Cases Of Intracerebral Hemorrhage Research Articles

Risk Factors for Intracerebral Hemorrhage: Genome-Wide Association Study and Mendelian Randomization Analyses.

The genetic and nongenetic causes of intracerebral hemorrhage (ICH) remain obscure. The present study aimed to uncover the genetic and modifiable risk factors for ICH. We meta-analyzed genome-wide association study data from 3 European biobanks, involving 7605 ICH cases and 711 818 noncases, to identify the genomic loci linked to ICH. To uncover the potential causal associations of cardiometabolic and lifestyle factors with ICH, we performed Mendelian randomization analyses using genetic instruments identified in previous genome-wide association studies of the exposures and ICH data from the present genome-wide association study meta-analysis. We performed multivariable Mendelian randomization analyses to examine the independent associations of the identified risk factors with ICH and evaluate potential mediating pathways. We identified 1 ICH risk locus, located at the APOE genomic region. The lead variant in this locus was rs429358 (chr19:45411941), which was associated with an odds ratio of ICH of 1.17 (95% CI, 1.11-1.20; P=6.01×10-11) per C allele. Genetically predicted higher levels of body mass index, visceral adiposity, diastolic blood pressure, systolic blood pressure, and lifetime smoking index, as well as genetic liability to type 2 diabetes, were associated with higher odds of ICH after multiple testing corrections. Additionally, a genetic increase in waist-to-hip ratio and liability to smoking initiation were consistently associated with ICH, albeit at the nominal significance level (P<0.05). Multivariable Mendelian randomization analysis showed that the association between body mass index and ICH was attenuated on adjustment for type 2 diabetes and further that type 2 diabetes may be a mediator of the body mass index-ICH relationship. Our findings indicate that the APOE locus contributes to ICH genetic susceptibility in European populations. Excess adiposity, elevated blood pressure, type 2 diabetes, and smoking were identified as the chief modifiable cardiometabolic and lifestyle factors for ICH.

Risk factors for intracerebral hemorrhage in small-vessel disease and non-small-vessel disease etiologies-an observational proof-of-concept study.

Sporadic cerebral small-vessel disease (CSVD), i.e., hypertensive arteriopathy (HA) and cerebral amyloid angiopathy (CAA), is the main cause of spontaneous intracerebral hemorrhage (ICH). Nevertheless, a substantial portion of ICH cases arises from non-CSVD etiologies, such as trauma, vascular malformations, and brain tumors. While studies compared HA- and CAA-related ICH, non-CSVD etiologies were excluded from these comparisons and are consequently underexamined with regard to additional factors contributing to increased bleeding risk beyond their main pathology. As a proof of concept, we conducted a retrospective observational study in 922 patients to compare HA, CAA, and non-CSVD-related ICH with regard to factors that are known to contribute to spontaneous ICH onset. Medical records (available for n = 861) were screened for demographics, antithrombotic medication, and vascular risk profile, and CSVD pathology was rated on magnetic resonance imaging (MRI) in a subgroup of 185 patients. The severity of CSVD was assessed with a sum score ranging from 0 to 6, where a score of ≥2 was defined as advanced pathology. In 922 patients with ICH (median age of 71 years), HA and CAA caused the majority of cases (n = 670, 73%); non-CSVD etiologies made up the remaining quarter (n = 252, 27%). Individuals with HA- and CAA-related ICH exhibited a higher prevalence of predisposing factors than those with non-CSVD etiologies. This includes advanced age (median age: 71 vs. 75 vs. 63 years, p < 0.001), antithrombotic medication usage (33 vs. 37 vs. 19%, p < 0.001), prevalence of vascular risk factors (70 vs. 67 vs. 50%, p < 0.001), and advanced CSVD pathology on MRI (80 vs. 89 vs. 51%, p > 0.001). However, in particular, half of non-CSVD ICH patients were either aged over 60 years, presented with vascular risk factors, or had advanced CSVD on MRI. Risk factors for spontaneous ICH are less common in non-CSVD ICH etiologies than in HA- and CAA-related ICH, but are still frequent. Future studies should incorporate these factors, in addition to the main pathology, to stratify an individual's risk of bleeding.

High-Volume Hospital Had Lower Mortality of Severe Intracerebral Hemorrhage Patients.

