Diagnosis Of Intracerebral Hemorrhage Research Articles

Intracerebral Hemorrhage Prognosis Classification via Joint-Attention Cross-Modal Network.

Intracerebral hemorrhage (ICH) is a critical condition characterized by a high prevalence, substantial mortality rates, and unpredictable clinical outcomes, which results in a serious threat to human health. Improving the timeliness and accuracy of prognosis assessment is crucial to minimizing mortality and long-term disability associated with ICH. Due to the complexity of ICH, the diagnosis of ICH in clinical practice heavily relies on the professional expertise and clinical experience of physicians. Traditional prognostic methods largely depend on the specialized knowledge and subjective judgment of healthcare professionals. Meanwhile, existing artificial intelligence (AI) methodologies, which predominantly utilize features derived from computed tomography (CT) scans, fall short of capturing the multifaceted nature of ICH. Although existing methods are capable of integrating clinical information and CT images for prognosis, the effectiveness of this fusion process still requires improvement. To surmount these limitations, the present study introduces a novel AI framework, termed the ICH Network (ICH-Net), which employs a joint-attention cross-modal network to synergize clinical textual data with CT imaging features. The architecture of ICH-Net consists of three integral components: the Feature Extraction Module, which processes and abstracts salient characteristics from the clinical and imaging data, the Feature Fusion Module, which amalgamates the diverse data streams, and the Classification Module, which interprets the fused features to deliver prognostic predictions. Our evaluation, conducted through a rigorous five-fold cross-validation process, demonstrates that ICH-Net achieves a commendable accuracy of up to 87.77%, outperforming other state-of-the-art methods detailed within our research. This evidence underscores the potential of ICH-Net as a formidable tool in prognosticating ICH, promising a significant advancement in clinical decision-making and patient care.

Association Between Early Hyperoxemia Exposure and Intensive Care Unit Mortality in Intracerebral Hemorrhage: An Observational Cohort Analysis.

Supraphysiologic levels of oxygen could have potential adverse effects on the brain that may be dose and time dependent in patients with brain injury. We therefore aimed to assess whether exposure to excess supplemental oxygen, measured as time-weighted mean exposure to hyperoxemia, was associated with intensive care unit (ICU) mortality in patients with intracerebral hemorrhage (ICH). In this single-center retrospective cohort study, we included all patients admitted to our ICU with a diagnosis of primary spontaneous ICH. To provide a longitudinal measure of hyperoxemia exposure, we calculated the hyperoxemia dose, defined as the area under the partial pressure of oxygen in arterial blood (PaO2) time curve above the threshold PaO2 value of 100mm Hg (13.3kPa) divided by the number of hours of potential exposure. To provide consistent potential exposure windows and limit bias from informative censoring, nested subsets were created with progressively longer exposure periods (0-1day, 0-2days, 0-3days, 0-4days, 0-5days, 0-6days, 0-7days). We used multivariable Cox regression, with hyperoxemia dose as a time-dependent covariate, to model ICU mortality. Admission ICH and Acute Physiology and Chronic Health Evaluation II scores were included as predictor covariables. A step-function extended Cox model was also fitted. Between September 2019 and July 2022, 275 patients met the inclusion criteria, with 24,588 arterial blood gas results available for analysis. The mean age was 57.19years (± 13.99), 59.64% were male, 23.64% had an infratentorial origin of hemorrhage, and ICU mortality was 35.64%. Almost all patients (97.45%) were exposed to hyperoxemia during their ICU admission. Cox regression modeling showed an association between hyperoxemia dose and ICU mortality (hazard ratio 1.15, confidence interval 1.05-1.25, p = 0.003). This association was observed in the 0-1day subset in the step-function extended Cox model (hazard ratio 1.19, confidence interval 1.06-1.35, p = 0.005) but not in any of the subsequent exposure periods. In patients with ICH admitted to the ICU, we observed an association between hyperoxemia dose and ICU mortality. Further prospective study is required to inform guidance on early systemic oxygen targets in ICH.

Thiazolidinediones Decrease the Recurrence of Intracerebral Hemorrhage in Type 2 Diabetes Mellitus Patients: A Nested Case-Control Study

Introduction: Preclinical evidence demonstrated the therapeutic potential of thiazolidinediones (TZDs) for the treatment of intracerebral hemorrhage (ICH). The present study conducted an investigation of cerebrovascular and cardiovascular outcomes following ICH in patients with type 2 diabetes mellitus (T2DM) treated with or without TZDs. Methods: This retrospective nested case-control study used data from the Taiwan National Health Insurance Research Database. A total of 62,515 T2DM patients who were hospitalized with a diagnosis of ICH were enrolled, including 7,603 TZD users. Data for TZD non-users were extracted using propensity score matching. Primary outcomes included death and major adverse cardiovascular events (MACEs), which were defined as a composite of ischemic stroke, hemorrhagic stroke (HS), acute myocardial infarction, and congestive heart failure. Patients aged <20 years with a history of traumatic brain injury or any prior history of MACEs were excluded. Results: TZD users had significantly lower MACE risks compared with TZD non-users following ICH (adjusted hazard ratio [aHR]: 0.90, 95% confidence interval [CI]: 0.85–0.94, p < 0.001). The most significant MACE difference reported for TZD users was HS, which possessed lower incidence than in TZD non-users, especially for the events that happened within 3 months following ICH (aHR: 0.74, 95% CI: 0.62–0.89 within 1 month, p < 0.01; aHR: 0.68, 95% CI: 0.54–0.85 between 1 and 3 month). Conclusion: The use of TZD in patients with T2DM was associated with a lower risk of subsequent HS and mortality following ICH.

