Basal Ganglia Intracerebral Hemorrhage Research Articles

Abstract T MP67: Different Hematoma Volume Threshold to Predict Favorable Outcome in Basal Ganglia and Thalamic Hemorrhage

Background and Purpose: Hematoma volume is the strongest predictor of outcome in intracerebral hemorrhage (ICH). Historically, basal ganglia (BG) and thalamic ICH have been aggregated as “deep” ICH in the prior studies. We assessed whether BG and thalamic ICH have different hematoma volume threshold that is associated with 3-month functional outcome. Design/Methods: From a prospective observational cohort study of ICH patients between July 2011 and May 2014, we compared the hematoma volume of groups that achieved favorable outcome (modified Rankin Scale of 0-2) and unfavorable outcome (modified Rankin Scale of 3-6) at 3 months in BG and thalamic ICH patients. Based on the hematoma size analyses, four different ICH Score models were tested for their accuracy in predicting favorable 3-month outcome, using each component of the original ICH Score except for the hematoma size threshold: ≥30 mL (model 1), ≥15 mL (model 2), ≥10 mL (model 3), and ≥5 mL (model 4). Results: A total of 108 deep ICH patients (60 BG, 48 thalamic) with available 3-month outcome data were studied. For BG ICH, median hematoma volume for favorable outcome group was 10.7 mL [6.2-14.4] and unfavorable outcome group was 40.1 mL [21.0-86.3] (p<0.001). For thalamic ICH, median hematoma volume for favorable outcome group was 2.7 mL [1.2-9.9] and unfavorable outcome group was 9.8 mL [5.4-20.4] (p=0.002). For BG ICH, an area under the ROC curve for the different models of ICH Score was 0.85 (model 1), 0.88 (model 2), 0.84 (model 3), and 0.80 (model 4). For thalamic ICH, an area under the ROC curve was 0.86 (model 1), 0.87 (model 2), 0.85 (model 3), and 0.89 (model 4). Conclusions: Basal ganglia and thalamic ICH have different hematoma volume threshold that is associated with favorable 3-month outcome. Hematoma volume threshold of 15 mL for BG ICH and 5 mL for thalamic ICH may enhance the ICH Score for predicting favorable functional outcome.

Transsylvian-Transinsular Approach for Deep-Seated Basal Ganglia Hemorrhage: An Experience at a Single Institution

ObjectiveTreatment of spontaneous intracerebral hemorrhage (ICH) remains controversial. However, an extensive hemorrhage with a poor mental status is suitable for surgical evacuation. Our experience with the transsylvian-transinsular (TS-TI) microsurgical approach for deep-seated basal ganglia (BG) ICH was investigated.Material and MethodsA retrospective review was conducted on 86 patients with BG ICH who underwent an operation at the Department of Neurosurgery of our Hospital from September 2011 to October 2014. Thirteen patients underwent craniotomy and the TS-TI microsurgical approach for hematoma evacuation. Twenty-seven patients underwent conventional craniotomy with the trans-cortical transtemporal (TC-TT) approach, and 46 patients underwent a burrhole operation and hematoma drainage using a frameless stereotaxic device (ST).ResultsThe average age distribution was similar. The preoperative Glasgow coma scale (GCS) was similar for the TC-TT and TS-TI groups. The pre-operative hematoma levels were higher in the TC-TT (109.4 ± 48.6 mL) and TS-TI (96.0 ± 39.0 mL) groups than in the ST group (46.5 ± 23.5 mL). The hematoma removal rate was 77% in the TC-TT group, 88% in the TS-TI group, and 34% in the ST group. The mean maintenance period of a hematoma catheter was 3.6 days in the ST group. The clinical outcome showed correlation with the preoperative neurological symptoms.ConclusionThe TS-TI group was superior to the TC-TT group for evacuation of an intracerebral hematoma.

Modeling the pattern of contrast extravasation in acute intracerebral hemorrhage using dynamic contrast-enhanced MR.