Intracerebral hemorrhage (ICH) accompanies higher mortality rates than other type of stroke. This study aimed to investigate the association between hospital volume and mortality for cases of ICH. We used nationwide data from 2013 to 2018 to compare high-volume hospitals (≥32 admissions/year) and low-volume hospitals (<32 admissions/year). We tracked patients' survival at 3-month, 1-year, 2-year, and 4-year endpoints. The survival of ICH patients was analyzed at 3-month, 1-year, 2-year, and 4-year endpoints using Kaplan-Meier survival analysis. Multivariable logistic regression analysis and Cox regression analysis were performed to determine predictive factors of poor outcomes at discharge and death. Among 9,086 ICH patients who admitted to hospital during 18-month period, 6,756 (74.4%) and 2,330 (25.6%) patients were admitted to high-volume and low-volume hospitals. The mortality of total ICH patients was 18.25%, 23.87%, 27.88%, and 35.74% at the 3-month, 1-year, 2-year, and 4-year, respectively. In multivariate logistic analysis, high-volume hospitals had lower poor functional outcome at discharge than low-volume hospitals (odds ratio, 0.80; 95% confidence interval, 0.72-0.91; p < 0.001). In the Cox analysis, high-volume hospitals had significantly lower 3-month, 1-year, 2-year, and 4-year mortality than low-volume hospitals (p < 0.05). The poor outcome at discharge, short- and long-term mortality in ICH patients differed according to hospital volume. High-volume hospitals showed lower rates of mortality for ICH patients, particularly those with severe clinical status.

Long-term treatment outcomes and natural course of low-grade intracranial dural arteriovenous fistulas.

In contrast to high-grade dural arteriovenous fistula (dAVF), low-grade dAVF is mainly associated with tinnitus and carries a low risk of morbidity and mortality. It remains unclear whether the benefits of active interventions outweigh the associated risk of complications in low-grade dAVF. The authors conducted a retrospective single-center study that included all consecutive patients diagnosed with an intracranial low-grade dAVF (Cognard type I and IIa) during 2012-2022 with DSA. The authors analyzed symptom relief, symptomatic angiographic cure, treatment-related complications, risk for intracerebral hemorrhage (ICH), and mortality. All patients were followed up until the end of 2022. A total of 81 patients were diagnosed with a low-grade dAVF. Of these, 48 patients (59%) underwent treatment (all primary endovascular treatments), and 33 patients (41%) did not undergo treatment. Nine patients (19%) underwent retreatments. Angiographic follow-up was performed after median (IQR) 7.7 (6.1-24.1) months by means of DSA (mean 15.0, median 6.4 months, range 4.5-83.4 months) or MRA (mean 29.3, median 24.7 months, range 5.9-62.1 months). Symptom control was achieved in 98% of treated patients after final treatment. On final angiographic follow-up, 73% of patients had a completely occluded dAVF. There were 2 treatment-related complications resulting in 1 transient (2%) and 1 permanent (2%) neurological complication. One patient showed recurrence and progression of a completely occluded low-grade dAVF to an asymptomatic high-grade dAVF. No cases of ICH- or dAVF-related mortality were found in either treated patients (median [IQR] follow-up 5.1 [2.0-6.8] years) or untreated patients (median [IQR] follow-up 5.7 [3.2-9.0] years). Treatment of low-grade dAVF provides a high rate of symptom relief with small risks for complications with neurological sequela. The risks of ICH and mortality in patients with untreated low-grade dAVF are minimal. Symptoms may not reveal high-grade recurrence, and radiological follow-up may be warranted in selected patients with treated low-grade dAVF. An optimal radiographic follow-up regimen should be developed by a future prospective multicenter registry.

Comparison between transradial and transfemoral mechanical thrombectomy for ICA and M1 occlusions: insights from the Stroke Thrombectomy and Aneurysm Registry (STAR)

BackgroundThe role for the transradial approach for mechanical thrombectomy is controversial. We sought to compare transradial and transfemoral mechanical thrombectomy in a large multicenter database of acute ischemic stroke.MethodsThe prospectively...

