Hematoma Volume Research Articles

Indian Trial of Tranexamic acid in Spontaneous Intracerebral Haemorrhage (INTRINSIC TRIAL) Study Protocol.

Early mortality in intracerebral haemorrhage (ICH) is due to haematoma volume (HV) expansion and there are no effective treatments available other than reduction in blood pressure. Tranexamic acid (TXA) a hemostatic drug which is widely available and safe can be a cost-effective treatment for ICH, if proven efficacious. Administration of TXA in ICH patients when given within 4.5 hours of symptom onset will reduce early mortality at 30 days. Indian Trial of Tranexamic acid in Spontaneous Intracerebral Haemorrhage (INTRINSIC Trial) is a multicenter, randomized, open-label, trial enrolling patients aged more than 18 years presenting with non-traumatic ICH within 4.5 hours of symptom onset or when last seen well. Study participants receive 2 grams of TXA administered within 45 minutes while control group receives standard of care. Intensive blood pressure reduction as per INTERACT 2 protocol is followed in done in both groups. Study plans to recruit 3400 patients. Primary outcome is mortality at day 30. Secondary outcomes are radiological reduction of HV at 24 hours from baseline, neurological impairment at day 7 or earlier (if discharged), and assessments of dependency and quality of life at day 90. If proven to be beneficial, TXA will have a major impact on medical management of ICH. Clinical Trial Registry India (CTRI/2023/03/050224) and Clinical Trials.gov (NCT05836831).

Prognostic value of nomogram model based on clinical risk factors and CT radiohistological features in hypertensive intracerebral hemorrhage.

To construct a nomogram model based on clinical risk factors and CT radiohistological features to predict the prognosis of hypertensive intracerebral hemorrhage (HICH). A total of 148 patients with HICH from April 2022 to July 2024 were retrospectively selected as the research subjects. According to the modified Rankin scale at the time of discharge, they were divided into good group (Rankin scale score 0-2) and bad group (Rankin scale score 3-6). To compare the clinical data and the changes of CT radiographic characteristics in patients with different prognosis. Relevant factors affecting the prognosis were analyzed, and nomogram model was established based on the influencing factors. The fitting degree, prediction efficiency and clinical net benefit of the nomogram model were evaluated by calibration curve, ROC curve and clinical decision curve (DCA). Compared with the good group, the hematoma volume in the poor group was significantly increased, the serum thromboxane 2(TXB2) and lysophosphatidic acid receptor 1(LPAR1) levels were significantly increased, and the energy balance related protein (Adropin) level was significantly decreased. The proportions of irregular shape, promiscuous sign, midline displacement, island sign and uneven density were all significantly increased (p < 0.05). In Logistic multivariate analysis, hematoma volume, Adropin, TXB2, LPAR1 and CT radiological features were all independent factors influencing the poor prognosis of HICH (p < 0.05). A nomogram prediction model was established based on the influencing factors. The calibration curve showed that the C-index was 0.820 (95% CI: 0.799-0.861), the goodness of fit test χ2 = 5.479, and p = 0.391 > 0.05, indicating a high degree of fitting. The ROC curve showed that the AUC was 0.896 (95% CI: 0.817-0.923), indicating that this model had high prediction ability. The DCA curve shows that the net benefit of the nomogram model is higher when the threshold probability is 0.1-0.9. The nomogram prediction model established based on hematoma volume, Adropin, TXB2, LPAR1 and other clinical risk factors as well as CT radiographic characteristics has high accuracy and prediction value in the diagnosis of poor prognosis in patients with HICH.

The use of cloud based machine learning to predict outcome in intracerebral haemorrhage without explicit programming expertise

Machine Learning (ML) techniques require novel computer programming skills along with clinical domain knowledge to produce a useful model. We demonstrate the use of a cloud-based ML tool that does not require any programming expertise to develop, validate and deploy a prognostic model for Intracerebral Haemorrhage (ICH). The data of patients admitted with Spontaneous Intracerebral haemorrhage from January 2015 to December 2019 was accessed from our prospectively maintained hospital stroke registry. 80% of the dataset was used for training, 10% for validation, and 10% for testing. Seventeen input variables were used to predict the dichotomized outcomes (Good outcome mRS 0–3/ Bad outcome mRS 4–6), using machine learning (ML) and logistic regression (LR) models. The two different approaches were evaluated using Area Under the Curve (AUC) for Receiver Operating Characteristic (ROC), Precision recall and accuracy. Our data set comprised of a cohort of 1000 patients. The data was split 8:1 for training & testing respectively. The AUC ROC of the ML model was 0.86 with an accuracy of 75.7%. With LR AUC ROC was 0.74 with an accuracy of 73.8%. Feature importance chart showed that Glasgow coma score (GCS) at presentation had the highest relative importance, followed by hematoma volume and age in both approaches. Machine learning models perform better when compared to logistic regression. Models can be developed by clinicians possessing domain expertise and no programming experience using cloud based tools. The models so developed lend themselves to be incorporated into clinical workflow.