Contrast extravasation (CE) in spontaneous intracerebral hemorrhage (ICH), coined the spot sign, predicts hematoma expansion (HE) and poor clinical outcome. The dynamic relationship between CE and the mode of ICH growth are poorly understood. We characterized the in vivo pattern and rate of HE using a novel animal model of acute ICH. Basal ganglia ICH was created in 14 Yorkshire swine utilizing a novel MRI integrated model, permitting real-time CE observation using dynamic contrast-enhanced (DCE) MRI. Computerized planimetry measured CE volume at each time point. Spatial vector analysis along three orthogonal axes determined distance vectors. Maximizing and minimizing the coefficient of determination defined the temporal phases of growth and stability, respectively. CE rate was calculated using a Patlak model. Asymmetric growth and variable rates of expansion characterized HE defining three distinct growth phases and patterns. A primary growth phase (duration 160 s; IQR 50-130) demonstrated rapid linear growth (0.04 mm/s IQR 0.01-0.10) accounting for 85 ± 15 % of total HE. The stationary phase demonstrated stability (duration 145 s; IQR 0-655). A secondary growth phase (duration 300; 130-600 s) accounted for 23 ± 8 % of total HE. In the primary and secondary growth phase, asymmetric growth occurred in the anterior-posterior (AP) planes (0.056 mm/s; p = 0.026 and 0.0112 mm/s; p = 0.03). Monophasic 2 (14 %), biphasic 4 (35 %) (primary followed by secondary growth), and triphasic 8 (56 %) patterns (primary, stationary, and secondary growth phase) were observed. A novel model of ICH provides real-time study of the dynamics and rate of CE. This data facilitates the understanding of pattern and rate of ICH formation.

Successful Management of Reversible Cerebral Vasoconstriction Syndrome-Induced Intracerebral Hemorrhage with Minimally Invasive Surgery Plus Recombinant Tissue-Type Plasminogen Activator

Background: Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headaches associated with radiographic evidence of reversible segmental vasoconstriction of cerebral arteries. RCVS is associated with both ischemic and hemorrhagic strokes. Methods: We present a case of probable RCVS with intracerebral hemorrhage (ICH) in the setting of antidepressant medication use that was successfully managed with minimally invasive surgery plus intra-hematomal delivery of recombinant tissue plasminogen activator (rtPA). Results: A 45-year-old woman underwent an elective repair of a left superior semicircular canal dehiscence. On postoperative day 3 she developed a severe headache followed by acute onset of left face and body hemiparesis. Head computed tomography (CT) showed a large acute ICH in the right basal ganglia. Due to concern for impending cerebral herniation, the patient underwent stereotactic aspiration of ICH and placement of an indwelling catheter for intra-hematomal delivery of rtPA. Seven doses of 1 mg rtPA were administered via the intraparechymal catheter with significant clot reduction. Repeat cerebral angiogram showed arterial beading in both the anterior and posterior circulation. Conclusion: RCVS is an important diagnosis to consider in cases of ICH without identifiable cause even when initial angiography is normal. In severe cases, secondary management of ICH plays an important role, including minimally invasive surgical intervention to reduce clot volume and minimize perihematomal edema.

Abstract W P248: Cerebral Tissue Iron Quantification on MRI Following Intracerebral Hemorrhage

Purpose: Intracerebral hemorrhage (ICH) is a fatal subtype of Hemorrhagic stroke. Tissue iron at the periphery of ICH has been demonstrated to be neurotoxic in animal models. No robust method to quantify tissue iron following ICH currently exists. Our aim is to determine a robust algorithm based on MRI to quantify tissue iron in the wake of ICH. Methods: Following Institutional review board approval we constructed an MRI phantom. Eight 4 cc vials with 50 % decreasing dilutions of Ferraheme (iron for IV therapy) were prepared starting from 0.6 mg/ml ending at 0.005 mg/ml. The vials were stuck to the undersurface of the lid of a water bath container and scanned in a 3T MRI with T2* sequences. The T2* signal magnitudes were calculated for each concentration. Subsequently a human control brain and two patients with left basal ganglia ICH were scanned with identical parameters. The T2* signal magnitude was calculated at 3 ROIs at the periphery of the ICH. Results: The R2* maps demonstrated a near linear correlation with the iron concentration in the phantom. The control T2* signal magnitude corresponded to 0.01 mg/ml iron concentration. The two patients on ICH day 7 had measurements of iron concentration of 0.04 mg/ml (4 x baseline) at the periphery of the hematoma. This corresponds favorably to a threefold increase in measured tissue iron levels in animal ICH model studies. Conclusion: Our experiment demonstrates that quantitative susceptibility measurements on MRI may be a robust technique to assess iron level in brain tissue following ICH. Encouraged by the results we have applied to the NIH (#GRANT11426089) for funding to be able to evaluate the validity of the algorithm. Tissue iron quantification by MRI may assist in judging severity of ICH and act as a surrogate marker for assessing treatment with iron chelator.

