Prognosis Of Spontaneous Intracerebral Hemorrhage Research Articles

Prognostic significance of the stress hyperglycemia ratio and admission blood glucose in diabetic and nondiabetic patients with spontaneous intracerebral hemorrhage

BackgroundThe role of stress hyperglycemia ratio (SHR) on the prognosis of spontaneous intracerebral hemorrhage (ICH) in patients with different diabetic status has not been elucidated. This study aimed to evaluate the prognostic value of SHR and admission blood glucose (ABG) for the short- and long-term mortality in diabetic and nondiabetic populations with ICH.MethodParticipants with ICH were retrospectively retrieved from the Medical Information Mart for Intensive Care (MIMIC-IV). The primary outcome was all-cause 30-day and 1-year mortality. The association of SHR and ABG with the primary outcomes in diabetic and nondiabetic cohorts were assessed by Cox proportional hazard regression.ResultsOverall, 1029 patients with a median age of 71.09 (IQR: 60.05–81.97) were included. Among them, 548 (53%) individuals were male, and 95 (19%) as well as 323 (31%) ones experienced the 30-day and 1-year mortality, respectively. After adjusting for confounding variables, individuals in quintile 5 of SHR had significantly higher risk of the 30-day and 1-year mortality than those in quintile 1 in the whole cohort (30-day mortality: HR 3.33, 95%CI 2.01–5.51; 1-year mortality: HR 2.09, 95% CI 1.46-3.00) and in nondiabetic patients (30-day mortality: HR 4.55, 95%CI 2.33–8.88; 1-year mortality: HR 3.06, 95%CI 1.93–4.86), but no significant difference was observed in diabetic patients. Similar results were observed for ABG as a categorical variable. As continuous variable, SHR was independently correlated with the 30-day and 1-year mortality in both of the diabetic and nondiabetic cohorts (30-day mortality: HR 2.63, 95%CI 1.50–4.60. 1-year mortality: HR 2.12, 95%CI 1.33–3.39), but this correlation was only observed in nondiabetic cohort for ABG (HR 1.00, 95%CI 0.99–1.01 for both of the 30-day and 1-year mortality). Moreover, compared with ABG, SHR can better improve the C-statistics of the original models regarding the 30-day and 1-year outcomes, especially in patients with diabetes (p < 0.001 in all models).ConclusionSHR might be a more useful and reliable marker than ABG for prognostic prediction and risk stratification in critically ill patients with ICH, especially in those with diabetes.

Association of inflammatory cytokines expression in cerebrospinal fluid with the severity and prognosis of spontaneous intracerebral hemorrhage

ObjectiveTo investigate the potential diagnostic and prognostic implications of inflammatory cytokine levels in the cerebrospinal fluid (CSF) of patients with spontaneous intracerebral hemorrhage (SICH) upon their initial hospital admission.MethodsOur cohort included 100 patients diagnosed with acute SICH, presenting to the Department of Neurosurgery. Additionally, we recruited 50 individuals without central nervous system (CNS) pathology, treated concurrently at our facility, as controls. CSF samples, collected upon hospital entry, were quantitatively assessed for 10 inflammatory cytokines using the Mesoscale Discovery Platform (MSD, Rockville, MD, USA) electrochemiluminescence technology, followed by validation through enzyme-linked immunosorbent assay (ELISA).ResultsWe observed a marked elevation of IL-6, IL-8, IL-10, and TNF-α in the CSF of the SICH subgroup compared to controls. Higher Glasgow Coma Scale (GCS) scores in SICH patients corresponded with lower CSF concentrations of IL-6, IL-8, IL-10, and TNF-α, indicating an inverse relationship. Notably, CSF inflammatory cytokine levels were consistently higher in SICH patients with hydrocephalus than in those without. Increases in IL-6, IL-8, IL-10, and TNF-α in the CSF were notably more pronounced in the poor prognosis group (Glasgow Outcome Scale, GOS 1–3) compared to those with a favorable prognosis (GOS 4–5). The AUC values for these cytokines in predicting SICH prognosis were 0.750, 0.728, 0.717, and 0.743, respectively.ConclusionsInitial CSF levels of IL-6, IL-8, IL-10, and TNF-α upon admission provide significant insights into the severity of neural damage and are robust indicators for prognosis in SICH patients.