Characteristics of rehabilitation duration in patients with intracerebral hemorrhage

Background and PurposeNo consensus exists on the ideal duration of rehabilitation in patients with intracerebral hemorrhage (ICH). The aim of this study is to identify demographic and clinical characteristics associated with rehabilitation duration (RD) in patients with ICH during hospitalization. MethodsThis retrospective study followed consecutive patients admitted to a tertiary care center between 2016 and 2019 with primary diagnosis of ICH. The primary outcome, RD was calculated by adding the total number of therapy (speech, occupational, and physical) minutes received during admission, divided by the hospital length of stay. Variables abstracted included demographic and clinical characteristics (ICH score, neurosurgical procedure). Multiple linear regression models were used to measure adjusted association between select predictors and mean RD. ResultsA total of 316 ICH patients (62.5 ± 15.9 years, 49 % White) were included in the final analysis. Compared to Whites, other racial minorities (β= -9.017, p = 0.002) received rehabilitation therapy for a significantly shorter duration in the adjusted model. Age was significantly associated with having higher RD (β=0.320, p < 0.001). Patients with lobar ICH (β= -7.486, p = 0.014) had significantly shorter RD compared to deep. ICH score was significantly associated with having a lower RD (β= -8.624, p < 0.001). ConclusionAge, race, ICH score, and location were significantly associated with RD. Non-White patients had significantly shorter RD, indicating a potential racial disparity in the rehabilitation of patients with ICH.

Abstract NS3: Nurse Led Interventions Improve the Timeliness of Blood Pressure Reduction in Patients Presenting With Acute Nontraumatic Intracerebral Hemorrhage

Introduction: The 2022 AHA/ASA Guidelines for Intracerebral Hemorrhage (ICH) recommend initiating treatment and lowering blood pressure (BP) within 2 hours of ICH onset and reaching the target systolic BP of 130-150mmHg within one hour of treatment initiation. This study evaluates the effectiveness of nursing education at a Comprehensive Stroke Center (CSC) on improving the timeliness of BP medication administration and BP reduction in ICH patients. Methods: Emergency Department (ED) code stroke patients with a diagnosis of ICH were included in the analysis from 6/2022-12/2022 (pre-intervention) and 1/2023-6/2023 (post-intervention). Guideline based education regarding the importance of timely medication administration was provided in nursing huddles. Nurse to patient ratios were changed to 1:1 until goal BP achieved. BP medications were also placed in the CT scanner pyxis for immediate access. Baseline demographics, NIHSS, ICH score, and door to blood pressure reduction related time metrics were collected. Data were analyzed using R package. Results: 34 patients were analyzed, 12 (35%) pre and 22 (65%) post-intervention. Patient demographics and characteristics were not different between both groups (Table 1). Time from first BP medication order to BP in range improved: 62(46.7-80) vs 43(33-52.3) mins p=0.02. In addition, the time from door to Systolic BP 130-150mmHg improved 81 (68.5-91.3) vs 56 (37.38-73.5) mins p=0.02 (Table 2). Conclusion: Guideline based education is effective in promoting nursing-led interventions to achieve timely BP reduction of ICH patients to the target goal of 130-150 mmHg.

Radiological features of brain hemorrhage through automated segmentation from computed tomography in stroke and traumatic brain injury.

Radiological assessment is necessary to diagnose spontaneous intracerebral hemorrhage (ICH) and traumatic brain injury intracranial hemorrhage (TBI-bleed). Artificial intelligence (AI) deep learning tools provide a means for decision support. This study evaluates the hemorrhage segmentations produced from three-dimensional deep learning AI model that was developed using non-contrast computed tomography (CT) imaging data external to the current study. Non-contrast CT imaging data from 1263 patients were accessed across seven data sources (referred to as sites) in Norway and Sweden. Patients were included based on ICH, TBI-bleed, or mild TBI diagnosis. Initial non-contrast CT images were available for all participants. Hemorrhage location frequency maps were generated. The number of estimated haematoma clusters was correlated with the total haematoma volume. Ground truth expert annotations were available for one ICH site; hence, a comparison was made with the estimated haematoma volumes. Segmentation volume estimates were used in a receiver operator characteristics (ROC) analysis for all samples (i.e., bleed detected) and then specifically for one site with few TBI-bleed cases. The hemorrhage frequency maps showed spatial patterns of estimated lesions consistent with ICH or TBI-bleed presentations. There was a positive correlation between the estimated number of clusters and total haematoma volume for each site (correlation range: 0.45-0.74; each p-value < 0.01) and evidence of ICH between-site differences. Relative to hand-drawn annotations for one ICH site, the VIOLA-AI segmentation mask achieved a median Dice Similarity Coefficient of 0.82 (interquartile range: 0.78 and 0.83), resulting in a small overestimate in the haematoma volume by a median of 0.47 mL (interquartile range: 0.04 and 1.75 mL). The bleed detection ROC analysis for the whole sample gave a high area-under-the-curve (AUC) of 0.92 (with sensitivity and specificity of 83.28% and 95.41%); however, when considering only the mild head injury site, the TBI-bleed detection gave an AUC of 0.70. An open-source segmentation tool was used to visualize hemorrhage locations across multiple data sources and revealed quantitative hemorrhage site differences. The automated total hemorrhage volume estimate correlated with a per-participant hemorrhage cluster count. ROC results were moderate-to-high. The VIOLA-AI tool had promising results and might be useful for various types of intracranial hemorrhage.