Accuracy of automated segmentation and volumetry of acute intracerebral hemorrhage following minimally invasive surgery using a patch-based convolutional neural network in a small dataset

PurposeIn cases of acute intracerebral hemorrhage (ICH) volume estimation is of prognostic and therapeutic value following minimally invasive surgery (MIS). The ABC/2 method is widely used, but suffers from inaccuracies and is time consuming. Supervised machine learning using convolutional neural networks (CNN), trained on large datasets, is suitable for segmentation tasks in medical imaging. Our objective was to develop a CNN based machine learning model for the segmentation of ICH and of the drain and volumetry of ICH following MIS of acute supratentorial ICH on a relatively small dataset.MethodsNinety two scans were assigned to training (n = 29 scans), validation (n = 4 scans) and testing (n = 59 scans) datasets. The mean age (SD) was 70 (± 13.56) years. Male patients were 36. A hierarchical, patch-based CNN for segmentation of ICH and drain was trained. Volume of ICH was calculated from the segmentation mask.ResultsThe best performing model achieved a Dice similarity coefficient of 0.86 and 0.91 for the ICH and drain respectively. Automated ICH volumetry yielded high agreement with ground truth (Intraclass correlation coefficient = 0.94 [95% CI: 0.91, 0.97]). Average difference in the ICH volume was 1.33 mL.ConclusionUsing a relatively small dataset, originating from different CT-scanners and with heterogeneous voxel dimensions, we applied a patch-based CNN framework and successfully developed a machine learning model, which accurately segments the intracerebral hemorrhage (ICH) and the drains. This provides automated and accurate volumetry of the bleeding in acute ICH treated with minimally invasive surgery.

Abstract TP162: Polyamine Levels Are Elevated After Intracerebral Hemorrhage

Introduction: Intracerebral hemorrhage (ICH) has high morbidity and mortality without available targets for intervention. Polyamines are metabolites implicated in neurological diseases such as traumatic brain injury, Alzheimer’s Disease, and ischemic stroke. No studies have evaluated polyamines as they relate to ICH occurrence or outcomes. In this pilot study, we sought preliminary data on whether polyamines could be potential novel targets to improve outcomes after ICH. Methods: We analyzed plasma samples from 7 ICH cases and 10 control participants from the Genetics and Environmental Risk Factors for Stroke (GERFHS) IV study for polyamine measurements using Capillary Electrophoresis with Laser Induced Fluorescence Detection with the modality of Micellar Electrokinetic Chromatography. Plasma samples were deproteinized and derivatized with Fluorescein Isothiocyanate. Samples were spiked with standard solutions and compared with standard curves developed per each polyamine. We report median age and sex of the cohort. Peak spermine, spermidine and putrescine levels were compared using a student’s t-test. Results: In this pilot study of participants enrolled into GERFHS IV (median age 67 vs 61, cases vs controls respectively, 50% female) all three unacetylated polyamine levels were higher in cases. Although sample size is modest, there was a trend towards increased spermidine levels with higher mRS at 90 days (r 2 = 0.3342) (Figure 1). Conclusions: For the first time, we have shown that polyamines are elevated after ICH, and that higher polyamine levels may be associated with worse outcomes. This preliminary data supports further evaluation of polyamines as potential targets to improve outcomes after ICH in a larger cohort.

Abstract WP158: Cortical Superficial Siderosis is Associated With Ischemia After Intracerebral Hemorrhage

Background: Ischemia on diffusion weighted imaging (DWI) after intracerebral hemorrhage (ICH) increases the risk of future ischemic stroke. Radiographic markers of small vessel disease, including cerebral microbleeds (CMB), are associated with DWI lesions. Though cortical superficial siderosis (cSS) is also a hemorrhagic small vessel disease subtype, it is unclear if cSS similarly relates to DWI lesions. We hypothesized that cSS would represent a more severe phenotype of small vessel disease and would associate with DWI lesions after ICH independent to other small vessel disease markers. Methods: Using the Intracerebral Hemorrhage Outcomes Project (ICHOP), we included all cases of spontaneous ICH who underwent DWI and susceptibility imaging/gradient echo. DWI hyperintensities were identified if &gt;10mm from the hematoma with decreased ADC signal. cSS were identified as subarachnoid hemosiderin deposition without acute subarachnoid hemorrhage. The relationship of cSS with DWI lesion presence as the outcome was assessed with logistic regression adjusted for ICH score, blood pressure change within 24 hours, and small vessel disease markers (CMB and white matter hyperintensity). Sensitivity analyses were performed to adjust for demographics and ICH location. A secondary analysis using linear regression assessed the association with the number of DWI lesions adjusted for similar covariates. Results: Of 198 patients analyzed, DWI lesions were observed in 31.3% and cSS in 10.6%. The presence of cSS was associated with DWI lesions (adjusted OR 3.72, CI: 1.29-10.72), independent of other small vessel disease markers. Separate sensitivity analyses adjusting for sex, race, and ICH location did not change the association of cSS with DWI lesions. In secondary analyses, cSS was not associated with greater number of DWI lesions counts (b 0.213, CI -0.53-0.63). Discussion: cSS is associated with the presence of DWI lesions, independent to other small vessel disease markers. cSS may represent a severe phenotype of small vessel disease with a risk of ICH recurrence and ischemia. Further work is required to investigate underlying mechanisms and optimal strategies to mitigate competing risks of future hemorrhage and ischemic events in these patients.