Mitigating mitochondrial dysfunction and neuroinflammation by hematoma aspiration in a new surgical model for severe intracerebral hemorrhage.

Intracerebral hemorrhage (ICH) is associated with a large hematoma that causes compression, increased intracranial pressure (IICP), midline shift, and brain herniation, and may ultimately lead to death. Urgent surgical removal of the large hematoma can ameliorate these injuries, which would be life-saving, but has not improved clinical outcome. A suitable animal model that mimics the clinically relevant human severe ICH injury requiring surgical hematoma evacuation is urgently needed. Here, we established a novel model of severe ICH in rats allowing aspiration of the hematoma and studying the effects of mitochondrial dysfunction in ICH. Severe ICH was induced by intra-striatal injection of 0.6 U of collagenase in 3 μl sterile saline over 15 min. Aspiration of approximately 75 % of the total hematoma was performed 6 h after induction of severe ICH. The effects of hematoma aspiration on hematoma volume, mortality, oxidative stress, ATP levels, mitochondrial dysfunction, and neurological function were measured in rats. Severe ICH induction increased hematoma volume, neurological deficits, and mortality. Hematoma aspiration abolished mortality and significantly reduced hematoma volume, and neurological deficits. In addition, hematoma aspiration ameliorated the pronounced mitochondrial dysfunction responsible for the failure of energy production and excessive oxidative stress associated with severe hemorrhagic injury. Hematoma aspiration also modulated mitochondrial biogenesis and mitophagy, thereby promoting mitochondrial homeostasis. Markers of neuroinflammation, including iNOS, MMP9, and MPO, were elevated in severe ICH but attenuated by hematoma aspiration. This study established an animal model of severe ICH and provides valuable insights into the complex pathogenesis of severe ICH. The results showed that hematoma aspiration effectively ameliorates mitochondrial dysfunction, oxidative stress, and neuroinflammation, highlighting its potential as a therapeutic intervention.

Diffusion-weighted imaging findings predictive of postoperative recurrence of chronic subdural hematoma

ObjectivesTo identify the brain magnetic resonance imaging (MRI) findings associated with the postoperative recurrence of chronic subdural hematoma (CSDH). MethodsWe examined 1099 consecutive patients admitted to our hospital with CSDH between 2005 and 2014. Of those, 1021 who underwent surgery for CSDH and were followed-up for >3 months after surgery were included. Preoperative brain MRI findings were classified as homogeneous, laminar, separate, or trabecular, according to the nature of the hematoma. Postoperative recurrence was defined in patients who required reoperation for ipsilateral hematoma growth within three months of surgery. The clinical and radiological factors associated with postoperative recurrence were evaluated using univariate and multivariate analyses. ResultsOf the 1021 CSDH patients with CSDH who underwent surgery, 91 (8.9%) experienced postoperative recurrence. Postoperative recurrence was significantly associated with male sex (p = 0.0004) and hematoma volume (p < 0.0001). Additionally, isotype or separate types of hematoma on computed tomography (CT) (p < 0.0001) and laminar/separate types of hematoma types on MRI (p = 0.0008) were significant. Multivariate analysis revealed odds ratios of 2.50 (95% CI, 1.45–4.61; p = 0.0007) for male sex and 3.05 (95% CI, 1.95–4.87; p < 0.0001) for iso/separate hematoma types in CT. Conversely, among the patients who underwent MRI, multivariate analysis revealed odds ratios of 4.33 (95% CI, 1.20–27.92; p = 0.001) for male sex and 4.88 (95% CI, 1.90–14.18; p = 0.023) for laminar/separate hematoma types. ConclusionWhile distinguishing the nature of hematomas is challenging with brain CT examination, detailed laminar/trabecular differentiation using MRI images may predict postoperative recurrence.

