Falcone Guido J, Brouwers H Bart, Biffi Alessandro, Anderson Christopher D, Battey Thomas W K, Ayres Alison M, Vashkevich Anastasia, Schwab Kristin M, Rost Natalia S, Goldstein Joshua N, Viswanathan Anand, Greenberg Steven M, Rosand Jonathan
Center for Human Genetic Research, Massachusetts General Hospital, 185 Cambridge Street, CPZN-6818, Boston, MA, 02114, USA.
Neurocrit Care. 2014 Oct;21(2):192-9. doi: 10.1007/s12028-013-9839-9.
Despite extensive studies of supratentorial intracerebral hemorrhage (ICH), limited data are available on determinants of hematoma volume in infratentorial ICH. We therefore aimed to identify predictors of infratentorial ICH volume and to evaluate whether location specificity exists when comparing cerebellar to brainstem ICH.
We undertook a retrospective analysis of 139 consecutive infratentorial ICH cases (95 cerebellar and 44 brainstem ICH) prospectively enrolled in a single-center study of ICH. ICH volume was measured on the CT scan obtained upon presentation to the Emergency Department using an established computer-assisted method. We used linear regression to identify determinants of log-transformed ICH volume and logistic regression to evaluate their role in surgical evacuation.
Median ICH volumes for all infratentorial, cerebellar, and brainstem ICH were nine [interquartile range (IQR), 3-23], ten (IQR, 3-25), and eight (IQR, 3-19) milliliters, respectively. Thirty-six patients were on warfarin treatment, 31 underwent surgical evacuation, and 65 died within 90 days. Warfarin was associated with an increase in ICH volume of 86 % [β = 0.86, standard error (SE) = 0.29, p = 0.003] and statin treatment with a decrease of 69 % (β = -69, SE = 0.26, p = 0.008). Among cerebellar ICH subjects, those on warfarin were five times more likely to undergo surgical evacuation (OR = 4.80, 95 % confidence interval 1.63-14.16, p = 0.005).
Warfarin exposure increases ICH volume in infratentorial ICH. Further studies will be necessary to confirm the inverse relation observed between statins and ICH volume.
尽管对幕上脑出血（ICH）进行了广泛研究，但关于幕下ICH血肿体积的决定因素的数据有限。因此，我们旨在确定幕下ICH体积的预测因素，并评估比较小脑与脑干ICH时是否存在部位特异性。
我们对前瞻性纳入一项单中心ICH研究的139例连续幕下ICH病例（95例小脑ICH和44例脑干ICH）进行了回顾性分析。使用既定的计算机辅助方法在急诊科就诊时获得的CT扫描上测量ICH体积。我们使用线性回归来确定对数转换后的ICH体积的决定因素，并使用逻辑回归来评估它们在手术清除中的作用。
所有幕下、小脑和脑干ICH的ICH体积中位数分别为9毫升[四分位数间距（IQR），3 - 23]、10毫升（IQR，3 - 25）和8毫升（IQR，3 - 19）。36例患者接受华法林治疗，31例接受手术清除，65例在90天内死亡。华法林与ICH体积增加86%相关[β = 0.86，标准误（SE）= 0.29，p = 0.003]，他汀类药物治疗与ICH体积减少69%相关（β = - 69，SE = 0.26，p = 0.008）。在小脑ICH患者中，服用华法林的患者接受手术清除的可能性是其他患者的5倍（比值比 = 4.80，95%置信区间1.63 - 14.16，p = 0.005）。
华法林暴露会增加幕下ICH的体积。需要进一步研究来证实他汀类药物与ICH体积之间观察到的负相关关系。