Abstract TP157: Utility of CT Angiography in Patients With Intracerebral Hemorrhage

Introduction: Patients with intracerebral hemorrhage (ICH) often undergo CT and CT angiography with the latter being done to identify vascular abnormalities for ICH etiology. It is unclear whether CTA yields are high enough to warrant routine use particularly for subcortical ICH, however. Methods: Retrospective chart review was done on the Loyola Stroke Database of ICH patients over the last 10 years. Data from CT, CTA (and other imaging modalities) regarding ICH size and location, as well as vascular abnormalities, were collected. Demographics, comorbidities, and clinical outcomes were also recorded. Frequencies and percentages are reported to describe overall sample and bivariate associations. Univariate logistic regression estimated unadjusted effects of ICH type, age, hypertension (HTN), and other predictors on the logit of vascular abnormalities. Chi square values are reported for overall interaction effects. Stratified odds ratios (OR) are reported with 95% confidence intervals and p-values. Multivariable binary logistic regression estimated adjusted effects of ICH type on the logit of vascular abnormalities, after adjusting for covariates; OR are reported for adjusted effects. Results: Of 744 ICH cases analyzed, 376 were subcortical (50.54%) and 368 cortical (49.46%). Eighty-one had vascular abnormalities (10.89%); 46 of those being lesion-related (6.18%). Unadjusted odds of lesion-related vascular abnormalities were higher for cortical versus subcortical ICH (OR: 7.04; 95% CI: 3.09, 16.04; p &lt; 0.01). Two-way interaction was non-significant for effects of ICH type and age (p = 0.76), ICH type and HTN (p = 0.68), age and hypertension (p = 0.09), and ICH type and ICH size (p = 0.93) on the logit of lesion-related vascular abnormalities. Thus, these effects did not co-vary significantly with respect to lesion-related vascular abnormalities. Odds of lesion-related vascular abnormalities are significantly higher for cortical versus subcortical ICH, after adjusting for age, HTN ICH size, and CTA (OR: 6.91; 95% CI: 2.93, 16.30; p &lt; 0.01). Conclusion: Our analysis suggests there is decreased utility for CTA in subcortical compared to cortical ICH and CTA should probably not be performed routinely on subcortical ICH.

Spectrum of Intracerebral Hemorrhage in a Tertiary Hospital

Introduction: Intracerebral hemorrhage is a devastating type of stroke that leads to profound morbidity and carries high mortality. Survivors of hemorrhagic stroke suffer not only from physical and social decline but also results in loss of productivity and financial burden.&#x0D; Causes of hemorrhagic stroke are hypertension, coagulopathic condition, diabetes mellitus and cardiovascular diseases. lesional hemorrhagic stroke can be due to subarachnoid hemorrhage from intracranial aneurysm, arteriovenous malformation, dural arteriovenous fistula etc.&#x0D; Methods: A retrospective cross sectional study carried out at KISTMCTH. Data from six years duration was analysed from hospital records, outpatient department records. Patients that presented with intracranial hemorrhage were included. Post operative patients and traumatic intracerebral hemorrhage cases were not included.&#x0D; &#x0D; Results: Total of 112 patients was included in the study. 73 (65.1%) of them were male and 39 (34.8%) were female. putamen and caudate region were most common 47 (41.9%) followed by subarachnoid region 27 (24.1%), thalamus 19 (16.9%), cerebellum 9 (8.04%) , lobar region 8 (7.1%) and brainstem 2 (1.7%). Intracranial hemorrhage was more common in age group of 41-60 years 59 (52.6%) followed by age group 61- 100 years 42 (37.5%). 14 (51.8%) female had subarachnoid hemorrage in comparision to 13 male (48.1%). Anterior communicating artery aneurysm had highest occurrence 10 (37%) followed by middle cerebral artery aneurysm 6 (22.2%) , paraclinnoidal / anterior choroidal/posterior communicating artery aneurysm 5 (18.5%), vertebral artery aneurysm 3 (11.1%), distal anterior cerebral artery aneurysm 1 (3.7%).&#x0D; Intracranial hemorrhage had highest occurrence on the month of January (15%) and lowest on the month of November (3.57%). 29 (25.8%) of total intracranial hemorrhage patient had intraventricular extension of hemorrhage. Intraventricular extension was more common in thalamic hematoma 15 (13.39%) followed by caudate/putaminal hematoma 10 (8.9%), cerebellum 3 (2.6%).Modified Rankin Scale ( MRS) outcome score was found to be highest as MRS 6 for 34 (30.6%) patients . while good outcome in terms of MRS 1 , MRS 2 and MRS 3 were observed for 7 (6.2%), 26 (23.2%), 25 (22.3%) patients respectively.&#x0D; Conclusion: Hypertension remains one of the major risk factor that results in various location specific hemorrhage and it shows specific peak seasonal variation. Proper blood pressure control is recommended for prevention of intracranial hemorrhages.