Effect of statin therapy patterns on readmission and mortality in patients with intracerebral hemorrhage.

There is limited and inconsistent evidence for the association of statin therapy and statin treatment patterns with the risk of recurrent intracerebral hemorrhage (ICH) in patients with prior ICH. To assess the association of statin therapy and its intensity, type, initiation time, and discontinuation with the risk of recurrent ICH and mortality in Chinese patients with ICH. Patients with newly diagnosed ICH in the Beijing Employee Medical Claims Data database from 2010 to 2017 were included. Post-ICH statin users (post-diagnosis only) and nonusers (never), statin discontinuers (pre-diagnosis only) and continuers (pre- and post-diagnosis) were matched on a 1:1 propensity score, respectively. Adjusted Cox proportional risk models were used to estimate the risk ratios for ICH readmission and mortality under various statin patterns. A total of 2668 post-ICH statin users and 2668 nonusers without a history of statin use were enrolled. Post-ICH statin users had a lower risk of ICH readmission (HR, 0.57; 95% CI 0.48, 0.69) and all-cause death (0.56: 0.49, 0.63) than nonusers. Low/moderate-intensity treatment was associated with a 63% lower risk of recurrent ICH compared with nonusers (0.37: 0.29, 0.46), whereas high-intensity treatment did not reduce the risk (0.93: 0.74, 1.16). Both low/moderate-intensity (0.42: 0.36, 0.48) and high-intensity statins (0.57: 0.48, 0.69) were associated with a lower risk of all-cause mortality. The risk of ICH readmission was 53% (0.47: 0.30, 0.74) lower with adherence to rosuvastatin than with atorvastatin. Only starting medication within 30days of the first diagnosis of ICH reduced the risk of ICH readmission (0.49: 0.40, 0.60). Among patients with a history of statin use, 1807 discontinuing and 1,807 continuing users of statins were included. The risk of ICH readmission (4.00: 3.32, 4.80) and the risk of all-cause death (4.01: 3.57, 4.50) were substantially increased in statin discontinuation compared with continued statin use. Statin therapy after ICH was associated with lower risks for ICH readmission and all-cause mortality compared with non-statin therapy, especially at low/moderate intensity and early initiation of statins after ICH. Adherence to rosuvastatin was associated with a lower risk of recurrence of ICH than atorvastatin. Among patients with a statin history prior to ICH, discontinuation of statins after ICH was associated with increased risk of ICH recurrence and death.

Deep Medullary Vein and MRI Markers Were Related to Cerebral Hemorrhage Subtypes.

To explore the performance of deep medullary vein (DMV) and magnetic resonance imaging (MRI) markers in different intracerebral hemorrhage (ICH) subtypes in patients with cerebral small vessel disease (CSVD). In total, 232 cases of CSVD with ICH were included in this study. The clinical and image data were retrospectively analyzed. Patients were divided into hypertensive arteriopathy (HTNA)-related ICH, cerebral amyloid angiopathy (CAA)-related ICH, and mixed ICH groups. The DMV score was determined in the cerebral hemisphere contralateral to the ICH. The DMV score was different between the HTNA-related and mixed ICH groups (p < 0.01). The MRI markers and CSVD burden score were significant among the ICH groups (p < 0.05). Compared to mixed ICH, HTNA-related ICH diagnosis was associated with higher deep white matter hyperintensity (DWMH) (OR: 0.452, 95% CI: 0.253-0.809, p < 0.05) and high-degree perivascular space (PVS) (OR: 0.633, 95% CI: 0.416-0.963, p < 0.05), and CAA-related ICH diagnosis was associated with increased age (OR: 1.074; 95% CI: 1.028-1.122, p = 0.001). The DMV score correlated with cerebral microbleed (CMB), PVS, DWMH, periventricular white matter hyperintensity (PWMH), and CSVD burden score (p < 0.05) but not with lacuna (p > 0.05). Age was an independent risk factor for the severity of DMV score (OR: 1.052; 95% CI: 0.026-0.076, p < 0.001). DMV scores, CSVD markers, and CSVD burden scores were associated with different subtypes of ICH. In addition, DMV scores were associated with the severity of CSVD and CSVD markers.

