Intracerebral Hemorrhage In Adults Research Articles

ABO blood type and thromboembolic complications after intracerebral hemorrhage: An exploratory analysis

Background and purposeNon-O blood types are known to be associated with thromboembolic complications (TECs) in population-based studies. TECs are known drivers of morbidity and mortality in intracerebral hemorrhage (ICH) patients, yet the relationships of blood type on TECs in this patient population are unknown. We sought to explore the relationships between ABO blood type and TECs in ICH patients. MethodsConsecutive adult ICH patients enrolled into a prospective observational cohort study with available ABO blood type data were analyzed. Patients with cancer history, prior thromboembolism, and baseline laboratory evidence of coagulopathy were excluded. The primary exposure variable was blood type (non-O versus O). The primary outcome was composite TEC, defined as pulmonary embolism, deep venous thrombosis, ischemic stroke or myocardial infarction, during the hospital stay. Relationships between blood type, TECs and clinical outcomes were separately assessed using logistic regression models after adjusting for sex, ethnicity and ICH score. ResultsOf 301 ICH patients included for analysis, 44% were non-O blood type. Non-O blood type was associated with higher admission GCS and lower ICH score on baseline comparisons. We identified TECs in 11.6% of our overall patient cohort. . Although TECs were identified in 9.9% of non-O blood type patients compared to 13.0% in O blood type patients, we did not identify a significant relationship of non-O blood type with TECs (adjusted OR=0.776, 95%CI: 0.348-1.733, p=0.537). The prevalence of specific TECs were also comparable in unadjusted and adjusted analyses between the two cohorts. In additional analyses, we identified that TECs were associated with poor 90-day mRS (adjusted OR=3.452, 95% CI: 1.001-11.903, p=0.050). We did not identify relationships between ABO blood type and poor 90-day mRS (adjusted OR=0.994, 95% CI:0.465-2.128, p=0.988). ConclusionsWe identified that TECs were associated with worse ICH outcomes. However, we did not identify relationships in ABO blood type and TECs. Further work is required to assess best diagnostic and prophylactic and treatment strategies for TECs to improve ICH outcomes.

Utilizing the International Normalized Ratio-Platelet Index for Predicting Hospital Outcomes After Spontaneous Supratentorial Intracerebral Hemorrhage

ObjectiveSpontaneous intracerebral hemorrhage (ICH) poses a public health issue due to its elevated mortality rates. The International Normalized Ratio-platelet index (INR-Plt index) has recently been recognized as a predictive factor for liver disease progression. The potential of applying the INR-Plt index in forecasting ICH prognosis presents an intriguing subject. This study endeavors to examine the correlation between the INR-Plt index and hospital outcomes in patients with spontaneous supratentorial ICH. MethodsA retrospective examination of 283 adult ICH patients was undertaken. The INR-Plt index was computed using the formula: [INR/platelet counts (1000/μL)]×100. The clinical outcomes evaluated consisted of mortality rates and the Modified Rankin Scale (mRS) at discharge. An unfavorable outcome was defined as an mRS score from 4 to 6. ResultsThe study found a significant correlation between the INR-Plt index and hospital mortality (odds ratio: 4.31, 95% CI: 1.07 - 17.31, p = 0.04). There was a 43% rise in mortality risk for every 0.1 unit increase in the INR-Plt index. Kaplan-Meier survival curves illustrated a considerably lower survival rate at discharge for patients with an INR-Plt index > 0.8 (log-rank test: p = 0.047). Regarding unfavorable outcomes, the INR-Plt index was not a significant factor according to logistic regression analyses. ConclusionsThe INR-Plt index is a predictor of hospital mortality in patients with spontaneous supratentorial ICH. A higher INR-Plt index value is associated with an increased risk of mortality, underlining the potential usefulness of this composite index in guiding clinical decision-making and enabling risk stratification.