A Radiomics Model Based on CT Images Combined with Multiple Machine Learning Models to Predict the Prognosis of Spontaneous Intracerebral Hemorrhage

PurposeWe aimed to construct three predictive models, including a clinical model, a radiomics model, and a combined model, to forecast the discharge prognosis of patients with intracerebral hemorrhage on admission. MethodsA retrospective study was conducted, involving a total of 161 patients with intracerebral hemorrhage (ICH). At a ratio of 7:3, 115 of these patients were assigned to the training cohort, and 46 of these patients were assigned to the validation cohort. To produce the radionics signature and pick the features to use in its construction, the least absolute shrinkage and selection operator (LASSO) regression was applied. Five machine models were applied, and the optimal model was chosen to construct the radionics model. A clinical model was constructed using univariate and stepwise analysis to identify independent risk variables for poor outcomes at discharge. A predictive combined model nomogram was generated by integrating the clinical model and radiomics model. The performance of the nomogram was assessed in the training cohort and validated in the validation cohort. Analyses of the receiver operating characteristic curve (ROC), the calibration curve, and the decision curve were performed to assess the performance of the combined model. ResultsThis study encompassed a cohort of 161 individuals diagnosed with intracerebral hemorrhage (ICH), consisting of 110 males and 51 females. Utilizing the modified Rankin Scale (mRS) at discharge, the analysis revealed that 89 patients (55.3%) had a good prognosis, while 72 patients (44.7%) had a poor prognosis. Only 8 out of 1130 radiomics features were selected and used in conjunction with the LR algorithm to develop the radiomics model. Sex, IVH, GCS score, and ICH volume were determined to be independent predictors of poor outcomes at the time of discharge. The AUC values of the combined model, radiomics model, and clinical model were 0.8583, 0.8364, and 0.7579 in the training cohort, and 0.9153, 0.8692, and 0.7114 in the validation cohort, respectively. The combined model nomogram exhibited good calibration and clinical benefit in both the training and validation cohorts. The decision curve analysis (DCA) displays that the combined model obtained the highest net benefit compared to the radiomics model and clinics model in the training cohort. ConclusionThe combined model demonstrates reliability and efficacy in predicting the discharge prognosis of ICH, enabling physicians to perform individualized risk assessments and make optimal choices about patients with ICH.

Intracerebral Hemorrhage-Grading Scale (ICH-GS) Score as a Prognosis Prediction of Spontaneous Intracerebral Hemorrhage at Rumah Sakit Islam Surabaya Jemursari

Background: Spontaneous intracerebral hemorrhage or hemorrhagic stroke is one of the leading causes of mortality and disability in Indonesia, but until now there is no specific therapy for this disease. The intracerebral hemorrhage (ICH) score is a widely used predictive tool for the prognosis of death 30 days after spontaneous intracerebral hemorrhage, but the intracerebral hemorrhage-grading scale (ICH-GS) score has a more specific interval to assess the prediction of the prognosis after intracerebral hemorrhage. Rumah Sakit Islam (RSI) Jemursari Surabaya has not carried out data collection related to the ICH-GS score with the outcome (death) of patients with spontaneous intracerebral hemorrhage, especially while still receiving hospital treatment. Objective: To identify the number of ICH-GS scores in patients with spontaneous intracerebral hemorrhage as a predictor of prognosis at RSI Jemursari Surabaya. Method: The type of this research is retrospective research. The population comprised of all patients with spontaneous intracerebral hemorrhage hospitalized at RSI Jemursari Surabaya in 2017-2019, with affordable population of all patients with spontaneous intracerebral hemorrhage diagnosed by a neurologist. Results: The data showed that 5.5% (6 people) had an ICH-GS score of 5; 38.2% (42 people) had an ICG-GS score of 6; 21.8% (24 people) had an ICH-GS score of 7; 20 % (22 people) had an ICH-GS score of 8; 5.5% (6 people) had an ICH-GS score of 9; 4.5% (5 people) had an ICH-GS score of 10; 3.6% (4 people) had an ICH-GS score of 11; and 0.9% (1 patient) had an ICH-GS score of 12. Conclusions: The results of the ICH-GS score can be used to facilitate communication both with fellow health workers and with the patient's family. Trend of the data showed that ICH-GS score is not consistent in showing the prognosis of spontaneous intracerebral hemorrhage (the smaller the ICH-GS score should have better prognosis than the higher score), while the information based only on volume and location can predict the prognosis more consistently`.