Stroke in the very old: A study from the Philippine Neurological Association One Database.

The very old, although a minority in many populations, experience stroke with distinct risk factors and more complications. We sought to understand the profile, stroke subtypes, risk factors and outcomes among the very old compared to younger stroke patients in our population in the Philippine Neurological Association One Database-Stroke (PNA1DB-Stroke). The PNA1DB-Stroke registry (clinicaltrial.gov NCT04972058) is a multi-centre, prospective database of all patients hospitalised for transient ischaemic attack or acute stroke in 11 neurology residency training institutions. Of the 6314 patients with stroke, 463 (7%) were 80 years or older, and among them, 320 (69%) were women. Traditional risk factors were more frequent in the very old compared to the younger group (hypertension 76% vs. 66%, diabetes mellitus 26% vs. 19%, previous stroke 14% vs. 10%, atrial fibrillation 13% vs. 3%; p ≤ .005), while current smoking (5%) and excess alcohol consumption (4%) were less common than in younger stroke patients (p < .001). Overall, in-hospital fatality was not remarkably increased in our very old compared to younger stroke patients, with comparable rates between cases of ischaemic stroke (18%) and intracerebral haemorrhage (20%). However, they had longer hospital stay (mean 13.4 ± 17.2 days vs. 10.9 ± 15.4 days, p = .001), had more medical complications (p < .001) and were more functionally dependent at discharge (p < .0001). Very old stroke patients have relatively more risk factors for stroke. In-hospital fatality rates are comparable between ischaemic and haemorrhagic strokes. Risk factor modification, prevention of medical complications and optimisation of functional recovery are potential strategies in managing stroke in the very old.

Prevalence, clinical characteristics, and risk factors of intracerebral haemorrhage in CADASIL: a case series and systematic review

BackgroundCerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common monogenic form of stroke and is characterised by early onset stroke and dementia. Most strokes are lacunar ischaemic strokes, but intracerebral haemorrhage (ICH) has also been reported, although there are limited published data on its frequency and characteristics.MethodsA retrospective review of a prospectively recruited CADASIL register from the British National Referral clinic was performed to identify acute ICH cases and their characteristics. In addition, a systematic review of ICH in CADASIL was performed. MEDLINE (Pubmed), Embase, and Web of Science were searched for articles published from inception until 31/05/2023.ResultsTen cases of ICH were identified from the National clinic register of 516 symptomatic patients, giving an estimated point prevalence of 1.9%. An additional 119 cases were identified from the systematic review, comprising 129 cases and 142 ICH events in total. Including all identified cases, the mean age at onset of ICH was 56.6 ± 15.7 (SD) years, and 74 (57.4%) were male. ICH was the first manifestation of the disease in 32 patients (38.1%), and ICH recurrence occurred in 16 (12.4%). Most ICHs were subcortical, with the thalamus, 58 (40.8%), and basal ganglia, 34 (23.9%), being the commonest sites. Anticoagulation, but not antiplatelet agents, was associated with an increased risk of ICH (20.0% vs. 1.9%, p = 0.006).ConclusionsICH is a relatively rare manifestation of CADASIL, occurring in about 2% of symptomatic cases. Most of the haemorrhages occurred in the subcortical regions.

The Usefulness of the 3.1-mm-diameter 4K Rigid Endoscope for Intracerebral Hematoma Evacuation.