Abstract 111: Membrane Lipid-Sensing Receptor MS4A Modulates Microglial Reparative Phenotype in Acute Germinal Matrix Hemorrhage-Intraventricular Hemorrhage (GMH-IVH)

Background: GMH-IVH refers to spontaneous bleeding in the periventricular germinal zone and ventricles of an immature brain. Preterm infants with GMH-IVH often have lifelong neurologic deficits. Microglia play crucial roles during development; however, what role they play in neonatal cerebrovascular injury such as GMH-IVH is less known. Here we established a mouse GMH-IVH model and unveiled an immature brain-specific microglial response. Methods: GMH-IVH and adult intracerebral hemorrhage (ICH)-IVH were induced by blood injection into the caudate-putamen and periventricular region of postnatal day 5 and 8-week-old mice. Astrogliosis, myelin loss, MS4A receptor expression, neuron morphology, and spine density were evaluated by immunofluorescence and Golgi’s staining. Transcriptome of microglia was profiled by NanoString. Cx3cr1 CreER ; iDRT mice and PLX3397 treatment were used to deplete microglia. Cognitive and affective functions were evaluated. In vivo siRNA delivery was used to explore the mechanism underlying acute microglia reparative activation after GMH-IVH. Result: Astrogliosis and myelin loss were sustained till at least 8 weeks after GMH-IVH. Reduced neuronal dendritic complexity in the dentate gyrus and medial prefrontal cortex suggested compromised neuronal development in GMH-IVH. Upon adulthood, GMH-IVH mice had impaired cognitive and affective functions . Microglia showed heterogeneous phenotypes on day 3 after GMH-IVH. Interestingly, acute depletion of microglia aggravated myelin loss and neurobehavioral deficits, implying a beneficial role of these cells in the early stage of GMH-IVH. Compared with day 28 after GMH-IVH and day 3 after ICH-IVH, microglia at day 3 GMH-IVH uniquely upregulated lipid-sensing receptor MS4A. Inhibition of MS4A worsened long-term GMH-IVH outcomes. Conclusion: MS4A-expressing microglia are beneficial for GMH-IVH and targeting their responses could be a therapeutic approach for treating GMH-IVH.

521: CEREBRAL ISCHEMIA AND OUTCOMES WITH RAPID BLOOD PRESSURE LOWERING IN INTRACEREBRAL HEMORRHAGE

Introduction: Guidelines support acute systolic blood pressure (SBP) lowering in intracerebral hemorrhage (ICH) if SBP is between 150 and 220 mmHg to improve outcomes. Recommendations for SBP >220 mm Hg are less clear. A proposed risk is failure of cerebral autoregulation, leading to brain ischemia and poor outcomes. Methods: A single center, retrospective cohort study of adult ICH patients from July 2017 to 2021. Patients from outside of the hospital system, in-hospital ICH, pregnant, or a prisoner were excluded. The primary outcome was incidence of cerebral ischemia in patients with SBP >220 mmHg (high) vs. 150-219 mmHg (low), assessed through percent SBP lowering and evaluation of radiographic imaging during admission. Secondary outcomes included poor neurologic status with mRS of 4 to 6 at discharge. Results: Of the 393 patients included, median (IQR) premorbid mRS was 0 in both groups, median (IQR) NIHSS was high; 16 (8, 23) vs. low; 13 (5, 19), p < 0.01. The median (IQR) presenting SBP was high; 236 (225, 246) mmHg vs. low; 180 (166, 197) mmHg. SBP goal was achieved in the first 24 hours in high; 86% vs. low; 77%, p = 0.09. Median (IQR) change in SBP 12 hours after arrival was high; -98 (-112, -83) mmHg vs. low; -47 (-62, -25) mmHg (p < 0.01) with a percent change in 12 hour SBP of 41% vs. 25%, p < 0.01. Significance persisted at 18 and 24 hours after arrival. Both groups had a mean (SD) of 7 (4) radiographic images obtained during admission. The median (IQR) time to detection of ischemia was high; 2.8 (1.4, 5.7) days vs. low; 3.1 (1.2, 6.6) days, p = 0.6. Presence of ischemic insults did not differ in the regression model based on presenting SBP groups [HR 0.57 (0.25, 1.3) p = 0.81] or percent change in SBP > or < 25% at 24 hours [HR 0.83 (0.41, 1.69) p = 0.61]. Poor neurologic outcome at discharge was present in high; 82% vs. low; 69% of patients (p = 0.07). Higher admission ICH score (p < 0.01) and NIHSS (p < 0.01) was associated with a poor outcome in the regression model. Conclusions: These results suggest there was no difference in the development of ischemic changes based on presenting SBP or percent change in the SBP. Poor neurologic outcome was associated with higher NIHSS and ICH score on admission in the analysis. These results will need to be confirmed in a randomized study.