Irregular shape as an independent predictor of prognosis in patients with primary intracerebral hemorrhage

The utility of noncontrast computed tomography markers in the prognosis of spontaneous intracerebral hemorrhage has been studied. This study aimed to investigate the predictive value of the computed tomography (CT) irregularity shape for poor functional outcomes in patients with spontaneous intracerebral hemorrhage. We retrospectively reviewed all 782 patients with intracranial hemorrhage in our stroke emergency center from January 2018 to September 2019. Laboratory examination and CT examination were performed within 24 h of admission. After three months, the patient's functional outcome was assessed using the modified Rankin Scale. Multinomial logistic regression analyses were applied to identify independent predictors of functional outcome in patients with intracerebral hemorrhage. Out of the 627 patients included in this study, those with irregular shapes on CT imaging had a higher proportion of poor outcomes and mortality 90 days after discharge (P < 0.001). Irregular shapes were found to be significant independent predictors of poor outcome and mortality on multiple logistic regression analysis. In addition, the increase in plasma D-dimer was associated with the occurrence of irregular shapes (P = 0.0387). Patients with irregular shapes showed worse functional outcomes after intracerebral hemorrhage. The elevated expression level of plasma D-dimers may be directly related to the formation of irregular shapes.

Large Relative Surface Area of Hematomas Predict a Poor Outcome in Patients with Spontaneous Intracerebral Hemorrhage

ObjectiveThe aim of this study is to investigate the predictive value of relative surface area of hematoma on poor prognosis of spontaneous intracerebral hemorrhage (sICH). Materials and MethodsWe retrospectively analyzed 102 patients with sICH who met the inclusion criteria, attending to Yongchuan Hospital of Chongqing Medical University from January 2019 to September 2020. Cranial CT within 6 h of onset was completed and repeated in 24 h. The volume and surface area of the hematoma are measured by software, and the relative surface area is calculated from the above data. The primary outcome was 90-day modified Rankin Scale(mRS) score, which was classified as good prognosis (≤2 points) and poor prognosis (>2 points) according to the results. Univariate analysis and binary logistic regression analysis were used to calculate the effect of each variable on poor prognosis. ResultsThe study is comprised of 52 patients with favorable functional prognosis and 50 patients with unfavorable one. The findings showed that admission National Institutes of Health Stroke Scale(NIHSS), hematoma volume, relative surface area, hematoma expansion(HE) and serum calcium concentration were independent influencing factors for poor prognosis(P=0.004,0.007,0.023,0.001,0.035, respectively). ROC curve analysis revealed that the area under the curve of the relative surface area of the hematoma predicted poor prognosis was 0.894(95% CI 0.830–0.985, P<0.001), which was better than the rest of the variables. ConclusionsThe relative surface area of hematoma in sICH is an independent risk factor for poor prognosis with a high predictive value, and large relative surface area suggests poor prognosis.

Total intracranial volume as a covariate for predicting prognosis in patients with primary intracerebral hemorrhage

ObjectivesThe initial hematoma volume is reliable and stable imaging predictor for the outcome of patients with intracerebral hemorrhage, and the total intracranial volume varies between patients. However, the role of total intracranial volume in predicting the prognosis of spontaneous intracerebral hemorrhage has not been previously addressed. Methods782 patients with spontaneous intracerebral hemorrhage were selected in this retrospective cohort at the Neurosurgery Emergency Unit of The First Affiliated Hospital of Harbin Medical University. Due to missing CT images, initial CT exceeding 24 h, traumatic cerebral hemorrhage, and aneurysm, 145 patients were excluded and the remaining 637 patients were included in our analysis. Functional outcome was assessed using the modified Rankin Scale(mRS) and mortality at 3-months after spontaneous intracerebral hemorrhage. CT image datasets were calculated by 3D-Slicer. The initial hematoma volume was normalized to the total intracranial volume to evaluate poor functional outcomes (mRS, 4–6) and mortality. ResultsThe results demonstrated that normalized initial hematoma volume can be used as an indicator of poor functional outcome (mRS, 4–6) (AUCNrIHV=0.753, 95%-CI:0.710–0.795, p < 0.001), mortality (AUCNrIHV=0.808, 95%-CI:0.754–0.862, p < 0.001) and hematoma expansion (AUCNrIHV=0.690, 95%-CI:0.613–0.767, p < 0.001). Meanwhile, the initial hematoma volume in predicting poor functional outcome (AUCIHV=0.749, 95%-CI:0.707–0.792, p < 0.001), mortality (AUCIHV=0.816, 95%-CI: 0.763–0.870, p < 0.001) and hematoma expansion (AUCIHV=0.704, 95%-CI: 0.626–0.782, p < 0.001) was similar to the normalized initial hematoma volume. ConclusionsThe normalized initial hematoma volume has no apparent benefit in predicting the prognosis of patients with cerebral hemorrhage compared with initial hematoma volume.