The indication for surgical intervention in spontaneous intracerebral hemorrhage remains controversial. Although many clinical trials have failed to demonstrate its efficacy over medical treatment, less invasive endoscopic treatment is expected to demonstrate its superiority. A novel endoscopic system for hematoma removal consisting of a 3.1-mm-diameter 4K high-resolution rigid endoscope was used.The system was used in eight cases of spontaneous intracerebral hemorrhage. It provided improved maneuverability of the surgical instrument while maintaining satisfactory image quality. The surgical goal was achieved in all cases without any complications, including perioperative rebleeding.Endoscopic hematoma removal using the 3.1 mm high-resolution endoscope is an alternative minimally invasive approach to spontaneous intracerebral hemorrhage with improved reliability.

Risk Factors and Functional Outcome of Ischemic Stroke Vis-à-vis Hemorrhagic Stroke at a Tertiary Care Hospital in North India

Abstract Background: Worldwide, stroke is the most common cause of death after coronary artery disease (CAD). The risk factor stratification and prognostication of stroke patients are vital in planning and allocating health-care resources. Methods: We conducted a prospective, comparative observational study. Fifty age- and sex-matched cases each of ischemic stroke (IS) and intracerebral hemorrhage (ICH) stroke were enrolled, and baseline demographic, risk factor profile, Glasgow Coma Scale, modified Rankin scale (mRS), and Barthel Index (BI) were recorded, and the cases were followed up for 90 days or till death. We looked at the risk factors associated with IS and ICH and functional outcome of IS vis-à-vis ICH using mRS and BI at 90 days postenrollment. We also compared the mortality of IS vis-à-vis ICH. Results: The presence of hypertension (100% vs. 88%) and smoking (50% vs. 26%) was significantly higher in ICH (P &lt; 0.05). The presence of diabetes mellitus (40% vs. 18%) and CAD (12% vs. 2%) was significantly more in IS cases (P &lt; 0.05). Consumption of alcohol was more prevalent in ICH patients compared to IS patients (30% vs. 24%). Based on mRS and BI at 90 days, ICH cases had significantly poorer functional outcome compared to IS cases (P &lt; 0.0001). Mortality of IS cases (4%) was also significantly less compared to ICH cases (30%). Conclusions: A combination of hypertension, smoking, and history of alcohol consumption had a higher predilection for the occurrence of ICH, whereas a combination of hypertension, diabetes mellitus, and CAD favored the occurrence of IS. The functional outcome of cases of ICH 90 days poststroke was significantly poorer compared to IS cases. The most important factors for poor outcome of ICH cases were more stroke severity at baseline compared to IS cases and the presence of intraventricular hemorrhages in some cases. Mortality was also found to be more in patients with ICH compared to IS.

PREDICTION OF FUNCTIONAL OUTCOMES IN SUPRATENTORIAL INTRACEREBRAL HEMORRHAGE PATIENTS TREATED WITH STEREOTACTIC COMPUTED TOMOGRAPHIC-GUIDED ASPIRATION AND RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR

Objectives: To evaluate factors influencing the outcomes in supratentorial intracerebral hemorrhage (ICH) patients treated with stereotactic computed tomographic (CT) guided aspiration and recombinant tissue plasminogen activator (rt-PA). Methods: A prospective study on 80 spontaneous supratentorial ICH cases from February 2017 to June 2020, analyzing the 12-month outcomes and identifying clinical and radiological factors for poor prognosis within 12 months. Results: The mean age was 55.6 years (SD 11.4). The median pre-operation GCS score was 9 (IQR 6 - 12). The mean final ICH volume was 23.9mL (SD 24.6), with ICH volume reduction by an average of 66%. 12 months after the procedure, 40 patients (50%) had poor outcomes (mRS score 4 - 6). In multivariate analysis, age (OR = 1.058, 95%CI = 1.007 - 1.112; p = 0.026), the GCS score before operation (OR = 0.666, 95%CI = 0.448 - 0.992; p = 0.046), the midline shift before operation (OR = 1.301, 95%CI = 1.057 - 1.601; p = 0.013), and the residual volume hematoma ≥ 20mL (OR = 4.402, 95%CI = 1.393 - 13.913, p = 0.012) were the significant predictors of a poor 12-month outcome. Conclusion: CT-guided thrombolysis and aspiration can be safe and effective in reducing ICH volume. Age, the GCS score before the operation, the midline shift before the operation, and final residual volume hematoma ≥ 20mL were significant predictors of a poor 12-month outcome.