BCL-3 Promotes Intracerebral Hemorrhage Progression by Increasing Blood-Brain Barrier Permeability, Inflammation, and Cell Apoptosis via Endoplasmic Reticulum Stress.

Intracerebral hemorrhage (ICH) is among the common types of stroke with high mortality and morbidity. Molecular biomarker selection is crucial for ICH diagnosis and treatment. However, the identification of ICH-related biomarkers remains inadequate. In vivo and in vitro ICH models were generated and transfected with silenced B-cell lymphoma-3 (BCL-3 and siRNA BCL-3), overexpressed BCL-3, and endoplasmic reticulum stress (ERS) agonist (2-CLHA). Hematoxylin-eosin staining and transmission electron microscopy were used to observe the transfected cells. RNA sequencing was performed in vivo on the sham and ICH groups. The blood-brain barrier (BBB) permeability was evaluated by determining Evans blue dye extravasation, transendothelial electrical resistance, and paracellular permeability. Moreover, tight junction-, cell apoptosis-, and endoplasmic reticulum stress- (ERS-) related proteins were evaluated through real-time quantitative PCR, western blotting, immunohistochemistry, and TUNEL staining. The levels of inflammatory cytokines were measured through the enzyme-linked immunosorbent assay. RNA-seq revealed that BCL-3 acts as a key player. BCL-3 promotes ICH progression by increasing BBB permeability, ERS, inflammation, and cell apoptosis. Silencing of BCL-3 slows ICH progression by reducing BBB permeability and inflammation and terminating cell apoptosis and ERS in vitro and in vivo. Our study identified ICH biomarkers and elucidated the role of BCL-3 in ICH for the first time.

Effect of Bypassing the Closest Stroke Center in Patients with Intracerebral Hemorrhage

Prehospital transfer protocols are based on rapid access to reperfusion therapies for patients with ischemic stroke. The effect of different protocols among patients receiving a final diagnosis of intracerebral hemorrhage (ICH) is unknown. To determine the effect of direct transport to an endovascular treatment (EVT)-capable stroke center vs transport to the nearest local stroke center. This was a prespecified secondary analysis of RACECAT, a multicenter, population-based, cluster-randomized clinical trial conducted from March 2017 to June 2020 in Catalonia, Spain. Patients were evaluated by a blinded end point assessment. All consecutive patients suspected of experiencing a large vessel occlusion stroke (Rapid Arterial Occlusion Evaluation Scale [RACE] score in the field >4 on a scale of 0 to 9, with lower to higher stroke severity) with final diagnosis of ICH were included. A total of 1401 patients were enrolled in RACECAT with suspicion of large vessel occlusion stroke. The current analysis was conducted in October 2022. Direct transport to an EVT-capable stroke center (n = 137) or to the closest local stroke center (n = 165). The primary outcome was tested using cumulative ordinal logistic regression to estimate the common odds ratio (OR) and 95% CI of the shift analysis of disability at 90 days as assessed by the modified Rankin Scale (mRS) score (range, 0 [no symptoms] to 6 [death]) in the intention-to-treat population. Secondary outcomes, included 90-day mortality, death or severe functional dependency, early neurological deterioration, early mortality, ICH volume and enlargement, rate of neurosurgical treatment, rate of clinical complications during initial transport, and rate of adverse events until day 5. Of 1401 patients enrolled, 1099 were excluded from this analysis (32 rejected informed consent, 920 had ischemic stroke, 29 had transient ischemic attack, 12 had subarachnoid hemorrhage, and 106 had stroke mimic). Thus, 302 patients were included (204 [67.5%] men; mean [SD] age 71.7 [12.8] years; and median [IQR] RACE score, 7 [6-8]). For the primary outcome, direct transfer to an EVT-capable stroke center (mean [SD] mRS score, 4.93 [1.38]) resulted in worse functional outcome at 90 days compared with transfer to the nearest local stroke center (mean [SD] mRS score, 4.66 [1.39]; adjusted common OR, 0.63; 95% CI, 0.41-0.96). Direct transfer to an EVT-capable stroke center also suggested potentially higher 90-day mortality compared with transfer to the nearest local stroke center (67 of 137 [48.9%] vs 62 of 165 [37.6%]; adjusted hazard ratio, 1.40; 95% CI, 0.99-1.99). The rates of medical complications during the initial transfer (30 of 137 [22.6%] vs 9 of 165 patients [5.6%]; adjusted OR, 5.29; 95% CI, 2.38-11.73) and in-hospital pneumonia (49 of 137 patients [35.8%] vs 29 of 165 patients [17.6%]; OR, 2.61; 95% CI, 1.53-4.44) were higher in the EVT-capable stroke center group. In this secondary analysis of the RACECAT randomized clinical trial, bypassing the closest stroke center resulted in reduced chances of functional independence at 90 days for patients who received a final diagnosis of ICH. ClinicalTrials.gov Identifier: NCT02795962.

Primary Intracranial Hemorrhage: Characteristics, Distribution, Risk Factors, and Outcomes-A Comparative Study between Jewish and Arab Ethnic Groups in Northern Israel.

