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Location of intracerebral haemorrhage predicts haematoma expansion.

作者信息

Yogendrakumar Vignan, Demchuk Andrew M, Aviv Richard I, Rodriguez-Luna David, Molina Carlos A, Blas Yolanda S, Dzialowski Imanuel, Kobayashi Adam, Boulanger Jean-Martin, Lum Cheemun, Gubitz Gord, Padma Vasantha, Roy Jayanta, Kase Carlos S, Bhatia Rohit, Hill Michael D, Dowlatshahi Dar

机构信息

Department of Medicine (Neurology), Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Canada.

Calgary Stroke Program, Department of Clinical Neurosciences, Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.

出版信息

Eur Stroke J. 2017 Sep;2(3):257-263. doi: 10.1177/2396987317715836. Epub 2017 Jun 15.


DOI:10.1177/2396987317715836
PMID:31008319
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6454825/
Abstract

INTRODUCTION: The role of intracerebral haemorrhage location in haematoma expansion remains unclear. Our objective was to assess the effect of lobar versus non-lobar haemorrhage on haematoma expansion and clinical outcome. PATIENTS AND METHODS: We analysed data from the prospective PREDICT study where patients with intracerebral haemorrhage presenting to hospital under 6 h of symptom onset received baseline computed tomography (CT), CT angiogram, 24 h follow-up CT, and 90-day mRS. Intracerebral haemorrhage location was categorised as lobar versus non-lobar, and primary outcomes were significant haematoma expansion (>6 ml) and poor clinical outcome (mRS > 3). Multivariable regression was used to adjust for relevant covariates. The primary analysis population was divided by spot sign status and the effect of haemorrhage location was compared to haematoma expansion in exploratory post hoc analysis. RESULTS: Among 302 patients meeting the inclusion criteria, lobar haemorrhage was associated with increased haematoma expansion >6 ml (p = 0.003), poor clinical outcome (p = 0.011) and mortality (p = 0.017). When adjusted for covariates, lobar haemorrhage independently predicted significant haematoma expansion (aOR 2.2 (95% CI: 1.1-4.3), p = 0.021) and poor clinical outcome (aOR 2.6 (95% CI: 1.2-5.6), p = 0.019). Post hoc analysis showed that patients who were spot sign negative had a higher degree of haematoma expansion with baseline lobar haemorrhage (lobar 26% versus deep 11%; p = 0.01). No significant associations were observed in spot-positive patients (lobar 52% versus deep 47%; p = 0.69). DISCUSSION AND CONCLUSION: Haematoma expansion is more likely to occur with lobar intracerebral haemorrhage and haemorrhage location is associated with poor clinical outcome. As expansion is a promising therapeutic target, hemorrhage location may be helpful for prognostication and as a selection tool in future ICH clinical trials.

摘要

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[5]
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[6]
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[7]
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[8]
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[9]
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[10]
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本文引用的文献

[1]
Noncontrast Computed Tomography Markers of Intracerebral Hemorrhage Expansion.

Stroke. 2017-4

[2]
Specific Lobar Affection Reveals a Rostrocaudal Gradient in Functional Outcome in Spontaneous Intracerebral Hemorrhage.

Stroke. 2017-3

[3]
Association of Key Magnetic Resonance Imaging Markers of Cerebral Small Vessel Disease With Hematoma Volume and Expansion in Patients With Lobar and Deep Intracerebral Hemorrhage.

JAMA Neurol. 2016-12-1

[4]
Noncontrast Computed Tomography Hypodensities Predict Poor Outcome in Intracerebral Hemorrhage Patients.

Stroke. 2016-10

[5]
Intracerebral Hemorrhage Location and Functional Outcomes of Patients: A Systematic Literature Review and Meta-Analysis.

Neurocrit Care. 2016-12

[6]
Magnitude of Hematoma Volume Measurement Error in Intracerebral Hemorrhage.

Stroke. 2016-4

[7]
Small intracerebral hemorrhages have a low spot sign prevalence and are less likely to expand.

Int J Stroke. 2016-2

[8]
APOE ε4 and lipid levels affect risk of recurrent nonlobar intracerebral hemorrhage.

Neurology. 2015-7-28

[9]
Which emphasizing factors are most predictive of hematoma expansion in spot sign positive intracerebral hemorrhage?

J Korean Neurosurg Soc. 2014-8

[10]
Risk factors for computed tomography angiography spot sign in deep and lobar intracerebral hemorrhage are shared.

Stroke. 2014-5-13

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