted odds ratio = 2.73; 95% confidence interval = 1.75–4.26; p < 0.001).ConclusionInvolvement of the posterior limb of the internal capsule in deep hemorrhage could be a promising predictor of HE.
Highlights
The Global Burden of Disease 2019 study ranked stroke as the primary cause of disability-adjusted life years in those aged 50 years and older [1]
Eligible individuals were screened in light of the following inclusion criteria: [1] Spontaneous Intracerebral hemorrhage (ICH) was identified on computed tomography (CT); and [2] baseline CT scans and follow-up CT scans were acquired within 6 h and 48 h after the initial ictus, respectively
Deep ICH was further divided into 6 sites according to a previous study [13], comprising the globus pallidus/putamen (GP/P), anterior limb of the internal capsule (ALIC), external capsule (EC), posterior limb of the internal capsule (PLIC), caudate head, and thalamus
Summary
The Global Burden of Disease 2019 study ranked stroke as the primary cause of disability-adjusted life years in those aged 50 years and older [1]. Intracerebral hemorrhage (ICH) is one of the most devastating and fatal subtypes of cerebrovascular accidents, and is associated with mortality rates of up to 40% [2]. 30% of patients with ICH will experience hematoma expansion (HE) within 6 hours after the onset of neurological deficits [3], and HE has long been deemed as. The Effect of ICH Locations an independent predictor for worse outcomes [4]. Every 1 mL increase in a hematoma has been estimated to elevate the risk of death by 5% [5]. Attempts to prevent HE are crucial in managing the early phase of ICH, and this is a potential target for hemostasis treatment [6, 7]. The timely detection of patients with ICH who have a high risk of hemorrhagic progression is of great importance
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