Effects of estimated glomerular filtration rate on clinical outcomes in patients with intracerebral hemorrhage

BackgroundThe influence of chronic kidney disease (CKD) on the severity and prognosis of spontaneous intracerebral hemorrhage (ICH) has been scarcely investigated. We aimed to explore the association of admission estimated glomerular filtration rate (eGFR) levels with hemorrhagic stroke severity and outcomes in ICH patients.Materials and methodsThe patients enrolled in this study were from the China Stroke Center Alliance study (CSCA). Patients were divided into four groups according to differences in eGFR at admission (≥90; 60–89; 45–59; < 45). Multivariable logistic regression analysis was used to determine the association of the eGFR at admission with hemorrhagic stroke severity, in-hospital complications, discharge disposition, and in-hospital mortality after ICH.ResultsA total of 85,167 patients with acute ICH were included in the analysis. Among them, 9493 (11.1%) had a baseline eGFR<60 ml/min/1.73 m2. A low eGFR was associated with an increased risk of in-hospital mortality [eGFR 60–89 ml/min/1.73 m2, odds ratio (OR) 1.36 (95% confidence interval (CI) 1.21–1.53); eGFR 45–59, 2.35 (1.97–2.82); eGFR<45, 4.18 (3.7–4.72); P for trend < 0.0001], non-routine discharge [eGFR 60–89, 1.11 (1.03–1.2); eGFR 45–59, 1.16 (1–1.35); eGFR<45, 1.37 (1.23–1.53); P for trend < 0.0001], hemorrhagic stroke severity [eGFR 60–89, 1 (0.95–1.05); eGFR 45–59, 1.39 (1.26–1.53); eGFR<45, 1.81 (1.67–1.96); P for trend < 0.0001], in-hospital complications of pneumonia [eGFR 60–89, 1.1 (1.05–1.14); eGFR 45–59, 1.3 (1.2–1.4); eGFR<45, 1.66 (1.57–1.76); P for trend < 0.0001] and hydrocephalus [eGFR 60–89, 0.99 (0.87–1.12); eGFR 45–59, 1.37 (1.1–1.7); eGFR<45, 1.54 (1.32–1.8); P for trend = 0.0139] after adjusting for confounding factors. With the decline in eGFR, the risk of hematoma evacuation increased in patients with an eGFR 45 to 59 ml/min/1.73 m2 (OR 1.48; 95% CI 1.37–1.61). No significant association between differences in eGFR at baseline and in-hospital complication of recurrent intracerebral hemorrhage was observed.ConclusionsLow eGFR at baseline was associated with an increased risk of in-hospital mortality, non-routine discharge, hemorrhagic stroke severity and in-hospital complications such as pneumonia, hydrocephalus and hematoma evacuation in acute ICH patients.

Gender differences in long-term mortality after spontaneous intracerebral hemorrhage in southern Portugal.

Introduction:the prognosis of spontaneous intracerebral hemorrhage (SICH) remains poor. Understanding gender differences can clarify the clinico-epidemiological and process of care related factors that influence SICH prognosis. We analyzed the long-term gender differences of mortality after SICH in Algarve, southern Portugal.Patients and Methods:analysis of consecutive community representative of SICH survivors (2009–2015). Logistic regression analysis and Kaplan–Meier method was used to assess gender differences on 1-year mortality and survival. We further analyzed if differences exist between 4 age and gender based subgroups (women <75 years, women ≥75 years, men <75 years, men ≥75 years).Results:a total of 285 survivors were analyzed; majority men (66.3%). Women were 2 years older on average. Overall case fatality was 11.6% [CI: 8.3–15.8]. A non-statistically significant (P = .094) higher case-fatality rate was observed in women; men were more frequently admitted to stroke unit; women had more often poor functional outcome or modified Rankin scale (mRS) ≥3. Predictors of death were: being women with ≥ 75 years, in-hospital pneumonia and hospital discharge mRS ≥3. The likelihood of death was higher in women ≥75 years (OR = 2.91 [1.23–8.1], P = .035) in comparison to women <75 years and men ≥75 years. Women <75 years had the longest survivor time, whereas women ≥75 years the shortest survivor time (P < .001).Conclusion:gender and age interact to influence long-term mortality after SICH. Women ≥75 years are at increased risk of death and have reduced survival after SICH in southern Portugal. Further studies are needed to clarify the biological or social factors contributing for the poor prognosis in the very old women in the region.