Background and purpose: This study aimed to investigate the differences in intracerebral hemorrhage (ICH) between Jews and Arabs residing in northern Israel, focusing on risk factors, hemorrhage volume, and functional outcome. Methods: A retrospective analysis was conducted utilizing a population-based registry to investigate intracerebral hemorrhage (ICH) characteristics, risk factors, and outcomes. The registry consisted of inpatients diagnosed with hemorrhagic stroke. Due to the wide variation in data on ICH characteristics and the limited availability of population-based data on predictors of ICH survival and functional outcomes, we collected retrospective data on all adult patients admitted to the Galilee Medical Center with a diagnosis of ICH. Data were obtained from the registry covering the period from 2013 to 2019. Ethnic differences and risk factors associated with intracranial hemorrhage (ICH) were examined within a diverse population of 241 patients, comprising 52.70% Jews (n = 127) and 47.30% Arabs (n = 114). Results: The results of this study revealed significant differences in age, obesity rates, and intracerebral hemorrhage (ICH) location between the two ethnic groups. Hypertension emerged as the most prevalent condition among ICH patients in both ethnic groups (76.70%), followed primarily by anticoagulant use (63.60%), dyslipidemia (60.70%), diabetes (44.60%), obesity (30.60%), smoking (24.60%), and a history of cardiovascular disease (21.80%). Furthermore, 20.90% of the patients had a history of previous cerebrovascular accidents (CVA). Arab patients with ICH were generally younger (62.90 ± 16.00 years) and exhibited higher rates of obesity (38.70%) compared to Jewish patients with ICH (70.17 ± 15.24 years, 23% obesity; p = 0.001, p = 0.013, respectively). Hemorrhage volume was identified as a crucial determinant of patient outcomes, with larger volumes associated with poorer Modified Rankin Scale (mRS) scores at discharge and higher mortality rates. Interestingly, patients without hypertension had higher hemorrhage volumes compared to those with hypertension. The extent of hemorrhage into the ventricles did not significantly correlate with mRS at discharge in our dataset. Conclusions: This study highlights significant differences in the characteristics and outcomes of intracranial hemorrhage (ICH) between Jews and Arabs in northern Israel. The findings reveal variations in age, obesity rates, and ICH location between the two groups. While hypertension was the most prevalent risk factor for both populations, other risk factors differed. Notably, hemorrhage volume emerged as a crucial prognostic factor, aligning with previously published data. These findings underscore the necessity for tailored approaches that consider ethnic-specific factors in the risk assessment, prevention, and management of ICH. Further research is warranted to elucidate the underlying mechanisms and develop interventions aimed at improving outcomes and enhancing healthcare practices in ICH management.

Impact of Atrial Fibrillation on Outcomes in Patients Hospitalized With Nontraumatic Intracerebral Hemorrhage

ObjectiveTo assess the effect of atrial fibrillation (AF) on outcomes in hospitalizations for non-traumatic intracerebral hemorrhage (ICH). Patients and MethodsWe queried the National Inpatient Sample database between January 1, 2016, and December 31, 2019, to identify hospitalizations with an index diagnosis of non-traumatic ICH using ICD-10 code I61. The cohort was divided into patients with and without AF. Propensity score matching was used to balance the covariates between AF and non-AF groups. Logistic regression was used to analyze the association. All statistical analyses were performed using weighted values. ResultsOur cohort included 292,725 hospitalizations with a primary discharge diagnosis of non-traumatic ICH. From this group, 59,005 (20%) recorded a concurrent diagnosis of AF, and 46% of these patients with AF were taking anticoagulants. Patients with AF reported a higher Elixhauser comorbidity index (19.8±6.0 vs 16.6±6.4; P<.001) before propensity matching. After propensity matching, the multivariate analysis reported that AF (aOR, 2.34; 95% CI, 2.26-2.42; P<.001) and anticoagulation drug use (aOR, 1.32; 95% CI, 1.28-1.37; P<.001) were independently associated with all-cause in-hospital mortality. Moreover, AF was significantly associated with respiratory failure requiring mechanical ventilation (odds ratio, 1.57; 95% CI, 1.52-1.62; P<.001) and acute heart failure (odds ratio, 1.26; 95% CI, 1.19-1.33; P<.001) compared with the absence of AF. ConclusionThese data suggest that non-traumatic ICH hospitalizations with coexistent AF are associated with worse in-hospital outcomes such as higher mortality and acute heart failure.

Prevalence of Concomitant Neurological Disorders and Long-Term Outcome of Patients Hospitalized for Intracerebral Hemorrhage with Versus without Cerebral Amyloid Angiopathy.