Prehospital Blood Pressure and Clinical and Radiological Outcomes in Acute Spontaneous Intracerebral Hemorrhage.

High blood pressure (BP) is associated with poor outcome in acute spontaneous intracerebral hemorrhage. Little is known about the predictive value of prehospital BP in intracerebral hemorrhage. We aimed to investigate the relationship between prehospital BP and clinical and radiological outcomes. This is a retrospective, hospital-based study of all adult intracerebral hemorrhage patients admitted within 24 hours of symptom onset to a large primary stroke centre during 2012 to 2019. The first prehospital and on-admission BP were recorded as systolic BP, diastolic BP, mean arterial pressure, and pulse pressure. The absolute differences between prehospital and on-admission BP were calculated (BPchange). Primary outcomes were in-hospital death, early neurological deterioration, and hematoma expansion. Associations between prehospital BP, BPchange, and outcomes were explored by regression with adjustment for relevant confounders. We included 426 patients aged median 76 (interquartile range 67-85) years and 203 (48%) were female. Median prehospital systolic BP was 179 (interquartile range 158-197) and diastolic BP was 100 (interquartile range 86-112) mm Hg. In-hospital death occurred in 121/426 (28%), early neurological deterioration in 107/295 (36%), and hematoma expansion in 50/185 (27%) patients. There were linear associations between 5 mm Hg increment of prehospital systolic BP (odds ratio 1.06, [95% CI, 1.01-1.12]) and mean arterial pressure (odds ratio 1.08, [95% CI, 1.01-1.15]) and in-hospital death, and between 5 mm Hg increment of prehospital diastolic BP (odds ratio 1.10, [95% CI, 1.00-1.21]) and mean arterial pressure (odds ratio 1.09, [95% CI, 1.00-1.18]) and hematoma expansion. There was a nonlinear association between prehospital systolic BP and in-hospital death. No consistent associations between prehospital BPchange and outcomes were found. In patients with acute intracerebral hemorrhage, elevated prehospital BP parameters were associated with in-hospital death and hematoma expansion. Changes in prehospital BP were not consistently associated with outcome. A possible U-shaped association between prehospital BP and in-hospital death needs further investigation.

413 ABO Blood Type and Thromboembolic Complications After Intracerebral Hemorrhage

INTRODUCTION: Thromboembolic complications (TECs) are preventable causes of morbidity and mortality in patients with intracerebral hemorrhage (ICH). METHODS: Consecutive adult ICH patients enrolled in the Intracerebral Hemorrhage Outcomes Project with available ABO blood type data were included. The primary analysis dichotomized patients by O blood type status (O versus non-O cohorts). The primary outcome was TEC, comprising pulmonary embolism, deep venous thrombosis, ischemic stroke, and myocardial infarction, during the hospital stay. Outcomes were compared between cohorts using multivariable regression and propensity score-matched analyses. A secondary analysis compared outcomes between individual non-type O (i.e., A, B, and AB) and type O blood phenotypes. RESULTS: Type O and non-type O cohorts comprised 269 and 244 patients, respectively. TECs were more common in the type O cohort compared to non-type O cohort (15.2% vs. 9.4%; OR = 1.728 [1.004-2.974], p = 0.048). In the propensity score-matched analysis, comprising 126 patients in each cohort, TEC rates were comparable between the two matched cohorts (13.5% vs. 11.1%; OR = 1.248 [0.586-2.654], p = 0.566). TEC rates were also comparable between individual non-type O and type O blood phenotypes in the secondary analysis. Type A blood phenotype was associated with a lower modified Rankin Scale score at 90 days in shift analysis (OR = 0.654 [0.434-0.985], p = 0.042). CONCLUSION: ABO blood phenotype does not appear to be associated with TECs after spontaneous ICH. Type A blood phenotype may be associated with a better 90-day functional outcomes after ICH. A multicenter, multiethnic ICH study capturing genetic and molecular patient data may help elucidate the potential role of blood phenotype in ICH pathophysiology.