Relationship Between Glycosylated Hemoglobin and Short-Term Mortality of Spontaneous Intracerebral Hemorrhage.

Background: The relationship between glycosylated hemoglobin (HbA1c) and prognosis of spontaneous intracerebral hemorrhage (SICH) patients has not been fully elucidated. This study aimed to reveal the relationship between HbA1c levels and short-term mortality after patient admission with SICH.Methods: It was a large-scale, multicenter, cross-sectional study. From August 1, 2015, to July 31, 2019, a total of 41910 SICH patients were included in the study from the Chinese Stroke Center Alliance (CSCA) program. Finally, we comprehensively analyzed the data from 21,116 patients with SICH. HbA1c was categorized into four groups by quartile. Univariate and multivariate logistic regression analyses were used to assess the association between HbA1c levels and short-term mortality in SICH patients.Results: The average age of the 21,116 patients was 62.8 ± 13.2 years; 13,052 (61.8%) of them were male, and 507 (2.4%) of them died. Compared to the higher three quartiles of HbA1c, the lowest quartile (≤5.10%) had higher short-term mortality. In subgroup analysis with or without diabetes mellitus (DM) patients, the mortality of the Q3 group at 5.60–6.10% was significantly lower than that of the Q1 group at ≤5.10%. After adjustment for potential influencing factors, the ROC curve of HbA1c can better predict the short-term mortality of patients with SICH (AUC = 0.6286 P < 0.001).Conclusions: Therefore, we concluded that low or extremely low HbA1c levels (≤5.10%) after stroke were associated with higher short-term mortality in SICH patients, with or without DM.

Uric Acid and Clinical Outcomes Among Intracerebral Hemorrhage Patients: Results From the China Stroke Center Alliance.

Background and Purpose: The effect of uric acid (UA) levels on severity and prognosis of spontaneous intracerebral hemorrhage (ICH) remains controversial. We aimed to explore the association of admission UA levels with stroke severity and outcomes in ICH patients.Materials and Methods: The patients enrolled in this study were from the China Stroke Center Alliance study (CSCA). Patients were divided into four groups (Q1–Q4) according to the quartiles of UA levels at admission. The primary outcome was in-hospital mortality. The secondary outcomes included stroke severity, in-hospital complications, and discharge disposition. Multivariate logistic regression was adopted to explore the association of UA levels with outcomes after ICH.Results: Patients (84,304) with acute ICH were included in the final analysis; the median (interquartile range) of UA was 277 (210, 354) μmol/L. The four groups were defined as follows: Q1 ≤ 210 μmol/L, 210 μmol/L < Q2 ≤ 277 μmol/L, 277 μmol/L < Q3 ≤ 354 μmol/L, Q4 > 354 μmol/L. There was no significant evidence indicating that UA levels were correlated with the discharge disposition and in-hospital mortality after ICH. However, compared to Q1, the patients with higher UA levels had decreased odds of severe stroke (NIHSS ≥ 16) at admission (OR 0.89, 95% CI 0.86–0.92). An L-shaped association was found between UA and severe stroke. Among in-hospital complications, decrease in pneumonia, poor swallow function, gastrointestinal bleeding, and deep vein thrombosis (DVT) were significantly associated with higher UA levels compared to Q1 (P for trend < 0.0001).Conclusions: UA was a protective factor for stroke severity and in-hospital complications such as pneumonia, poor swallow function, gastrointestinal bleeding, and DVT. However, no significant evidence indicated that UA levels were predictive of the discharge disposition and in-hospital mortality after ICH.

Neutrophil-to-Lymphocyte Ratio and Prognosis of Spontaneous Intracerebral Hemorrhage

Neutrophil-to-Lymphocyte Ratio and Prognosis of Spontaneous Intracerebral Hemorrhage

Frequent Emergency Department Visits After Spontaneous Intracerebral Hemorrhage: Who Is at Risk?