Early fever in patients with primary intracerebral hemorrhage is associated with worse long-term functional outcomes: a prospective study

BackgroundPrimary intracerebral hemorrhage (ICH) accounts for 85% of ICH cases and is associated with high morbidity and mortality rates. Fever can cause secondary injury after ICH; however, relevant studies have reported inconsistent results regarding the effects of fever on functional outcomes after ICH. This study examined the effects of early fever on the prognosis of ICH, particularly on long-term functional outcomes.MethodsThis prospective study recruited patients with primary ICH at a tertiary medical center between 2019 and 2021. Early fever was defined as a tympanic body temperature of ≥ 38 °C upon admission. Barthel Index (BI) and modified Rankin scale (mRS) were examined at 1 year after ICH. A BI of ≤ 60 or mRS of ≥ 4 was considered as indicating severe disability.ResultsWe included 100 patients, and early fever was significantly associated with less functional independence at 1 year post-ICH, as determined using the mRS (p = 0.048; odds ratio [OR] = 0.23), and with severe functional dependency at 1 year post-ICH, as determined using the BI (p = 0.043; OR = 3) and mRS (p = 0.045; OR = 3). In addition, patients with early fever had a longer length of hospital stay (p = 0.002; 95% confidence interval = 21.80–95.91).ConclusionsFever is common among patients with primary ICH. Our data indicate a significant association between early fever and worse functional outcomes in ICH survivors at 1 year after ICH. Additionally, patients with early fever had a significantly longer length of hospital stay after ICH.

Deep Resequencing of the 1q22 Locus in Non-Lobar Intracerebral Hemorrhage.

Genome-wide association studies have identified 1q22 as a susceptibility locus for cerebral small vessel diseases, including non-lobar intracerebral hemorrhage (ICH) and lacunar stroke. In the present study, we performed targeted high-depth sequencing of 1q22 in ICH cases and controls to further characterize this locus and prioritize potential causal mechanisms, which remain unknown. A total of 95,000 base pairs spanning 1q22, including SEMA4A, SLC25A44, and PMF1/PMF1-BGLAP were sequenced in 1,055 spontaneous ICH cases (534 lobar and 521 non-lobar) and 1,078 controls. Firth regression and Rare Variant Influential Filtering Tool analysis were used to analyze common and rare variants, respectively. Chromatin interaction analyses were performed using Hi-C, chromatin immunoprecipitation followed by sequencing, and chromatin interaction analysis with paired-end tag databases. Multivariable Mendelian randomization assessed whether alterations in gene-specific expression relative to regionally co-expressed genes at 1q22 could be causally related to ICH risk. Common and rare variant analyses prioritized variants in SEMA4A 5'-UTR and PMF1 intronic regions, overlapping with active promoter and enhancer regions based on ENCODE annotation. Hi-C data analysis determined that 1q22 is spatially organized in a single chromatin loop, and that the genes therein belong to the same topologically associating domain. Chromatin immunoprecipitation followed by sequencing and chromatin interaction analysis with paired-end tag data analysis highlighted the presence of long-range interactions between the SEMA4A-promoter and PMF1-enhancer regions prioritized by association testing. Multivariable Mendelian randomization analyses demonstrated that PMF1 overexpression could be causally related to non-lobar ICH risk. Altered promoter-enhancer interactions leading to PMF1 overexpression, potentially dysregulating polyamine catabolism, could explain demonstrated associations with non-lobar ICH risk at 1q22, offering a potential new target for prevention of ICH and cerebral small vessel disease. ANN NEUROL 2024;95:325-337.

The impact of bilateral brachial-ankle pulse wave velocity difference on cardiovascular disease and all-cause mortality.