Pharmacological Management of Spontaneous Intracerebral Hemorrhage in Older Adults

Pharmacological management of intracerebral hemorrhage in adult patients over 65 years of age requires special considerations due to differing clinical presentations, underlying organ dysfunction, and more complex medical histories and medication profiles. A literature review of articles focusing on the age-specific pharmacological management of intracerebral hemorrhage was conducted. Treatment approaches and clinical outcomes specific to older adults were evaluated and therapeutic considerations for this population are summarized. Older adults were commonly included in trials regarding reversal of anticoagulants and antiplatelet agents and these results are generalizable to older adults. Underlying organ dysfunction should frequently be considered throughout the treatment of intracerebral hemorrhage in older adults. Older adults with intracerebral hemorrhage should be managed similarly to younger adult patients; however, consideration of age-related comorbidities and physiological differences is critically important for optimizing patient care.

76352 Investigating the Association Between Intracerebral Hemorrhage (ICH) and Long-Term Encephalomalacia and Cortical Atrophy

ABSTRACT IMPACT: Investigating the relationship between ICH volume at presentation and cortical atrophy over time may help to explain the phenomenon of cognitive impairment after ICH. OBJECTIVES/GOALS: Non-traumatic intracerebral hemorrhage (ICH) is the most common type of hemorrhagic stroke. ICH causes both mechanical as well as oxidative injury leading to neurologic deterioration. However, the relationship between ICH volume and brain atrophy is not fully understood. To that end, we aimed to investigate this relationship. METHODS/STUDY POPULATION: A retrospective cohort of adult ICH patients over a 10-year study period were studied. Demographic data, ICH cause, location, laterality, and treatment, as well as other data, were collected. DICOM files of CT or MRI at presentation and all subsequent follow-up imaging up to 5-years post-ICH were obtained. Using a novel semi-automated image segmentation tool developed in MATLAB by our group, ICH volumes were segmented. Using T1w MRI data, ipsi- and contralateral brain volumes were segmented using NeuroQuant, a fully automated software for MRI volumetric processing, for both initial and follow-up MRIs. Ipsilateral and global cerebral volume changes over time were calculated using initial and follow-up MRI images. Spearman rank correlation between volume changes and ICH volumes were calculated for each patient. RESULTS/ANTICIPATED RESULTS: 75 spontaneous ICH patients with adequate imaging follow-up and both early and follow-up MRI comparisons were considered. Of these, 14 patients had MRIs adequate for segmentation by NeuroQuant. There was a positive correlation (R^2 = 0.72, p=0.03) between ABC/2, the traditional ICH volume measuring approach, and our semi-automatic segmentation tool, with ABC/2 tending to overestimate ICH volume. There was an average of -6.51% of total brain volume loss with respect to initial brain volume at follow-up. There was a negative correlation between ICH volume and both global (Spearman rank correlation coefficient (R)=-0.714, p=0.004)) and local atrophy (R=-0.785, p=0.0009), meaning that as ICH volume increases, there is greater brain volume loss. DISCUSSION/SIGNIFICANCE OF FINDINGS: Greater ICH volume is associated with greater brain volume loss both ipsilaterally, reflected as encephalomalacia, and globally. These findings are important as encephalomalacia can result in focal neurologic deficit and other neurological symptoms over time, while global brain atrophy is associated with dementia and cognitive decline.

Epidemiology of Intra-Cerebral Hemorrhage in Young Adult Patients

Introduction: This study aimed to define the CT scan imaging of young adult intracerebral hemorrhage (ICH) patients in Dr. Soetomo General Hospital, Surabaya.Methods: This was an observational descriptive study. The data were collected retrospectively with medical records of 18 to 45 years old ICH patients who were treated in Dr. Soetomo General Hospital, Surabaya between 2014 and 2017. The collected data were then presented into tables.Results: 207 patients were identified in this study. The locations of the ICH were basal ganglia (45.89%), lobar (41.55%), thalamus (10.63%), brainstem (8.7%), cerebellum (4.83%), and others (3.86%). The volume of ICH varied from less than 30 cc (66.67%), 30 to 59 cc (27.54%), and more than 60 cc (5.8%). Conclusion: The CT scan imaging of young adults ICH mainly had hematoma volume less than 30 cc and was mostly located in basal ganglia area then followed by lobar area.

Moyamoya disease with hemorrhagic stroke in a Nepalese woman

The authors report a case of Moyamoya disease in a middle aged Nepali female. Though the disease is common in other parts of Asia only one case has been reported previously from Nepal. It should be suspected as a rare cause for spontaneous intracerebral hemorrhage in adults.