The long-term prognosis of spontaneous intracerebral hemorrhage (SICH) is poor. Frequent emergency department (ED) visits can signal increased risk of hospitalization and death. There are no studies describing the risk of frequent ED visits after SICH. Retrospective cohort study of a community representative consecutive SICH survivors (2009-2015) from southern Portugal. Logistic regression analysis was performed to identify sociodemographic and clinical factors associated with frequent ED visits (≥4 visits) within the first year after hospital discharge. A total of 360 SICH survivors were identified, 358 (98.6%) of whom were followed. The median age was 72; 64% were males. The majority of survivors (n = 194, 54.2%) had at least 1 ED visit. Reasons for ED visits included infections, falls with trauma, and isolated neurological symptoms. Forty-four (12.3%) SICH survivors became frequent ED visitors. Frequent ED visitors were older and had more hospitalizations (P < .001) and ED visits (P < .001) prior to the SICH, unhealthy alcohol use (P = .049), longer period of index SICH hospitalization (P = .032), pneumonia during hospitalization (P = .001), and severe neurological impairment at discharge (P = .001). Pneumonia during index hospitalization (odds ratio [OR]: 3.08; confidence interval [CI]: 1.39-6.76; P = .005) and history of ED visits prior to SICH (OR: 1.64; CI: 1.19-2.26, P = .003) increased the likelihood of becoming a frequent ED visitor. Predictors of frequent ED visits are identifiable at hospital discharge and during any ED visit. Improvement of transitional care and identification of at-risk patients may help reduce multiple ED visits.

Hyperbaric-Oxygen Therapy Improves Survival and Functional Outcome of Acute Severe Intracerebral Hemorrhage

Prognosis of spontaneous intracerebral hemorrhage (ICH) remains poor worldwide. To investigate the effect and optimal protocol for hyperbaric-oxygen therapy (HBOT), and reduce incidence of upper gastrointestinal bleeding (UGIB) in ICH. This prospective, randomized, controlled trial included 565 patients with acute severe ICH. Participants were randomly assigned to a sham-control group (Group A) and four intervention groups: Groups B and C with 2.0atmospheres absolute (ATA) pressure and HBOT exposure for 60 or 90 sessions, respectively; and Groups D and E with 1.5 ATA for 60 or 90 sessions, respectively. All patients received emergency craniotomy with hematoma evacuation. Outcome measures were modified Barthel Index (MBI) and modified Rankin Scale (mRS) scores, mortality rates at follow-up six months. UGIB rates were assessed as potential side effect. In four intervention groups, MBI and mRS scores were all significantly improved, and mortality rates were all significantly decreased compared with Group A (all p<0.005). UGIB rates were 39.25, 60.00, 64.49, 36.79, and 34.26% in Groups A, B, C, D, and E, respectively. UGIB rates in Groups B and C were significantly increased compared with Groups A, D and E (all p<0.005). None of UGIB were clinically significant. HBOT significantly improves survival and functional outcomes of ICH. HBOT at 1.5 and 2.0 ATA had the same beneficial effect. A pressure of 1.5 ATA and 60 HBOT exposures represents an optimal protocol for HBOT. Further studies are needed to optimize the protocol per specific patient.

Long-Term Prognosis of Spontaneous Intracerebral Hemorrhage on the Tibetan Plateau: A Prospective Cohort Study at 2 Hospitals

Patterns of intracerebral hemorrhage (ICH) and outcomes in Tibetans are poorly understood. We aimed to investigate the long-term outcomes of Tibetan ICH patients. This prospective study involved a consecutive series of ICH patients admitted within 1 month of onset to West China Hospital (WCH) on the Chengdu Plain or People's Hospital of Garzê (PHG) on the Tibetan Plateau between January 2013 and December 2013. Basic characteristics and functional outcomes were compared between PHG and WCH groups. Of the 843 cases included, 105 (12.5%) were from PHG and 738 (87.5%) were from WCH. Compared with patients from WCH, patients from PHG were older and had higher blood pressure on admission, and a greater proportion had hypertension (all P < 0.001). Among patients from PHG, the 1-year death rate was 30.5%, similar to that in WCH (P= 0.987), and the adjusted 3-month disability risk was 2.0-fold higher than for WCH patients, while the adjusted 1-year disability risk was 2.5-fold higher than for WCH patients (both P ≤ 0.05). The adjusted 3-month risk of disability/death was 2.1-fold higher in PHG patients than in WCH patients, while the adjusted 1-year risk was 2.4-fold higher (both P ≤ 0.05). Most cases of ICH on the Tibetan Plateau involve concomitant hypertension. Tibetan patients are at higher risk of disability or disability/death on follow-up than are patients from Chengdu Plain.