This study aims to investigate the association between an elevated bilateral pulse wave velocity difference (BPWVD) and cardiovascular diseases (CVDs) and all-cause mortality. This study included a total of 38,356 participants. A multivariable Cox proportional hazards regression was used to assess the association between high BPWVD and the increased risk of CVDs and all-cause mortality by calculating hazard ratios (HRs) with 95% confidence intervals. A total of 1,213 cases of CVDs were identified over a mean duration of 6.19 years, including 886 cases of cerebral infarction (CI), 105 cases of intracerebral hemorrhage (ICH), and 222 cases of myocardial infarction (MI), along with 1,182 cases of all-cause mortality. The median BPWVD was 42 cm/s (19-80 cm/s). After adjusting for all confounders and baseline brachial-ankle PWV (baPWV), our analysis revealed a significant correlation between a higher risk of CVDs, MI, and all-cause mortality with an increase in BPWVD per standard deviation. HRs (95% confidence interval) were found to be 1.06 (1.01-1.11), 1.11 (1.02-1.21), and 1.07 (1.04-1.10), respectively. Among the participants with higher baPWV on the left side, the HRs (95% confidence interval) were 1.08 (1.02-1.14) for CVDs, 1.27 (1.10-1.46) for incident ICH, 1.16 (1.00-1.24) for incident MI, and 1.10 (1.07-1.15) for all-cause mortality, for per standard deviation increase in BPWVD. Our findings reveal a significant correlation between elevated BPWVD and the risks of developing CVDs and all-cause mortality. This highlights the importance of thoroughly evaluating BPWVD as a means of detecting individuals at risk for CVDs and mortality.

Natural History, Pathophysiology, and Recent Management Modalities of Intraventricular Hemorrhage.

Intraventricular hemorrhage (IVH) is a clinical challenge observed among 40-45% of intracerebral hemorrhage (ICH) cases. IVH can be classified according to the source of the hemorrhage into primary and secondary IVH. Primary intraventricular hemorrhage (PIVH), unlike secondary IVH, involves only the ventricles with no hemorrhagic parenchymal source. Several risk factors of PIVH were reported which include hypertension, smoking, age, and excessive alcohol consumption. IVH is associated with high mortality and morbidity and several prognostic factors were identified such as IVH volume, number of ventricles with blood, involvement of fourth ventricle, baseline Glasgow Coma Scale score, and hydrocephalus. Prompt management of patients with IVH is required to stabilize the clinical status of patients upon admission. Nevertheless, further advanced management is crucial to reduce the morbidity and mortality associated with intraventricular bleeding. Recent treatments showed promising outcomes in the management of IVH patients such as intraventricular anti-inflammatory drugs, lumbar drainage, and endoscopic evacuation of IVH, however, their safety and efficacy are still in question. This literature review presents the epidemiology, physiopathology, risk factors, and outcomes of IVH in adults with an emphasis on recent treatment options.

Association Between Prekallikrein and Stroke: A Mendelian Randomization Study.

Background High plasma prekallikrein was reported to be associated with increased risks of stroke, but the causality for these associations remains unclear. We aimed to investigate the associations of genetically predicted plasma prekallikrein concentrations with all-cause stroke, ischemic stroke, 3 ischemic stroke subtypes, and intracerebral hemorrhage (ICH) using a 2-sample Mendelian randomization approach. Methods and Results Seven independent prekallikrein-related single-nucleotide polymorphisms were identified as genetic instruments for prekallikrein based on a genome-wide association study with 1000 European individuals. The summary statistics for all-cause stroke, ischemic stroke, and ischemic stroke subtypes were obtained from the Multiancestry Genome-wide Association Study of Stroke Consortium with 40 585 cases and 406 111 controls of European ancestry. The summary statistics for ICH were obtained from the ISGC (International Stroke Genetics Consortium) with 1545 ICH cases and 1481 controls of European ancestry. In the main analysis, the inverse-variance weighted method was applied to estimate the associations of plasma prekallikrein concentrations with all-cause stroke, ischemic stroke, ischemic stroke subtypes, and ICH. Genetically predicted high plasma prekallikrein levels were significantly associated with elevated risks of all-cause stroke (odds ratio [OR] per SD increase, 1.04 [95% CI, 1.02-1.06]; P=5.44×10-5), ischemic stroke (OR per SD increase, 1.05 [95% CI, 1.03-1.07]; P=1.42×10-5), cardioembolic stroke (OR per SD increase, 1.08 [95% CI, 1.03-1.12]; P=3.75×10-4), and small vessel stroke (OR per SD increase, 1.11 [95% CI, 1.06-1.17]; P=3.02×10-5). However, no significant associations were observed for genetically predicted prekallikrein concentrations with large artery stroke and ICH. Conclusions This Mendelian randomization study found that genetically predicted high plasma prekallikrein concentrations were associated with increased risks of all-cause stroke, ischemic stroke, cardioembolic stroke, and small vessel stroke, indicating that prekallikrein might have a critical role in the development of stroke.