Kalita Jayantee, Kumar Dhiraj, Gupta Sandeep K, Pandey Prakash C, Mahajan Roopali, Singh Vivek
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Neurocrit Care. 2025 Aug 5. doi: 10.1007/s12028-025-02321-1.
Intracerebral hematoma (ICH) expansion occurs within 24 h, but perihematoma edema (PHE) may increase later due to blood breakdown products, leading to clinical deterioration and poor outcomes. There is a paucity of prospective studies evaluating the role of hematoma edema complex (HEC) and PHE in the death and disability of patients with ICH. We report the association between day 1 and day 7 HEC and PHE and outcomes at 3 months in patients with ICH.
Patients with primary ICH admitted within 24 h of ictus were included. Their demographic details, stroke risk factors, and Glasgow Coma Scale and National Institutes of Health Stroke Scale scores were recorded. A cranial computerized tomographic (CT) scan was done at admission and on the 7th day or earlier if there was clinical deterioration. Volumes of ICH, HEC, PHE, relative PHE, and midline shift were measured. Outcomes at 3 months were measured using the modified Rankin Scale.
Ninety patients with a median age of 57 (range 38-80) years were included. The majority had ganglionic or thalamic ICH (70 patients, 77.8%), and 20 patients (22.2%) had lobar ICH. HEC, PHE, and midline shift significantly increased on the repeat CT scan. Baseline ICH volume correlated with expansion in HEC (r = 0.97, P < 0.0001) and PHE (r = 0.54, P < 0.001). There was an independent association between HEC on the repeat CT scan and death (adjusted odds ratio 1.05, 95% confidence interval 1.02-1.08, P < 0.001) and poor outcome (adjusted odds ratio 0.87; 95% confidence interval 0.78-0.98, P = 0.02).
There was an independent association between HEC and outcomes in patients with primary ICH.
脑内血肿（ICH）在24小时内会发生扩大，但血肿周围水肿（PHE）可能会因血液分解产物而在之后增加，从而导致临床病情恶化和不良预后。目前缺乏前瞻性研究来评估血肿水肿复合体（HEC）和PHE在ICH患者死亡和残疾中的作用。我们报告了ICH患者第1天和第7天的HEC和PHE与3个月时预后之间的关联。
纳入发病24小时内入院的原发性ICH患者。记录他们的人口统计学细节、中风危险因素、格拉斯哥昏迷量表和美国国立卫生研究院卒中量表评分。入院时及如果出现临床病情恶化则在第7天或更早进行头颅计算机断层扫描（CT）。测量ICH、HEC、PHE、相对PHE和中线移位的体积。使用改良Rankin量表测量3个月时的预后。
纳入了90例患者，中位年龄为57岁（范围38 - 80岁）。大多数患者为基底节或丘脑ICH（70例，77.8%），20例患者（22.2%）为脑叶ICH。重复CT扫描时，HEC、PHE和中线移位显著增加。基线ICH体积与HEC扩大（r = 0.97，P < 0.0001）和PHE扩大（r = 0.54，P < 0.001）相关。重复CT扫描时的HEC与死亡（调整优势比1.05，95%置信区间1.02 - 1.08，P < 0.001）和不良预后（调整优势比0.87；95%置信区间0.78 - 0.98，P = 0.02）之间存在独立关联。
原发性ICH患者中，HEC与预后之间存在独立关联。