Etiology, clinical characteristics and prognosis of spontaneous intracerebral hemorrhage in children: A prospective cohort study in China

Background and objectiveMuch is known about spontaneous intracerebral hemorrhage (SICH) in adults, but few studies have examined pediatric SICH, especially in China. The aim of the present study was to describe the etiology, clinical characteristics and prognosis of SICH in children from southwest China. MethodConsecutive patients aged 1–18years with SICH at our medical center were prospectively enrolled from January 2012 to June 2014. SICH was defined by WHO criteria and confirmed by CT or MRI findings. Demographic and clinical information was collected at baseline, and follow-up assessments were conducted at 3 and 6months after SICH, when patients were scored on the modified Rankin Scale (mRS) and events of deaths and recurrent hemorrhagic stroke were recorded. ResultsAmong the 70 children (43 males; median age, 12.0years) in the final analysis, 44 patients (62.9%) had SICH due to arteriovenous malformation, and less frequent etiologies were cavernous malformation (n=4), aneurysm (n=2), tumors (n=2), moyamoya (n=2), hemophilia (n=1), hypertension (n=1), while 14 (20.0%) had SICH of unknown etiology. The mortality rate at 3months and 6months was equal, which was both 3%. The rate of disability was 12.1% at 3months and 9.1% at 6months. ConclusionThe most frequent etiology of pediatric SICH in this Chinese cohort was arteriovenous malformation. SICH of unknown etiology occurred much more often in our cohort than in previously published Caucasian patients in the US and Europe.

Clinical analysis on spontaneous intracerebral hemorrhage in childhood, a report of 85 cases

Objective To investigate the characteristics,clinical manifestation,surgical treatment and prognosis of spontaneous intracerebral hemorrhage ( SIH ) in childhood.Method During a 5 - year period from 2004 to 2009,85 cases of spontaneous intracerebral hemorrhage in children( ≤ 14 years of age) were studies retrospectively.Results The main reason of spontaneous intracranial hemorrhage in children was cerebral arteriovenous malformation( AVM ) (84.7％ ),then Moyamoya disease (MMD) (8.2％ ),and aneurysm was rare(3.5％ ).Bleeding sites were mostly located in the brain parenchyma,supratentorial cases more than infratentorial. Headache,vomiting as initial symptoms were more common. DSA was the gold standard for diagnosis of cerebrovascular disease.Hematoma removal and lesion resection was the effective treatment.Conclusions AVM is the most important cause of spontaneous intracranial hemorrhage in childhood,surgical resection is the preferred method which can achieve good results. Key words: Cerebral hemorrhage; Intracranial arteriovenous malformations; Child; Neurosurgical procedures

Prognostic Value of Intraventricular Bleeding in Spontaneous Intraparenchymal Cerebral Hemorrhage of Small Volume

The literature is controversial on whether intraventricular bleeding has a negative impact on the prognosis of spontaneous intracerebral hemorrhage. Nevertheless, an association between intraventricular bleeding and spontaneous intracerebral hemorrhage volumes has been consistently reported. To evaluate the prognostic value of intraventricular bleeding in deep intraparenchymal hypertensive spontaneous hemorrhage with a bleeding volume <30 cm(3). Of the 320 patients initially evaluated, 33 met the inclusion criteria and were enrolled in this prospective study. The volume of intraparenchymal hemorrhage was calculated by brain computed tomography (CT) image analysis, and the volume of intraventricular bleeding was calculated by the LeRoux scale. Clinical data, including neurological complications, were collected daily during hospitalization. Neurological outcome was evaluated 30 days after the event by using the Glasgow outcome scale. Patients were assigned to 1 of 3 groups according to intraventricular bleeding: Control, no intraventricular bleeding; LR 1, intraventricular bleeding with LeRoux scale scores of 1 to 8; or LR 2, intraventricular bleeding with LeRoux scale scores >8. There were no significant differences among groups concerning age, mean blood pressure, and time from onset to brain CT scan. Patients with greater intraventricular bleeding presented lower initial Glasgow coma scale scores, increased ventricular index and width of temporal horns, increased number of clinical and neurological complications, and longer hospitalization. Furthermore, their relative risk for unfavorable clinical outcome was 1.9 (95% confidence interval 1.25-2.49). Intraventricular bleeding with a LeRoux scale score >8 appears to have a negative effect on deep spontaneous intraparenchymal cerebral hemorrhage of small volume.