3D Technology-Assisted Minimally Invasive Surgery for the treatment of primary brainstem hemorrhage: A prospective cohort study

PurposeThe objective of this study was to assess the therapeutic efficacy of minimally invasive puncture and drainage (MIPD) facilitated by a three-dimensional (3D)-printed guide plate in the management of primary brainstem hemorrhage (PBH). MethodsThis single-center, prospective cohort study enrolled 30 PBH patients who underwent MIPD guided by 3D printing technology and 30 PBH patients who received conservative treatment, serving as the control cohort. The primary endpoint was the proportion of patients achieving modified Rankin Scale (mRS) scores of 1 and 2 at 30 days post-discharge. Secondary endpoints included hematoma volume at admission and post-treatment, incidence of hospital-acquired pneumonia (HAP) and/or rebleeding, in-hospital mortality rate, and length of hospital stay. ResultsThe treatment cohort demonstrated a significantly higher proportion of patients with mRS scores of 1 and 2 at 30 days post-discharge compared to the control cohort. Conversely, the treatment cohort exhibited significantly lower postoperative hematoma volumes, National Institutes of Health Stroke Scale (NIHSS) scores, HAP incidence, in-hospital mortality, and hospital stay duration than the control cohort. However, no significant difference in rebleeding incidence was observed between the two cohorts. ConclusionMIPD guided by 3D printing technology is more effective than conservative treatment in PBH cases without extensive hemorrhage. This approach can alleviate hematoma pressure earlier, mitigate neurological deficits, reduce HAP incidence, shorten hospital stay, and decrease mortality and disability rates associated with PBH.

Early minimally invasive image-guided eNdoscopic evacuation of iNTracerebral hemorrhage: a phase II pilot trial.

Whether minimally invasive endoscopic surgery (ES) improves survival and functional outcome in people with spontaneous supratentorial intracerebral hemorrhage (SSICH) is unknown. This is a single-center pilot study performed between July 2021 to January 2023. Any supratentorial hematoma with a volume between 20 mL and 100 mL was endoscopically evacuated within 24 h after bleeding onset. Participants were followed-up for 6 months, assessing clinical and radiological outcomes. The primary feasibility outcome was satisfactory hematoma removal (<15 mL residual volume on the first postinterventional CT study) and the primary efficacy outcome was reaching a modified Rankin Scale 0-3 (mRS) at 6 months. Secondary outcomes were mortality and morbidity rates. Ten participants (median age 72.5 years [IQR 67-81], 70% male, median baseline hematoma volume 34.1 [IQR 25.5-58.0]) were included. Satisfactory hematoma evacuation was achieved in 70% (7/10) with a median evacuation percentage of 69.5% [IQR 45.3-93.9%]. The median duration of surgery was 91 min [IQR 73-111]. Favorable outcome at 6 months was observed in 60% of the participants and improved from within 24 h before the intervention to the last follow-up (6 months). Five participants (50%) experienced a total of six complications, two recurrent bleedings, three pneumonias and one epilepsy. Mortality rate was 30%, while one participant died from pneumonia, one from a recurrent bleeding, and one participant due to a glioblastoma. ES appears to be feasible, with satisfactory hematoma removal being achieved in the majority of participants. Based on the descriptive results of this pilot trial, a national multicenter RCT comparing ES to best medical treatment is currently ongoing. https://clinicaltrials.gov/, identifier NCT05681988.

Predictors of affective disturbances and cognitive impairment following small spontaneous supratentorial intracerebral hemorrhage.

Affective disturbances and cognitive impairment are common sequelae of intracerebral hemorrhage (ICH), yet predictive models for these outcomes remain limited, especially for spontaneous supratentorial ICH with small hematomas (<30 mL). The aim of this study was to investigate predictors of affective disturbances and cognitive impairment following small spontaneous supratentorial intracerebral hemorrhage. We retrospectively analyzed 1692 patients with spontaneous supratentorial ICH between January 2018 and December 2020 at the First Affiliated Hospital of Harbin Medical University. Of these, 1563 patients completed a median follow-up of 3.5 years. Cognitive function was evaluated using the modified Telephone Interview for Cognitive Status, and affective disturbances using the Hamilton Depression Scale and the Hamilton Anxiety Scale. Restricted cubic spline analyses were employed to examine the relationships between predictors and outcomes. In this cohort, 58.5% had cognitive impairment, 52.8% reported depressive symptoms, and 39.4% exhibited anxiety symptoms. Logistic regression models using Boruta's algorithm demonstrated strong predictive capacity, with areas under the curve of 0.82 for cognitive impairment, 0.78 for depressive symptoms, and 0.73 for anxiety symptoms. Hematoma volume was significantly linked to depressive symptoms (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.38-1.76) and inversely to cognitive impairment (OR 0.67, 95% CI 0.59-0.77). Uric acid levels displayed a nonlinear relationship with cognitive impairment (OR 0.70, 95% CI 0.61-0.81). Hospitalization days significantly raised the risk of both depressive (OR 1.16, 95% CI 1.03-1.30) and anxiety symptoms (OR 1.17, 95% CI 1.04-1.31). The logistic regression model, enhanced by Boruta's algorithm, provides a valuable tool for predicting affective disturbances and cognitive impairment after ICH. It facilitates early identification and improves risk assessment for these neuropsychiatric outcomes in patients with small hematomas.