Sonography of the optic nerve sheath beyond the hyperacute stage of intracerebral hemorrhage.

To evaluate the feasibility and utility of serial measuring of the optic nerve sheath diameter beyond the hyperacute and acute stage of intracerebral hemorrhage (ICH). Four patients with extensive ICH in the left basal ganglia were followed using ultrasound (US) and cerebral CT scans. Optic nerve sheath diameter values assessed beyond the acute stage of ICH showed a high correlation (ρ=0.84, p=0.0022) with midline shift of the third ventricle seen on CT scans. Optic nerve sonography can be useful to evaluate patients with extensive ICH beyond the acute stage and help monitoring clinical evolution in these patients, when ICP monitoring is not feasible.

Parinaud's Syndrome after Right Thalamic and Basal Ganglia Intracerebral Hemorrhage: A Case Report

PM&RVolume 5, Issue 9S p. S250-S250 Neurological Rehabilitation Parinaud's Syndrome after Right Thalamic and Basal Ganglia Intracerebral Hemorrhage: A Case Report Joanna Reusser DO, Joanna Reusser DO University Cincinnati Medical Center, Cincinnati, OH, United StatesSearch for more papers by this authorMaria Humayun DO, Maria Humayun DO University Cincinnati Medical Center, Cincinnati, OH, United StatesSearch for more papers by this authorMark J. Goddard MD, Mark J. Goddard MD University Cincinnati Medical Center, Cincinnati, OH, United StatesSearch for more papers by this author Joanna Reusser DO, Joanna Reusser DO University Cincinnati Medical Center, Cincinnati, OH, United StatesSearch for more papers by this authorMaria Humayun DO, Maria Humayun DO University Cincinnati Medical Center, Cincinnati, OH, United StatesSearch for more papers by this authorMark J. Goddard MD, Mark J. Goddard MD University Cincinnati Medical Center, Cincinnati, OH, United StatesSearch for more papers by this author First published: 17 September 2013 https://doi.org/10.1016/j.pmrj.2013.08.412Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume5, Issue9SSeptember 2013Pages S250-S250 RelatedInformation

A clinical comparison of endoscopic surgery versus craniotomy in hypertensive basal ganglia intracerebral hemorrhage

Objective To compare the clinical effects and characteristics between hypertensive intracerebral hemorrhage (HICH) and haematoma clearance by craniotomy for basal ganglia.Methods Clinical data of 50 patients with HICH in basal ganglia were collected,including operation duration,amount of intraoperative bleeding,cleared amount of haematoma,postoperative intracranial infection,and GOS at the sixth month after operation.The patients were divided into endoscopic group and craniotomy group.Clinical effects were analyzed by using GOS at the sixth month as a prognosis index.Results Preoperatively,the two groups showed no significant difference in any type of clinical materials(all P ＞ 0.05).Operation durations were (1.5 ± 0.8) h and (3.5 ± 1.1) h (P ＜ 0.05),respectively; amounts of intraoperative bleeding were (40.0 ± 19.7) rnl and (40.6 ± 13.2) ml (P ＜ 0.05),respectively; clearance rates of haematoma were (92.6 ± 9.4) ％ and (73.1 ± 21.1) ％ (P ＜ 0.05),respectively; cases of postoperative intracranial infections were 0 and 3 (P ＜ 0.05),respectively,for the endoscopy group and the craniotomy group.GOS prognosis at 6 months showed 7 cases of good recovery,12 cases of slight disability,2 cases of severe disability,1 case of vegetative state,and 1 death in the endoscopy group;6 cases of good recovery,9 cases of slight disability,6 cases of severe disability,3 case of vegetative state,and 1 death in the craniotomy group.Prognosis was better in the endoscopy group than in the craniotomy group(P ＜ 0.05).Conclusion Endoscopic surgery is an efficient and minimally invasive and operating technique for the treatment of hypertensive basal ganglia intracerebral hemorrhage. Key words: Intracranial hemorrhage, hypertensive; Neurosurgical procedures ; Minimally invasive; Removal

