McCarron M O, McCarron P, Alberts M J
Department of Neurology, Altnagelvin Hospital, Londonderry, BT47 6SB, UK.
J Neurol Neurosurg Psychiatry. 2006 Mar;77(3):378-80. doi: 10.1136/jnnp.2005.070714.
The natural history and triggers of perihaematomal oedema (PHO) remain poorly understood. Cerebral amyloid angiopathy (a common cause of lobar haemorrhage) has localised anticoagulant and thrombolytic properties, which may influence PHO. We hypothesised that early (within 24 hours) oedema to haematoma volume ratios are smaller in patients with lobar intracerebral haemorrhage (ICH) than in patients with deep ICH.
Haematoma and PHO volumes were measured in consecutive patients admitted to an acute stroke unit with a diagnosis of spontaneous supratentorial ICH proven by computed tomography. The oedema to haematoma volume ratios were calculated and compared in patients with lobar ICH and deep ICH.
In total, 44 patients with ICH were studied: 19 patients had deep ICH, median haematoma volume 8.4 ml (interquartile range (IQR) 4.8 to 20.8), median PHO 8.2 ml (2.8 to 16), and 25 had lobar ICHs, median haematoma volume 17.6 ml (6.6 to 33.1) and median oedema volume 10.2 ml (3.4 to 24.2). Patients with lobar ICH were older than those with deep ICH (65.7 v 57.4 years, p = 0.009) but ICH location did not differ by sex or race. There was no evidence that haematoma or oedema volumes were related to type of ICH (p = 0.23, p = 0.39 respectively). The median oedema to haematoma volume ratios were similar in patients with lobar and deep ICH (0.67 v 0.58, p = 0.71). Controlling for age, sex, and race made little difference to these comparisons.
There are no major location specific differences in PHO volumes within 24 hours of ICH onset. Deep and lobar ICH may have common therapeutic targets to reduce early PHO.
血肿周围水肿（PHO）的自然病程和诱发因素仍未完全明确。脑淀粉样血管病（脑叶出血的常见病因）具有局部抗凝和溶栓特性，这可能会影响PHO。我们推测，脑叶脑出血（ICH）患者早期（24小时内）的水肿与血肿体积比低于深部ICH患者。
连续纳入急性卒中单元收治的经计算机断层扫描证实为自发性幕上ICH的患者，测量其血肿和PHO体积。计算并比较脑叶ICH和深部ICH患者的水肿与血肿体积比。
共纳入44例ICH患者，其中19例为深部ICH，血肿体积中位数为8.4 ml（四分位间距[IQR] 4.8至20.8），PHO中位数为8.2 ml（2.8至16）；25例为脑叶ICH，血肿体积中位数为17.6 ml（6.6至33.1），水肿体积中位数为10.2 ml（3.4至24.2）。脑叶ICH患者比深部ICH患者年龄更大（65.7岁对57.4岁，p = 0.009），但ICH部位在性别或种族上无差异。没有证据表明血肿或水肿体积与ICH类型相关（分别为p = 0.23，p = 0.39）。脑叶ICH和深部ICH患者的水肿与血肿体积比中位数相似（0.67对0.58，p = 0.71）。校正年龄、性别和种族后，这些比较结果变化不大。
ICH发病24小时内，PHO体积在主要部位上无显著差异。深部和脑叶ICH可能有共同的治疗靶点来减轻早期PHO。