Hypothermia Reduces Perihemorrhagic Edema After Intracerebral Hemorrhage

The prognosis of spontaneous intracerebral hemorrhage (sICH) is poor because of the mass effect arising from the hematoma and the associated peri-hemorrhagic edema, leading to increased intracranial pressure. Because the efficacy of surgical and anti-edematous treatment strategies is limited, we investigated the effects of mild induced hypothermia in patients with large sICH. Twelve patients with supratentorial sICH >25 mL were treated by hypothermia of 35 degrees C for 10 days. Evolution of hematoma volume and perifocal edema was measured by cranial CT. Functional outcome was assessed after 90 days. These patients were compared to patients (n=25; inclusion criteria: sICH volume >25 mL, no acute restriction of medical therapy on admission) from the local hemorrhage data bank (n=312). Side effects of hypothermia were analyzed. All patients from both groups needed mechanical ventilation and were treated in a neurocritical care unit. All hypothermic patients (mean age, 60+/-10 years) survived until day 90, whereas 7 patients died in the control group (mean age, 67+/-7 years). Absolute hematoma size on admission was 58+/-29 mL (hypothermia) compared to 57+/-31 mL (control). In the hypothermia group, edema volume remained stable during 14 days (day 1, 53+/-43 mL; day 14, 57+/-45 mL), whereas edema significantly increased in the control group from 40+/-28 mL (day 1) to 88+/-47 mL (day 14). ICH continuously dissolved in both groups. Pneumonia rate was 100% in the hypothermia group and 76% in controls (P=0.08). No significant side effects of hypothermia were observed. Hypothermia prevented the increase of peri-hemorrhagic edema in patients with large sICH.

Prognostic significance of third ventricle dilation in spontaneous intracerebral hemorrhage: a preliminary clinical study

Objective: Although numerous factors have been described that predict outcome after spontaneous intracerebral hemorrhage (ICH), very little is know about the role of hemorrhagic dilation of the third ventricle in development of hydrocephalus and prognosis. The objective of this study was to investigate whether the presence of hemorrhagic third ventricle dilation after ICH would predict development of hydrocephalus and outcome.Methods: We identified the patients with spontaneous ICH treated with external ventricular drainage (EVD) in this retrospective study. Computerized tomography (CT) was performed at admission within 24 hours of onset and retrospectively analysed to determine lesion size and location, status of third and fourth ventricle and frontal horn index (FHI). Glasgow coma scale (GCS) score, mean arterial pressure (MAP), etiology and demographic data were obtained from medical records. Outcome was determined using modified Rankin score at month 3. Patients with and without third ventricle dilation were compared in terms of hydrocephalus (FHI>0.38), initial GCS score, age and MAP, and analyses were performed to determine whether third ventricle dilation was a predictor of poor outcome.Results: Of the 22 patients studied, all had thalamic or basal ganglia hemorrhage with intraventricular hemorrhage (IVH) and all are treated with external ventricular drainage (EVD). Of the 22 patients, 12 had third ventricle dilation (width≥10 mm) and ten patients had non-dilated third ventricle (width<10 mm). Patients with third ventricle dilation had lower GCS scores (7.4 ± 1.8 versus 9.7 ± 2.1, p<0.005) and had higher FHI (0.46 ± 0.06 versus 0.38 ± 0.02, p<0.005) as compared to patients with non-dilated third ventricle. The differences in age (59.5 ± 9.4 versus 59.2 ± 11.2) and MAP (128.3 ± 16.0 versus 130.5 ± 13.6) of the patients were not significant statistically. Sixty-six percent of patients (8/12) with third ventricle dilation and 60% of patients (6/10) with normal third ventricle were dead 6 months post-operation and mortality rate did not differ significantly.Discussion: Although the roles of various factors are well described in the prognosis of spontaneous ICH, little is known about the role of third ventricle dilation. Based on our results, we concluded that third ventricle dilation is a poor prognostic factor.