Aquaporin-4 activation facilitates glymphatic system function and hematoma clearance post-intracerebral hemorrhage.

Efficient clearance of hematomas is crucial for improving clinical outcomes in patients with intracerebral hemorrhage (ICH). The glymphatic system, facilitated by aquaporin-4 (AQP4), plays a crucial role in cerebrospinal fluid (CSF) entry and metabolic waste clearance. This study examined the role of the glymphatic system in ICH pathology, with a focus on AQP4. Collagenase-induced ICH models were established, with AQP4 expression regulated through mifepristone as an agonist, TGN-020 as an inhibitor, and Aqp4 gene knockout. Fluorescence tracing and multimodal magnetic resonance imaging (MRI) were employed to observe glymphatic system functionality, hematoma, and edema volumes. Neurological deficit scoring was performed using the modified Garcia Scale. AQP4 expression was quantified using RT-qPCR and Western blotting, and cellular localization was explored using immunofluorescence. The brain tissue sections were examined for neuronal morphology, degenerative changes, and iron deposition. Three days post-ICH, the AQP4 agonist group showed increased AQP4 protein expression and perivascular polarization, decreased hemoglobin levels, and reduced iron deposition. Conversely, the inhibition group exhibited contrasting trends. AQP4 activation improved glymphatic system function, leading to a wider distribution, improved neurological function, and reduced hematoma. Pharmacological inhibition and genetic knockout of AQP4 have opposing effects. The glymphatic system, facilitated by AQP4, plays a crucial role in hematoma clearance following cerebral hemorrhage. Upregulation of AQP4 improves glymphatic system function, facilitates hematoma clearance, and promotes brain tissue recovery.

A Five-Point Score Grading System for Predicting Early Hematoma Expansion in Patients with Spontaneous Intracerebral Hemorrhage

Background: Stroke is the second leading cause of mortality and morbidity worldwide, with spontaneous Intracranial Hemorrhage (ICH) accounting for 9%-27% of all strokes. The study evaluates clinical and NCCT markers to predict early Hematoma Expansion (HE) in patients with Intracranial Hemorrhage (ICH), focusing on directing management objectives. Methods: We prospectively evaluated 96 patients with spontaneous ICH who underwent a baseline NCCT within four hours of admission, followed by a follow-up scan within six hours or at the time of clinical deterioration, whichever was earlier. Hematoma volumes were determined using baseline and follow-up CT images and imaging characteristics that predicted HE were evaluated. A grading system score was created to predict HE. Results: Of the ninety-six patients studied, 29 displayed black hole signs, 31 had island signs and 22 had swirl signs on baseline NCCT. On follow-up scans, the total incidence of HE in ICH patients was 53 out of 96 (55.2%). The average baseline hematoma volume in HE patients was 44.1 ml, compared to 12.2 ml in non-hematoma expansion patients. Of the 53 patients with HE, 29 had black hole sign, 16 had swirl sign and 28 had island sign. A higher grading system score (P &lt; 0.001) was associated with a higher likelihood of HE.

Các yếu tố tiên lượng của bệnh nhân chảy máu não cấp vùng trên lều do tăng huyết áp

Objectives: Comments on the relationship of prognostic factors in patients with acute supratentorial cerebral hemorrhage due to hypertension. Subjects and method: A cross-sectional, prospective descriptive study was conducted on 150 patients diagnosed with acute supratentorial cerebral hemorrhage due to hypertension, admitted for inpatient treatment at the Neurology Center, Bach Mai Hospital from August 1, 2023 to July 31, 2024. Results: The rate of patients with good outcome after 3 months (73.3%). In terms of prognostic factors, the study showed that in the age group ≤ 60 years old, the rate of poor outcome was 18.1%, the group &gt; 60 years old had a rate of poor outcome of 34.6%. Thus, in the age group &gt; 60 years old, the outcome was worse, this difference was statistically significant with p&lt;0.05. In our study, there was no statistically significant difference in outcome at day 90 between patients with a history of hypertension, diabetes, coronary artery disease, antiplatelet drugs, smoking, alcohol consumption and patients without this history. In the group without cerebral hemorrhage, the rate of patients with poor outcome was 18.8%; while in the group with cerebral hemorrhage, this rate was 36.9%, this difference was statistically significant with p&lt;0.05. In the group with no hematoma volume &lt; 30 ml, the rate of patients with poor outcome was 14.1%; meanwhile, in the group with hematoma volume ≥ 30 ml, this rate was 100%, this difference was statistically significant with p &lt; 0.01. In the group with Glasgow score at admission ≥ 14 points, the rate of patients with poor outcome was 14.4%; meanwhile, in the group with Glasgow score at admission &lt; 14 points, the rate of patients with poor outcome was 71.9%, this difference was statistically significant with p &lt; 0.01. Conclusion: Studying 150 patients with acute supratentorial cerebral hemorrhage due to hypertension treated at the Neurology Center - Bach Mai Hospital from August 1, 2023 to July 31, 2024, we drew the following conclusions: factors leading to poor outcomes for patients with acute cerebral hemorrhage due to hypertension include age &gt; 60, hematoma volume ≥ 30 ml, Glasgow score at admission below 14 points, and intraventricular hemorrhage.