History of Nonsteroidal Anti-inflammatory Drug Use and Functional Outcomes After Spontaneous Intracerebral Hemorrhage.

Preclinical and clinical studies have suggested a potential benefit from COX-2 inhibition on secondary injury activation after spontaneous intracerebral hemorrhage (ICH). The aim of this study was to investigate the effect of pre-admission NSAID use on functional recovery in spontaneous ICH patients. Consecutive adult ICH patients enrolled in the Intracerebral Hemorrhage Outcomes Project (2009-2018) with available 90-day follow-up data were included. Patients were categorized as NSAID (daily COX inhibitor use ≤ 7days prior to ICH) and non-NSAID users (no daily COX inhibitor use ≤ 7days prior to ICH). Primary outcome was the ordinal 90-day modified Rankin Scale (mRS) score. Outcomes were compared between cohorts using multivariable regression and propensity score-matched analyses. A secondary analysis excluding aspirin users was performed. The NSAID and non-NSAID cohorts comprised 228 and 361 patients, respectively. After 1:1 matching, the matched cohorts each comprised 140 patients. The 90-day mRS were comparable between the NSAID and non-NSAID cohorts in both the unmatched (aOR = 0.914 [0.626-1.336], p = 0.644) and matched (aOR = 0.650 [0.392-1.080], p = 0.097) analyses. The likelihood of recurrent ICH at 90days was also comparable between the NSAID and non-NSAID cohorts in both the unmatched (aOR = 0.845 [0.359-1.992], p = 0.701) and matched analyses (aOR = 0.732 [0.241-2.220], p = 0.581). In the secondary analysis, the non-aspirin NSAID and non-NSAID cohorts comprised 38 and 361 patients, respectively. After 1:1 matching, the matched cohorts each comprised 38 patients. The 90-day mRS were comparable between the non-aspirin NSAID and non-NSAID cohorts in both the unmatched (aOR = 0.615 [0.343-1.101], p = 0.102) and matched (aOR = 0.525 [0.219-1.254], p = 0.147) analyses. The likelihood of recurrent ICH at 90days was also comparable between the non-aspirin NSAID and non-NSAID cohorts in both the unmatched (aOR = 2.644 [0.258-27.091], p = 0.413) and matched (aOR = 2.586 [0.228-29.309], p = 0.443) analyses. After the exclusion of patients with DNR or withdrawal of care status, NSAID use was associated with lower mRS at 90days (aOR = 0.379 [0.212-0.679], p = 0.001), lower mRS at hospital discharge (aOR = 0.505 [0.278-0.919], p = 0.025) and lower 90-day mortality rates (aOR = 0.309 [0.108-0.877], p = 0.027). History of nonselective COX inhibition may affect functional outcomes in ICH patients. Pre-admission NSAID use did not appear to worsen the severity of presenting ICH or increase the risk of recurrent ICH. Additional clinical studies may be warranted to investigate the effects of pre-admission NSAID use on ICH outcomes.

Von Willebrand factor, ABO blood group, and risk of first-ever intracerebral hemorrhage: A prospective nested case-control study

Background and purposeLow levels of von Willebrand factor (VWF) were associated with intracerebral hemorrhage (ICH) in a previous study. Persons with blood group O have lower VWF levels than other ABO blood groups. This study aimed to investigate the association between VWF and the risk of ICH in adults, as well as the association between ABO blood group and risk of ICH. MethodsThis population-based, nested case-control study was conducted using data and blood samples from health examinations between 1985 and 2007. All participants were followed, and cases with first-ever ICH were identified and validated. One or two controls were matched to each case. ResultsDuring a median follow-up time from blood sampling to ICH of 5.6 years, 176 cases with ICH were identified. The mean age at health examination was 57 years; 50% of participants were women. There was an association between hypertension and risk of ICH, but there was no association between VWF level and risk of ICH. There was no association between blood group O and risk of ICH. ConclusionsTo our knowledge this is the largest prospective study investigating the association between VWF, ABO blood group and ICH. We found no association between VWF or blood group O and risk of future ICH.

Spontaneous Intracerebral Hemorrhage.