Patients with intracerebral hemorrhage (ICH) related to cerebral amyloid angiopathy (CAA) are at increased risk of developing epilepsy and cognitive disorders such as Alzheimer's disease (AD), mild cognitive impairment (MCI), and vascular dementia. In a retrospective cohort observation study of patients hospitalized for ICH with CAA versus ICH without CAA, we evaluated the prevalence of neurological comorbidities at admission and the risk of new diagnosis of epilepsy, relevant cognitive disorders, and mortality at 1year. In the TriNetX health research network, adult patients aged ≥ 55years hospitalized with a diagnosis of ICH were stratified based on presence or absence of concomitant CAA diagnosis. Demographics and medical comorbidities were compared by using χ2 test and Student's t-test. After 1:1 propensity score matching, 1-year survival was assessed with Kaplan-Meier curves. The 1-year risk of new diagnosis of epilepsy, AD, MCI, vascular dementia, and dementia unspecified was assessed with Cox proportional hazards estimate. The study included a total of 1757 patients with ICH and CAA and 53,364 patients with ICH without CAA.Patients with CAA were older compared with those without CAA (74.1 ± 7.5 vs. 69.8 ± 8.8years, p ≤ 0.001). Compared with ICH without CAA, patients with ICH and CAA had higher baseline prevalence of cerebral infarction (30% vs. 20%), nontraumatic ICH (36% vs. 7%), nontraumatic subarachnoid hemorrhage (14% vs. 5%), epilepsy (11% vs. 6%), and AD (5% vs. 2%) with significance at p < 0.001. After propensity score matching, a total of 1746 patients were included in both cohorts. In the matched cohorts, compared with patients with ICH without CAA, patients with ICH and CAA had lower 1-year all-cause mortality (479 [27%] vs. 563 [32%]; hazard ratio [HR] 0.80; 95% confidence interval [CI] 0.71-0.90) and higher risk of new diagnosis of epilepsy (280 [18%] vs. 167 [11%]; HR 1.70; 95% CI 1.40-2.06), AD (101 [6%] vs. 38 [2%]; HR 2.62; 95% CI 1.80-3.80), MCI (85 [5%] vs. 35 [2%]; HR 2.39; 95% CI 1.61-3.54), vascular dementia (117 [7%] vs. 60 [4%]; HR 1.92; 95% CI 1.41-2.62), and dementia unspecified (245 [16%] vs. 150 [9%]; HR 1.70; 95% CI 1.39-2.08). Among patients admitted for ICH, patients with CAA have lower mortality but have 2-3 times more risk of diagnosis of epilepsy and dementia at 1year, compared with those without CAA.

A computer-aided tool for automatic volume estimation of hematoma using non-contrast brain CT scans

The computation of hematoma volume is the key parameter for treatment planning of Intracerebral hemorrhage (ICH). Non-contrast computed tomography (NCCT) imaging is routinely used for the diagnosis of ICH. Hence, the development of computer-aided tools for three-dimensional (3D) computed tomography (CT) image analysis is essential to estimate the gross volume of hematoma. We propose a methodology for automatic estimation of the hematoma volume from 3D CT volumes. Our approach integrates two different methods, multiple abstract splitting (MAS) and seeded region growing (SRG) to develop a unified hematoma detection pipeline from pre-processed CT volumes. The proposed methodology was tested on 80 cases. The volume was estimated from the delineated hematoma region, validated against the ground-truth volumes, and compared with those obtained from the conventional ABC/2 approach. We also compared our results with the U-Net model (supervised technique) to show the applicability of the proposed method. The volume calculated from manually segmented hematoma was considered the ground truth. The R 2 correlation coefficient between the volume obtained from the proposed algorithm and the ground truth is 0.86, which is equivalent to the R 2 value resulting from the comparison between the volume calculated by ABC/2 and the ground truth. The experimental results of the proposed unsupervised approach are comparable to the deep neural architecture (U-Net models). The average computation time was 132.76 ± 14 seconds. The proposed methodology provides a fast and automatic estimation of hematoma volume, which is similar to the baseline user-guided ABC/2 approach. Implementation of our method does not demand a high-end computational setup. Thus, recommended in clinical practice for computer-assistive volume estimation of hematoma from 3D CT volumes and can be implemented in a simple computer system.

Quantitative Susceptibility Mapping and Amide Proton Transfer-Chemical Exchange Saturation Transfer for the Evaluation of Intracerebral Hemorrhage Model.

This study aimed to evaluate an intracerebral hemorrhage (ICH) model using quantitative susceptibility mapping (QSM) and chemical exchange saturation transfer (CEST) with preclinical 7T-magnetic resonance imaging (MRI) and determine the potential of amide proton transfer-CEST (APT-CEST) for use as a biomarker for the early detection of ICH. Six Wistar male rats underwent MRI, and another six underwent histopathological examinations on postoperative days 0, 3, and 7. The ICH model was created by injecting bacterial collagenase into the right hemisphere of the brain. QSM and APT-CEST MRI were performed using horizontal 7T-MRI. Histological studies were performed to observe ICH and detect iron deposition at the ICH site. T2-weighted images (T2WI) revealed signal changes associated with hemoglobin degeneration in red blood cells, indicating acute-phase hemorrhage on day 0, late-subacute-phase hemorrhage on day 3, and chronic-phase hemorrhage on day 7. The susceptibility alterations in each phase were detected using QSM. QSM and Berlin blue staining revealed hemosiderin deposition in the chronic phase. APT-CEST revealed high magnetization transfer ratios in the acute phase. Abundant mobile proteins and peptides were observed in early ICH, which were subsequently diluted. APT-CEST imaging may be a reliable noninvasive biomarker for the early diagnosis of ICH.