The correlation between lateralization of intracerebral hemorrhage in basal ganglia and handedness

To investigate the correlation between lateralization of cerebral basal ganglia hemorrhage and handedness. Medical records and computed tomography (CT) scans for 84 patients with primary hypertensive intracerebral hemorrhage (ICH) in basal ganglia were reviewed. Data of gender, age, handedness, and location of basal ganglia hematoma were statistically analyzed. Data of age, gender, handedness, health condition, and mean blood flow velocity (BFV) in middle cerebral arteries (MCAs) and anterior cerebral arteries (ACAs) on both sides of 114 healthy individuals were statistically analyzed. We found out that the patients with right basal ganglia hemorrhage were mostly left-handed, while patients with left basal ganglia hemorrhage were mostly right handed (p=0.021, r=0.251). And the mean BFV in the right MCAs of left-handed ones are relatively higher, the mean BFV in the left MCAs of right-handers are relatively higher (p=0.008, r=0.248). There 's a correlation between lateralization of cerebral basal ganglia hemorrhage and handedness.

Dynamic cerebral autoregulation after intracerebral hemorrhage: A case-control study

BackgroundDynamic cerebral autoregulation after intracerebral hemorrhage (ICH) remains poorly understood. We performed a case-control study to compare dynamic autoregulation between ICH patients and healthy controls.MethodsTwenty-one patients (66 ± 15 years) with early (< 72 hours) lobar or basal ganglia ICH were prospectively studied and compared to twenty-three age-matched controls (65 ± 9 years). Continuous measures of mean flow velocity (MFV) in the middle cerebral artery and mean arterial blood pressure (MAP) were obtained over 5 min. Cerebrovascular resistance index (CVRi) was calculated as the ratio of MAP to MFV. Dynamic cerebral autoregulation was assessed using transfer function analysis of spontaneous MAP and MFV oscillations in the low (0.03-0.15 Hz) and high (0.15-0.5 Hz) frequency ranges.ResultsThe ICH group demonstrated higher CVRi compared to controls (ipsilateral: 1.91 ± 1.01 mmHg·s·cm-1, p = 0.04; contralateral: 2.01 ± 1.24 mmHg·s·cm-1, p = 0.04; vs. control: 1.42 ± 0.45 mmHg·s·cm-1). The ICH group had higher gains than controls in the low (ipsilateral: 1.33 ± 0.58%/mmHg, p = 0.0005; contralateral: 1.47 ± 0.98%/mmHg, p = 0.004; vs. control: 0.82 ± 0.30%/mmHg) and high (ipsilateral: 2.11 ± 1.31%/mmHg, p < 0.0001; contralateral: 2.14 ± 1.49%/mmHg, p < 0.0001; vs. control: 0.66 ± 0.26%/mmHg) frequency ranges. The ICH group also had higher coherence in the contralateral hemisphere than the control (ICH contralateral: 0.53 ± 0.38, p = 0.02; vs. control: 0.38 ± 0.15) in the high frequency range.ConclusionsPatients with ICH had higher gains in a wide range of frequency ranges compared to controls. These findings suggest that dynamic cerebral autoregulation may be less effective in the early days after ICH. Further study is needed to determine the relationship between hematoma size and severity of autoregulation impairment.

A double-injection model of intracerebral hemorrhage in rabbits

We aimed to develop a double-injection model of intracerebral hemorrhage (ICH) in rabbits and to evaluate it as a tool for investigating post-ICH brain injury. Rabbits were injected with 300 μL fresh autologous whole blood into the right basal ganglia. Behavioral changes were rated, brain water content (BWC) was measured and brain tissue morphology was also examined. ICH was established in 93.5% of the blood injection group. At 1, 3 and 7 days after ICH, there were significant differences in the total neurological scores ( p < 0.01) and BWC ( p < 0.01) between a sham-operated group and the ICH group. These findings suggest that the model produces a persistent neurological deficit, hematoma volume and perihematomal edema and closely mimics human hypertensive basal ganglia ICH; it is a controllable and reproducible hematoma that lends itself to quantitative investigation.