The impact of early surgery on mortality and functional recovery in older adults with traumatic intracranial lesions: a propensity score-based analysis.

There is skepticism about the benefit of surgery in elderly patients affected by traumatic brain injury (TBI) due to the negative effect of age on the outcome and surgical complications. However, there are few studies that have investigated differences in patient's outcome between surgically and conservatively managed patients after adjusting for the imbalance in preinjury characteristics and clinical and radiological features. The primary aim of this study was to evaluate the effect of early surgery on mortality and functional recovery in a cohort of older adults with acute traumatic intracranial lesions after adjustment by Propensity Score (PS) matching. MATERIALS AND METHODS: We conducted a retrospective cohort study on older adult patients (≥ 65 years) admitted for TBI between 2013 and 2023 to a single level 1 trauma center. Patients were categorized based on whether they underwent early surgery (< 48h after TBI) for a space-occupying lesion evacuation. PS model was constructed based on age, frailty, comorbidities (Charlson comorbity index and American Society of Anaesthesiologists score), anticoagulants, hypoxia, shock, pupillary abnormalities and GCS motor response upon admission, midline shift, basal cistern effacement, volume of subdural and intracerebral hematomas, and limitation of life-sustaining treatment decisions.The effect of early surgery on 30-day mortality and unfavorable functional outcomes (GOSE 1-3) at 6 and 12 months were investigated after matching by paired test. We identified and reviewed 301 patients who met all inclusion criteria and contained no exclusions. After matching, 62 patients (31 pairs of conservative and surgical patients) remained as the matched datasets. Our key finding was that older adult TBI patients who underwent early surgery had a statistically significant reduction in the risk of 30-day mortality (OR 0.313, 95% CI 0.114-0.853, p = 0.023) and unfaourable outcome at 12 months after TBI (OR 0.286, 95% CI 0.094-0.868, p = 0.027). Early surgery was associated with decreased 30-day mortality and better functional outcome at 12 months after TBI in older adults with few comorbidities and good functionality when clinically affected by acute traumatic intracranial lesions with mass effect.

Sex Modifies the Severity and Outcome of Spontaneous Intracerebral Hemorrhage.

The limited existing evidence on sex differences in the clinical characteristics of patients with spontaneous, non-traumatic intracerebral hemorrhage (ICH) comes from small, single-center studies. Here, we performed an individual patient data meta-analysis of 3 randomized clinical trials and 1 multi-ethnic observational study of ICH to investigate the impact of sex on ICH severity and outcome. Inclusion criteria in our study were a neuroimaging-confirmed ICH. We evaluated whether sex was associated with ICH severity (hematoma volume and expansion) and poor functional outcomes (modified Rankin Scale >3) 3 or 6 months after the ICH. A total of 4,812 ICH patients were evaluated (mean age 62, 40% female). Males with ICH were younger, more likely to be smokers and have diabetes, and less likely to be on anticoagulants (all p < 0.05). In multivariable analyses, male sex was associated with non-lobar location (odds ratio [OR]: 1.63; 95% confidence interval [CI]: [1.39-1.92]; p < 0.001), larger hemorrhages (beta: 0.16 [0.08-0.23]; p < 0.001) and a higher risk of hematoma expansion (OR: 1.43 [1.20-1.71]; p < 0.001). Despite the larger hemorrhage volume and higher risk of expansion, male sex was associated with a 24% lower risk of poor outcomes (OR: 0.76 [0.64-0.90]; p = 0.002). Compared to females, males with ICH have larger bleeds and higher risk of hematoma expansion. Despite the larger bleeds and higher risk of hematoma expansion, males with ICH have lower risk of poor outcomes. Our results suggest that the biology and clinical trajectory are different in females and males with ICH, supporting sex-specific research in this condition. ANN NEUROL 2024.

Tranexamic Acid in Symptomatic Chronic Subdural Hematoma in the Absence of Surgical Intervention.