A pilot study on intracerebral hemorrhage imaging based on electrical capacitance tomography

Introduction: Intracerebral hemorrhage (ICH) is a devastating disease with high rates of mortality and disability. The survival rate and postoperative outcome of ICH can be greatly improved through prompt diagnosis and treatment. CT and MRI are now the gold standards for the diagnosis of ICH, but they are not practical for use in pre-hospital emergencies or at the bedside monitoring.Methods: Based on the earlier research of ICH detection with a single parallel plate electrode sensor, we developed a 16-electrode Electrical Capacitance Tomography (ECT) system for two-dimensional tomographic imaging of ICH in this study. A 5-layer spherical numerical model and an ex vivo porcine physical model of ICH were created for ECT simulation imaging and actual imaging, respectively, to assess the feasibility of this ECT for ICH imaging.Results: The bleeding circles were easily seen in the image reconstruction in numerical imaging. In ex vivo imaging, the existence of bleeding was also more clearly shown with the ECT system; however, the position of the bleeding reconstructed in the image was offset by 3 mm from the real site.Discussion: The study analyzes the causes of this discrepancy and discusses the steps that may be taken to rectify it. Overall, the simulation and ex vivo experimental trials validated the potential of ICH imaging with the ECT method; however, further work is required to increase the performance of the ECT and a more advanced imaging reconstruction algorithm is urgently needed for ICH imaging.

Exploring a shared genetic signature and immune infiltration between spontaneous intracerebral hemorrhage and Helicobacter pylori infection

BackgroundSpontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke with high morbidity, disability and mortality. Helicobacter pylori is a major pathogen responsible for chronic gastritis, leading to gastric ulcers and ultimately gastric cancer. Although it remains controversial whether H. pylori infection causes peptic ulcers under various traumatic stimuli, some related studies suggest that H. pylori infection may be an important factor in delaying peptic ulcer healing. However, the linking mechanism between ICH and H. pylori infection remain unclear. The purpose of this study was to examine the genetic features and pathways shared in ICH and H. pylori infection, and compare immune infiltration. MethodsWe used microarray data for ICH and H. pylori infection from the Gene Expression Omnibus (GEO) database. Differential gene expression analysis was performed on both datasets using the R software and the limma package to find the common differentially expressed genes (DEGs). In addition, we performed functional enrichment analysis on DEGs, determined protein-protein interactions (PPIs), identified Hub genes using the STRING database and Cytoscape software, and constructed microRNA-messenger RNA (miRNA-mRNA) interaction networks. Additionally, immune infiltration analysis was performed with the R software and related R packages. ResultsA total of 72 DEGs were identified between ICH and H. pylori infection, including 68 upregulated genes and 4 downregulated genes. Functional enrichment analysis revealed that multiple signaling pathways are closely linked to both diseases. In addition, the cytoHubba plugin identified 15 important hub genes, namely PLEK, NCF2, CXCR4, CXCL1, FGR, CXCL12, CXCL2, CD69, NOD2, RGS1, SLA, LCP1, HMOX1, EDN1, and ITGB3.Also, the correlation analysis of immune cell fractions revealed a limited link between their immune-related common genes and immune cells. ConclusionThrough bioinformatics methods, this study revealed that there are common pathways and hub genes between ICH and H. pylori infection. Thus, H. pylori infection may have common pathogenic mechanisms with the development of peptic ulcer after ICH. This study provided new ideas for early diagnosis and prevention of ICH and H. pylori infection.

Hypodensities within hematoma predict outcome after spontaneous intracerebral hemorrhage

Background and objective:&#x0D; Not much is known about the prevalence and significance of hypodensities within hematoma after spontaneous intracerebral hemorrhage (ICH). The objective of this study was to determine the prevalence of hypodensities within hematoma after spontaneous ICH and their significance to predict poor outcome after ICH.&#x0D; Methods:&#x0D; This observational cross sectional study was conducted in the Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad, from October 2021 to June 2022. Total 140 patients of acute stroke were included. Inclusion criteria was any patient of &gt;20 years of age with confirmed diagnosis of ICH on imaging, non-traumatic, who presented within 24 hours after onset of symptoms. Data was analyzed by SPSS ver.23.0.&#x0D; Results: &#x0D; Total 150 patients were included in the study. The mean age of patients was 52.28 ± 1.29 years. There were 100 (71.4%) males and 40 (28.6%) females. Hypertension was the most common comorbid present in 87 patients (62.1%).55% of patients had on presentation National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale score of moderate severity. The mean ICH score on presentation was 2.64 +1.26. Hematoma expansion was present in 55(39.3%) patients while interventricular extension was seen in 100(71.4%) patients. Hypodensities were seen in 125(89.3%) patients( p value 0.001). When hematoma volume were compared in both groups it was also significant (p value 0.002).&#x0D; Conclusion: &#x0D; We conclude that hypodensities within hematoma are a reliable marker of hematoma expansion after spontaneous ICH. Such reliable marker can be easily employed in resource-poor countries where CT angiography is not available everywhere. The higher NIHSS score and low GCS are significantly associated with hypodensities within hematoma.