Background and Purpose- We compared clinical and radiological predictors of long-term mortality in patients with spontaneous intracerebral hemorrhage (ICH) needing intensive care. Methods- A retrospective multicenter study of adult ICH patients treated in Finnish tertiary hospital's intensive care units during 2003 to 2013. We created 3 multivariable models (clinical, radiological, and combined clinical-radiological) for 12-month mortality prediction and compared their areas under receiver operating characteristic curves (AUCs). We analyzed supratentorial and infratentorial ICHs separately. Results- Of 972 patients (796 supratentorial ICH, 176 infratentorial ICH) included, 43% died within 12 months (42% supratentorial ICH, 49% infratentorial ICH). For all patients, the clinical model (AUC, 0.83; 95% CI, 0.81-0.86) outperformed the radiological model (AUC, 0.73; 95% CI, 0.70-0.77; P<0.001), yet the combined model (AUC, 0.85; 95% CI, 0.83-0.88) outperformed both condensed models (P<0.001). For supratentorial ICH, the combined model outperformed both the clinical and radiological models (AUC, 0.84; 95% CI, 0.81-0.87 versus AUC, 0.82; 95% CI, 0.79-0.85 and AUC, 0.73; 95% CI, 0.69-0.77; P<0.001 for all). For infratentorial ICH patients, the combined model significantly outperformed the radiological model but not the clinical model (AUC, 0.92; 95% CI, 0.88-0.96 versus AUC, 0.76; 95% CI, 0.69-0.83 versus AUC, 0.91; 95% CI, 0.87-0.95; P<0.001 and P=0.433, respectively). Conclusions- Clinical factors were more important than objective radiological factors for 12-month mortality prediction in intensive care unit-treated ICH patients. The effect of clinical and radiological factors on outcome was different for supratentorial and infratentorial ICHs stressing that these should not be treated as one entity.

Trends in the Incidence and Treatment of Cerebrovascular Diseases in Korea : Part I. Intracranial Aneurysm, Intracerebral Hemorrhage, and Arteriovenous Malformation.

ObjectiveTo analyze the incidence and treatment trends of hemorrhagic stroke (HS), according to HS subtypes, using nationwide data in Korea from January 2008 to December 2016. MethodsWe used data from the national health-claim database provided by the National Health Insurance Service for 2008–2016 using the International Classification of Diseases. The crude incidence and age-standardized incidence of each disease associated with HS, which included intracranial aneurysm (IA), hypertensive intracerebral hemorrhage (ICH), and arteriovenous malformation (AVM), were calculated and additional analysis was conducted according to age and sex. Changes in trends in treatment methods and number of treatments were analyzed for each cerebrovascular disease using the Korean Classification of Diseases procedure codes. ResultsIn 2016, the total number of newly diagnosed adult patients with HS was 24169, showing a decrease by 7.0% since 2008; the age-standardized incidence of HS was 46.2 per 100000 person-years. The age-standardized incidence of unruptured IA (UIA) in adults was 71.4 per 100000 person-years—increased by 2.6-fold since 2008—while that of ruptured IA (RIA) was 12.6 per 100000 person-years, which had decreased at a rate of 20.3% since 2008. The number of coil embolization (CE) for UIA increased by 3.4-fold over 9 years and exceeded that of clipping since 2008. With respect to RIA, CE increased by 2.0-fold over 9 years and exceeded that of clipping from 2014. As for spontaneous ICH in adults, the age-standardized incidence was 31.3 per 100000 person-years in 2016—decreased by 34.7% since 2008—and 14.6% of patients diagnosed with ICH were treated in 2016, which was not significantly different from the proportion of patients treated since 2008. The age-standardized incidence of unruptured AVM (UAVM) was 2.0 per 100000 person-year in 2016, while that of ruptured AVM (RAVM) was 2.4 per 100000 person-years in 2016, showing a decreasing rate of 17.2% from 2008. The total number of treated patients with AVM declined since 2014. ConclusionIn Korea, age-related cerebral vascular diseases, such as RIA, ICH, and RAVM, demonstrated a declining trend in agestandardized incidence; meanwhile, UIA and UAVM demonstrated an increased trend in both crude incidence and age-standardized incidence for 9 years. The increase in the elderly population, management of hypertension, and development of diagnostic and endovascular techniques appear to have influenced this trend.

Obesity Paradox in Intracerebral Hemorrhage.