Standard treatment for symptomatic chronic subdural hematoma (CSDH) is a burr-hole evacuation. However, in patients in whom surgical evacuation carries a very high risk, we do not have an established practice guideline. To analyze the outcome of symptomatic CSDH treated only by tranexamic acid. A total of 22 admitted patients with symptomatic chronic subdural hematoma from 2018 to 2019 were included in the study. All patients were managed conservatively with oral tablet tranexamic acid 250 mg thrice daily till the resolution of hematoma. Patients were followed up every month with CT scan brain. Data regarding the volume of hematoma, resolution of hematoma, and recurrence of hematoma were anonymized and analyzed. The median duration of treatment was 60 days (range 30-98). The median volume of hematoma before the initiation of the therapy was 74 ml (range 66-96), and it was reduced to 2 ml after the therapy with tranexamic acid. The median midline shift before the initiation of the therapy was 15 mm (range 10-20), and it was zero in all patients following the treatment. There was no progression or recurrence of hematoma in any one of patients. No major complications (thromboembolic events) due to the use of tranexamic acid were seen in any patient. Even symptomatic patients with chronic subdural hematoma can be effectively managed with tranexamic acid when the surgical drainage is risky or not possible. It can be used as an alternative to surgery when there is no immediate threat to life.

Predicting 30-Day Outcomes in Primary Intracerebral Hemorrhage Using the Intracerebral Hemorrhage Score: A Study in Bangladesh.

Introduction Intracerebral hemorrhage (ICH) is a severe subtype of stroke associated with high rates of mortality and morbidity. Accurate early prognostication is essential for optimizing treatment strategies and improving patient outcomes. The ICH score, which includes clinical and imaging variables, is widely used to predict mortality and functional outcomes in ICH patients. However, limited data on the applicability of this scoring system are available from low-income countries. This study aims to evaluate the ICH score as a predictor of 30-day mortality and functional outcome, as measured by the modified Rankin Scale (mRS), in ICH patients at a tertiary care hospital in Bangladesh. Methods We conducted a prospective cohort study over one year at the National Institute of Neurosciences and Hospital in Dhaka, Bangladesh. One hundred patients aged over 18 years with confirmed primary ICH were enrolled. We collected data on demographics, clinical presentation, risk factors, and imaging findings, including the Glasgow Coma Scale (GCS), ICH score components, and hematoma volume. Patients were followed up for 30 days, and outcomes were assessed using the mRS. Statistical analyses included univariate and multivariate logistic regression and Kaplan-Meier survival estimates. Results A total of 100 participants were enrolled for the study. The mean age of participants was 59.2 ± 14.5 years, and 57 were men, and 43 were women. The overall 30-day mortality rate was 44%. Mortality rates increased significantly with higher ICH scores (p < 0.001), with all patients scoring 4 or 5 on the ICH score dying within 30 days. Lower GCS scores, larger hematoma volumes, the presence of intraventricular hemorrhage (IVH), and increasing age were associated with higher mortality. Multivariate analysis identified increasing age (p = 0.023), lower GCS score (p = 0.003), and higher ICH score (p = 0.025) as independent predictors of 30-day mortality. Higher ICH scores were also significantly associated with poor functional outcomes (mRS ≥ 4) at both discharge and 30 days (p < 0.001). GCS score emerged as an independent predictor of poor functional outcomes at 30 days (p = 0.012). Conclusions The ICH score is an effective tool for predicting 30-day mortality and functional outcomes in patients with primary ICH. Incorporating the ICH score and GCS assessment into routine clinical practice can aid healthcare providers in early risk stratification, optimizing treatment plans, and improving resource allocation.

Management of intracavitary bleeding during ultra-early minimally invasive intracerebral hemorrhage evacuation.