Abstract 165: Nationwide Seasonal Variations And Increases In Incidence Of Intracerebral Hemorrhage And Acute Ischemic Stroke: An Analysis Of Pre-pandemic 16-year National Data

Introduction: There is paucity of evidence on long-term nationwide trends and seasonal variation in incidence of Intracerebral Hemorrhage (ICH) and Acute Ischemic Stroke (AIS). Methods: Using the Nationwide Inpatient Sample (2004 - 2019), we identified adults (≥ 18 years) discharged with primary diagnosis of ICH and AIS. We aggregated hospitalizations across quarters: Jan - Mar (Q1); Apr - Jun (Q2); Jul - Sep (Q3) and Oct - Dec (Q4). We used survey weights to calculate nationally representative estimates of quarter-specific incidence across age, sex, and race/ethnicity sub-cohorts and obtained time-specific denominators from the US Census Bureau. We calculated per quarter incidence rate (IR) across Q1-Q4 and Q2-Q3. We used multivariable Poisson regression model to report the adjusted incidence rate ratio (aIRR) and 95% confidence interval (CI) for the differences in quarterly incidence between Q1Q4 and Q2Q3. Results: Across 16 years, 985 959 ICH and 7 067 178 AIS hospitalizations were evaluated. The average quarterly crude IR of ICH in Q1Q4 of 6 per 100 000 was higher than the average rate of 5.4 per 100 000 observed in Q2Q3 (aIRR, CI: 1.10, 1.09 - 1.10). However, for AIS the average quarterly IR of ICH in Q1Q4 (41.2 per 100 000) was similar to the incidence rate in Q2Q3 (41.2 per 100 000) (aIRR, CI: 1.00, 1.00 - 1.00). Furthermore, we observed that average quarterly incidence is increasing overtime (aIRR, CI) for both ICH (1.01, 1.01 - 1.01) and AIS (1.03, 1.03 -1.03). The aIRR and CI for age, race, and sex are provided in the figure. Conclusion: Both stroke phenotypes demonstrate an increasing nationwide incidence. However, unlike AIS, ICH incidence is consistently and significantly higher in the months of October to March. Additional evaluation of factors such as holiday stress, seasonal variations in health behaviors (diet, physical activity, medication adherence) and physiological parameters (blood pressure, blood viscosity, fibrinogen, and cholesterol levels) is warranted.

Abstract HUP7: Contemporary Nationwide Estimates For Outcomes Associated With Craniotomy Among Patients With Intracerebral Hemorrhage

Introduction: Contemporary nationwide estimates of outcomes associated with craniotomy procedures (CP) among patients with primary intracerebral hemorrhage (ICH) are lacking. Methods: From the nationwide inpatient sample (2016 - 2019), we identified adults discharged with primary ICH diagnosis and those who received CP. We fit a series of multivariable logistic regression models to report the adjusted odds ratios (aOR) and 95% confidence interval (CI) for factors associated with receiving CP and the association of CP with in-hospital mortality, home discharge, and development of major complication (MCC): brain abscess, sepsis, deep vein thrombosis, urinary tract infection, and pneumonia. We also fit generalized linear model (γ family) to report the adjusted mean ratio (aMR) and CI for the association of craniotomy with length of stay (LOS) and cost of care. Results: Among 271 840 ICH hospitalizations (mean age [SD] 68.2 [14.9] years; 48% females), 15.3% received CP. Utilization of CP increased from 14.6% in 2016 to 15.8% in 2019 (aOR, CI: 1.10, 1.00 -1.21). Factors independently associated with lower odds of receiving CP (aOR, CI) are older age (0.97, 0.97 - 0.97); Hispanic ethnicity (0.87, 0.78 - 0.97) and Asian race (0.84, 0.73 - 0.96) (vs. Non-Hispanic White); congestive heart failure (0.86, 0.79 - 0.95); diabetes (0.79, 0.72 - 0.87) and renal failure (0.68, 0.62 - 0.74). Private (vs. Medicare) insurance (1.23, 1.13 - 1.34); and residence in large metropolitan (vs. non-metropolitan) counties (1.14, 1.03 - 1.25) is associated with higher odds of receiving a CP. CP is associated with significantly lower odds of in-hospital mortality (aOR, CI: 0.66, 0.61 - 0.72) and home discharge (0.51, 0.45 - 0.57). However, CP ICH patients had longer LOS (aMR, CI: 1.79. 1.75 - 1.84) and higher cost of care (1.82, 1.79 - 1.85). CP is not associated with MCC (aOR, CI: 0.99, 0.92 - 1.07). Conclusions: Modern-day craniotomy procedures likely improve ICH in-patient survival and are not associated with major complications. Large, pragmatic clinical trials for ICH patients are needed to evaluate effectiveness of craniotomy, particularly minimally invasive procedures, on longer term mortality and functional outcomes.