Background and Purpose- Although obesity is an established risk factor for cardiovascular disease and stroke, studies have shown evidence of an obesity paradox-a protective effect of obesity in patients who already have these disease states. Data on the obesity paradox in intracerebral hemorrhage is limited. Methods- Clinical data for adult intracerebral hemorrhage patients were extracted from the National Inpatient Sample between 2007 and 2014. Multivariable logistic regression analyzed the association of body habitus with in-hospital mortality, discharge disposition, length of stay, tracheostomy or gastrostomy placement, and ventriculoperitoneal shunt placement. Results- There were 99 212 patients who were eligible. Patients with both obesity (OR=0.69; 95% CI=0.62-0.76; P<0.001) and morbid obesity (OR=0.85; 95% CI=0.74-0.97; P=0.02) were associated with decreased odds of in-hospital mortality. Morbid obesity was significantly associated with increased odds of a tracheostomy or gastrostomy placement (OR=1.42; 1.20-1.69; P<0.001) and decreased odds of a routine discharge disposition (OR=0.84; 0.74-0.97; P=0.014). Conclusions- Obesity and morbid obesity appear to protect against mortality in intracerebral hemorrhage.

Early Life Body Size in Relation to First Intracerebral or Subarachnoid Hemorrhage.

Background and PurposeAs risk of hemorrhagic stroke may have early life origins, we investigated associations of birth weight and childhood body mass index (BMI) with adult intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH). MethodsWe included 240,234 Danish schoolchildren, born 1936 to 1989, with information on birth weight and measured weights and heights from 7 to 13 years. We calculated hazard ratios (HRs) and confidence intervals (CIs) for the associations between early life anthropometrics and ICH or SAH, identified through linkage with national registers. ResultsDuring the study period, 1,947 individuals (39% women) experienced an ICH and 797 individuals (64% women) experienced a SAH. Per 500 g increase in birth weight, women had a 10% decreased risk of SAH (HR, 0.90; 95% CI, 0.83 to 0.97) and men had a 10% decreased risk of ICH (HR, 0.90; 95% CI, 0.85 to 0.95). Birth weight was not associated with risks of ICH in women or SAH in men. In men, a childhood BMI below average (BMI z-score <0) was associated with increased risks of ICH. The association was stronger at older childhood ages, and at 13 years a BMI z-score of –1 was associated with a HR of 1.17 (95% CI, 1.06 to 1.28), and a BMI z-score of –2 with a HR of 1.46 (95% CI, 1.17 to 1.82) for ICH. Childhood BMI was not associated with risks of ICH in women or with risks of SAH in both sexes. ConclusionsEarly life body size is associated with ICH and SAH, and the associations differ by sex.

Bedsided Transcranial Sonographic Monitoring for Expansion and Progression of Subdural Hematoma Compared to Computed Tomography.

Transcranial high-resolution ultrasonography reliably allows diagnosis and monitoring of intracerebral hemorrhage in adults. Sonographic monitoring of subdural hematoma (SDH) has not been evaluated in adults so far. This study investigates the reliability of transcranial gray-scale sonography (TGS) in monitoring acute and chronic SDH in adults. TGS was performed in 47 consecutive patients with either acute or chronic SDH confirmed by cerebral CT. Four patients were excluded due to insufficient bone window. After identification of SDH in TGS extent was measured and correlated with extent of SDH on cerebral computer tomography (CCT). If possible measurement was performed at least on 2 days to evaluate the possibility to monitor SDH with TGS. In 43 patients with SDH, 76 examinations were performed with 2 examinations in 23 patients and 3 examinations in 10 patients. Overall extent of SDH correlated significantly between TGS and CCT (r = 0.962). Accordingly correlation was high during each single examination time point. In patients in need for surgical evacuation sonographic measurement yielded a sensitivity of 90.9% and specificity of 93.8% in predicting surgical evacuation (p < 0.001). Imaging of SDH with TGS is possible in patients with SDH and extent of SDH correlates significantly between TGS and CCT during initial as well as during follow-up examination. Thus monitoring of SDH with TGS at patients' bedside is possible.