Surgical evacuation of intracerebral hemorrhage (ICH) at early time points contributes to improved functional outcomes. However, ultra-early evacuation has been associated with postoperative rebleeding, a devastating complication that contributes to worse outcomes. Minimally invasive endoscopic techniques allow for intraoperative management of active bleeding, potentially allowing for safe and effective hemostasis at ultra-early time points. The authors proposed and prospectively assigned an intraoperative grading scale that quantified the severity of bleeding encountered intraoperatively. They hypothesized that ultra-early evacuation would correlate to increased intraoperative bleeding but not postoperative rebleeding or worse long-term clinical outcomes in a cohort of patients undergoing minimally invasive endoscopic evacuation. Patients presenting to a large healthcare system with spontaneous supratentorial ICH were triaged to a central hospital for potential surgical evacuation. Inclusion criteria for evacuation included age ≥ 18 years, premorbid mRS score ≤ 3, hematoma volume ≥ 15 mL, and presenting National Institutes of Health Stroke Scale score ≥ 6. A 5-point scale was developed and prospectively applied to grade the severity of bleeding encountered intraoperatively. A score of 1 indicated no active intraoperative bleeding. A score of 2 indicated minimal bleeding treated with irrigation alone. A score of 3 indicated bleeding that required cauterization to control. A score of 4 indicated bleeding that required irrigation or cauterization for at least 15 minutes to achieve hemostasis. A score of 5 indicated bleeding that required irrigation or cauterization for at least 1 hour. The authors evaluated 142 consecutive patients. The median bleeding score was 2 (IQR 2-4). Greater preoperative volume, concomitant intraventricular hemorrhage, and earlier time to evacuation were independently associated with increased bleeding score. Specifically, ultra-early evacuation within 5 hours was independently associated with a 2.4-point greater bleeding score as compared with evacuation thereafter (β = 2.41, 95% CI 1.44-3.38; p < 0.0001). Despite having higher intraoperative bleeding scores, patients undergoing ultra-early evacuation did not have an increased likelihood of postoperative rebleeding (14% vs 3%, p = 0.23), 30-day mortality (0% vs 6%, p = 0.99), or worse median 6-month mRS scores (4 [IQR 2-5] vs 4 [IQR 3-5], p = 0.51). Ultra-early evacuation within 5 hours of ictus is associated with increased intraoperative bleeding but not postoperative rebleeding or worse clinical outcomes. These findings suggest that the benefits of ultra-early evacuation can be explored without an increased risk of postoperative rebleeding when utilizing a minimally invasive endoscopic technique with good intraoperative visualization, active irrigation for targeted tamponade, and direct cauterization of bleeding vessels.

Automated Hematoma Detection and Outcome Prediction in Patients With Traumatic Brain Injury.

To develop a tool for automated subtype classification and segmentation of intracranial hemorrhages (ICH) on CT scans of patients with traumatic brain injury (TBI). Furthermore, outcome prediction for patients can effectively facilitate patient management. This study presents a cascade framework for two-stage segmentation and multi-label classification. The hematoma region of interest (ROI) is localized, and then the ROI is cropped and resized to the original pixel size before being input into the model again to obtain the segmentation results. In multilabel classification, the mask obtained from automatic segmentation is superimposed onto the corresponding ROI and CT slices, respectively, to constitute the input image. Subsequently, the ROI image is employed as the local network input to obtain local features. Third, the CT image is utilized to construct a feature extraction network to obtain global features. Ultimately, the local and global features are fused dimensions in the pooling layer,and calculated to generate the final retrieval results. For the prediction of 14-day in-hospital mortality, automatically extracted hematoma subtype and volume features were integrated to enhance the widely used CRASH model. The proposed segmentation method achieves the best estimates on the Dice similarity coefficient and Jaccard Similarity Index. The proposed multilabel classification method achieved an average accuracy of 95.91%. For mortality prediction, the best model achieved an average area under the receiver operating characteristic curve (AUC) of 0.91 by 5-fold cross-validation. The proposed method enhances the precision of hematoma segmentation and subtype classification. In clinical settings, the method can streamline the evaluation of ICH for radiologists, and the automatically extracted features are anticipated to facilitate prognosis assessment.

Reliability of ABC/2 volumetric estimation in spontaneous intracerebral hemorrhage for hematoma expansion prediction scores.

Prediction scores for hematoma expansion in spontaneous intracerebral hemorrhage (ICH), such as the 9-point and BRAIN scores, were developed predominantly using planimetry to measure hematoma volume. In this study, we aim to investigate whether the ABC/2 formula, which is known to overestimate hematoma volume, can be reliably used as a substitute for planimetry in these prediction scores. A total of 429 patients from four hospitals were retrospectively enrolled. CT scan and clinical data at admission and follow-up CT scan were collected. The 9-point and BRAIN scores were calculated using hematoma volume from ABC/2 and planimetry. Hematoma expansion was assessed using hematoma volume from planimetry. The median hematoma volume measured by ABC/2 was 11.97 ml (interquartile range [IQR], 4.8-30.0), whereas the volume measured by planimetry was 11.70 ml (IQR, 4.9-26.6). The median measurement error between ABC/2 and planimetry was 0.30 ml (IQR, -0.72-2.87). ABC/2 overestimated hematoma volume in 244 patients (56.9%) compared to planimetry. In the 9-point score, the area under the curves (AUCs) for predicting hematoma expansion were 0.735 (95% confidence interval [CI], 0.675-0.796) with ABC/2 and 0.732 (95% CI, 0.672-0.793) with planimetry. In the BRAIN score, the AUCs were 0.753 (95% CI, 0.693-0.813) with ABC/2 and 0.745 (95% CI, 0.688-0.803) with planimetry. The 9-point and BRAIN scores using hematoma volume measured by ABC/2 and planimetry showed good performance in predicting hematoma expansion in ICH. ABC/2 volumetric estimation proved to be reliable for these scores.

The efficacy of neuroendoscopic surgery treating patients with thalamic hemorrhage accompanied by intraventricular hematoma.

Neuroendoscopic surgery (NES) has been proven to be safe and effective in hematoma evacuation for cerebral hemorrhage. However, its efficacy for thalamic hemorrhage accompanied by intraventricular hematoma (THAVH) remains unclear. The aim of this study is to determine the efficacy of NES in treating THAVH. A retrospective study was carried out. The data of patients diagnosed with THAVH were collected from January 1st, 2019, to January 1st, 2022. Patients received the NES or external ventricle drainage (EVD) treatment were assigned to the NES or EVD group, respectively. As primary outcomes, the hematoma evacuation volume, residual hematoma volume, and hematoma clearance rate were separately calculated based on the hematoma site; and the 180-day-mRS score was assessed. As secondary outcomes, the length of stay in the ICU and hospital, and the adverse events were also compared. Thirty-five patients, aged 66.37 ± 6.62 years, were in the NES group; and 40 patients, aged 68.75 ± 7.22 years, were in the EVD group. The baseline characteristics in the two groups were similar (P > 0.05). The gross hematoma evacuation volume, volume of hematoma evacuated in the thalamus or the ventricle, and the hematoma clearance rate were greater in the NES group than in the EVD group on the 1st day after surgery (P < 0.05). The patients had a better rank of mRS in the NES group (P < 0.05). Compared with patients with mRS > 3, the mean residual hematoma volume in the thalamus of patients with mRS ≤3 on the 1st and 7th day were less in each group (P < 0.05), respectively. A residual hematoma volume in the ventricle of patients with mRS ≤3 was less than that of patients with mRS >3 in the EVD group on the 1st day after surgery (P < 0.05). GCS score on the 3rd day was greater in the NES group (P < 0.05). The incidence of lung infection was lower in the NES group (P < 0.05). The length of stay in the ICU and hospitalization duration were shorter in the NES group (P < 0.05). Neuroendoscopic surgery has a greater hematoma clearance rate, a lower lung infection rate and a shorter duration in the hospital. Neuroendoscopic surgery might improve patients' prognosis. Neuroendoscopic surgery is a safe and effective procedure for treating thalamic hemorrhage accompanied by intraventricular hematoma.

Development of a predictive model for assessing the risk factors associated with recurrence following surgical treatment of chronic subdural hematoma.

Chronic subdural hematoma (CSDH) is a common disease in neurosurgery. Although many studies have investigated the factors affecting the recurrence of CSDH, no comprehensive prediction model has been established for the risk effect of postoperative recurrence of the disease. This study aims to collect and analyze the data of CSDH patients treated in our hospital to determine the influence of preoperative, postoperative and treatment factors on the recurrence of CSDH, and to establish a corresponding prediction model to provide neurosurgeons with more accurate basis for identifying high-risk patients and guiding treatment. A total of 431 patients were collected in this study, including 323 patients who underwent traditional hematoma removal and 108 patients who underwent endoscopic hematoma removal. Relevant preoperative and postoperative data and medical history of patients were collected respectively to study the relevant factors affecting postoperative hematoma recurrence of patients, and to establish a prediction model. A total of 431 patients were enrolled in this study, 71 of whom had subdural blood recurrence. Possible relevant factors were included in univariate logistic regression, and the results showed that the preoperative GCS score, postoperative residual gas, preoperative CT hematoma thickness, coagulation function, unilateral and bilateral surgery, whether statin was taken after surgery, hematoma site, hematoma density and hematoma volume were all P < 0.2. It is a risk factor for recurrence of chronic subdural hematoma. The obtained data were further included in a multi-factor review. Six factors, including preoperative GCS score, postoperative gas residual, abnormal coagulation function, high-density hematoma, large hematoma volume, and irregular statin use after surgery, were independent risk factors for chronic subdural hematoma recurrence (P < 0.05). This study confirmed that six factors, including preoperative GCS score, postoperative gas residual, abnormal coagulation function, high-density hematoma, large hematoma volume, and irregular statin use, were independent risk factors for recurrence of chronic subdural hematoma. At the same time, long-term use of statins can reduce the recurrence rate of hematoma to a certain extent. In addition, the predictive model in this study could help neurosurgeons accurately identify high-risk CSDH patients.