Abstract TP334: Sex and Racial Disparities in Mortality for Patients With Intracerebral Hemorrhage

Introduction: Women and minorities are reported to have worse outcomes and higher in-hospital mortality (IHM) after ischemic stroke. However, sex and racial differences for IHM after intracerebral hemorrhage (ICH) are still uncertain. Methods: Using administrative data on all discharges from acute care hospitals in California (2005-2011) and Florida (2005-2014), we identified adult ICH patients (ICD-9 Code 431). We excluded patients who had a diagnosis of subarachnoid hemorrhage, arteriovenous malformation, trauma, or ischemic stroke. Logistic regression models were used to assess factors associated with IHM. We report odds ratios and 95% CIs. Results: Among 82,613 ICH patients, 40,124 (48.7%) were female. Median (IQR) age was 72 (58-82), 14% were black, and 15% were Hispanic. In univariate analysis, females were older (OR 1.37, CI 1.29-1.45, age&gt;60), had fewer extraventricular drains (EVD, OR 0.83, CI 0.74-0.95), and were less often intubated (OR 0.86, CI 0.84-0.89). Blacks had more EVDs (OR 2.5, CI 2.14-2.89), hemicraniectomys (OR 1.40, CI 1.12-1.75), and intubations (OR 1.55, CI 1.48-1.62) than whites. Hispanics were also intubated more often than whites (OR 1.19, CI 1.14-1.24). IHM rate was 24.2%. In univariate analysis, IHM was associated with female sex (OR 1.06, CI 1.03-1.10), age &gt; 45 (OR 1.24, CI 1.14-1.34), black vs white race (OR 0.81, CI 0.77-0.85), Hispanic vs white race (OR 0.80, CI 0.76-0.84), history of hypertension (OR 0.85, CI 0.82-0.88), obesity (OR 0.71, CI 0.67-0.76), use of EVD (OR 1.48, CI 1.29-1.69), and intubation (OR 11.6, CI 11.2-12.0). In multivariate analysis, women were more likely to suffer IHM (OR 1.09, CI 1.05-1.13) and minorities were less likely to suffer IHM (OR 0.74, CI 0.70-0.79, black, and OR 0.70, CI 0.66-0.74, Hispanic) after adjusting for age, hypertension, obesity, use of EVD and hemicraniectomy. Conclusions: In this large real-world cohort of ICH patients, female sex was associated with increased IHM, while black and Hispanic race were associated with lower rates of IHM compared to whites. These findings suggest disparities in the severity of this disease in these groups, or in the type of care provided to them.

Spontaneous cerebral haemorrhage in a young weight lifter: A case report and a review of current literature

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Electroacupuncture improves neurobehavioral function and brain injury in rat model of intracerebral hemorrhage.

Acupuncture has been widely used as a treatment for stroke in China for a long time. Recently, studies have demonstrated that electroacupuncture (EA) can accelerate intracerebral hemorrhage (ICH)-induced angiogenesis in rats. In the present study, we investigated the effect of EA on neurobehavioral function and brain injury in ICH rats. ICH was induced by stereotactic injection of collagenase type I and heparin into the right caudate putamen. Adult ICH rats were randomly divided into the following three groups: model control group (MC), EA at non-acupoint points group (non-acupoint EA) and EA at Baihui and Dazhui acupoints group (EA). The neurobehavioral deficits of ICH rats were assessed by modified neurological severity score (mNSS) and gait analysis. The hemorrhage volume and glucose metabolism of hemorrhagic foci were detected by PET/CT. The expression levels of MBP, NSE and S100-B proteins in serum were tested by ELISA. The histopathological features were examined by haematoxylin-eosin (H&E) staining. Apoptosis-associated proteins in the perihematomal region were observed by immunohistochemistry. EA treatment significantly promoted the recovery of neurobehavioral function in ICH rats. Hemorrhage volume reduced in EA group at day 14 when compared with MC and non-acupoint EA groups. ELISA showed that the levels of MBP, NSE and S100-B in serum were all down-regulated by EA treatment. The brain tissue of ICH rat in the EA group was more intact and compact than that in the MC and non-acupoint groups. In the perihematomal regions, the expression of Bcl-2 protein increased and expressions of Caspase-3 and Bax proteins decreased in the EA group vs MC and non-acupoint EA groups. Our data suggest that EA treatment can improve neurobehavioral function and brain injury, which were likely connected with the absorption of hematoma and regulation of apoptosis-related proteins.