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Spontaneous intracerebral hemorrhage (sICH) accounts for approximately 10% to 15% of stroke patients. The key factor affecting the prognosis of sICH is whether the initial hematoma volume and hematoma enlarge. Current research indicates that sICH is a common disease caused by rupture of small blood vessels with poor prognosis. More than 30% of patients have persistent bleeding after the first onset, indicating that the disease is a dynamic process. This persistent bleeding, also known as hematoma expansion (HE), is an independent predictor of neurological deterioration and poor prognosis. This article reviews the research progress of CT image features and specific imaging findings on CTA in predicting HE in patients with sICH.
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OBJECTIVE: Spontaneous intracerebral hemorrhage (ICH) is caused by the rupture of small blood vessels and other health problems. In ICH patients, hematoma enlargement is the most critical risk factor for poor outcomes. Tranexamic acid, an anti-fibrinolytic agent, has been used to reduce hematoma expansion. We analyzed the risk factors for hematoma expansion in ICH patients and compared the predictability of hematoma expansion in ICH patients with the use of tranexamic acid. METHODS: We performed retrospective analysis of ICH patients who underwent follow-up computed tomography scans from October 2008 to October 2018. Of the 329 included patients, 67 who received tranexamic acid and 262 who did not receive tranexamic acid were compared. We also analyzed the risk factors of 45 and 284 patients who did and did not experience hematoma expansion, respectively. RESULTS: Hematoma expansion was observed in 7 (10.4%) of 67 patients in the tranexamic acid group and 38 (14.5%) of the 262 patients who did not receive tranexamic acid. There was no statistically significant difference between patients who did and did not received tranexamic acid (p=0.389). In the multivariate logistic regression analysis of risk factors for hematoma expansion, spot sign and a maximal diameter of 40 mm were identified as risk factors. CONCLUSION: We could not confirm the effect of tranexamic acid on hematoma expansion in ICH patients. Spot sign and the maximal diameter of hematomas were confirmed as risk factors of hematoma expansion. If the maximal diameter is greater than 40 mm, the hematoma should be closely monitored.
Subject(s)
Humans , Antifibrinolytic Agents , Blood Vessels , Cerebral Hemorrhage , Follow-Up Studies , Hematoma , Logistic Models , Retrospective Studies , Risk Factors , Rupture , Tranexamic AcidABSTRACT
Objective To investigate the effect of blood pressure control for early enlargement of hypertensive intracerebral hemorrhage.Methods A total of 96 patients were divided randomly into intensive blood pressure lowering group (n = 48 )and standard antihypertensive group(n=48).Patients were checked head CT and was evaluated defect of nerve function score immedi-ately when they arrive at hospital and after 24 hours.Then the clinical curative effect was evaluated.Results The defect of nerve function score in intensive blood pressure lowering group was lower than that of the standard antihypertensive group(P <0.05 ). The hematomas volume within 24 hours of admission and the rate of hematoma enlargement of intensive blood pressure lowering group were sharply smaller than those of standard antihypertensive group(P <0.05).Conclusion Controlling blood pressure ac-tively could decrease ratio early enlargement of hematoma and defect of nerve function score in patients with hypertensive cerebral hemorrhage.
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OBJECTIVE: The spot sign is related with the risk of hematoma expansion in spontaneous intracerebral hemorrhage (ICH). However, not all spot sign positive patients undergo hematoma expansion. Thus, the present study investigates the specific factors enhancing the spot sign positivity in predicting hematoma expansion. METHODS: We retrospectively studied 316 consecutive patients who presented between March 2009 to March 2011 with primary ICH and whose initial computed tomography brain angiography (CTA) was performed at our Emergency Department. Of these patients, 47 primary ICH patients presented spot signs in their CTA. We classified these 47 patients into two groups based on the presence of hematoma expansion then analyzed them with the following factors : gender, age, initial systolic blood pressure, history of anti-platelet therapy, volume and location of hematoma, time interval from symptom onset to initial CTA, spot sign number, axial dimension, and Hounsfield Unit (HU) of spot signs. RESULTS: Of the 47 spot sign positive patients, hematoma expansion occurred in 26 patients (55.3%) while the remaining 21 (44.7%) showed no expansion. The time intervals from symptom onset to initial CTA were 2.42+/-1.24 hours and 3.69+/-2.57 hours for expansion and no expansion, respectively (p=0.031). The HU of spot signs were 192.12+/-45.97 and 151.10+/-25.14 for expansion and no expansion, respectively (p=0.001). CONCLUSIONS: The conditions of shorter time from symptom onset to initial CTA and higher HU of spot signs are the emphasizing factors for predicting hematoma expansion in spot sign positive patients.
Subject(s)
Humans , Angiography , Blood Pressure , Brain , Cerebral Hemorrhage , Emergency Service, Hospital , Hematoma , Retrospective StudiesABSTRACT
Objective Clinical studies show that the level of C-reactive protein ( CRP ) markedly increases in the acute phase of cerebral hemorrhage .However , the correlation of the CRP level with early neurological deterioration ( END) in patients with basal ganglia hemorrhage remains unclear .This study investigated the correlation between CRP and END in basal ganglia hemorrhage . Methods This study included 142 cases of basal ganglia hemorrhage diagnosed by cranial CT between Jan 2010 and Dec 2012 .END was defined as any decrease in Canadian Stroke Scale ( CSS) score≥1 point in the first 48 hours after stroke onset .We compared the baseline data between the END and non-END patients and evaluated the correlation between CRP and END by logistic regression analy -sis. Results END was found in 31 (21.8%) of the 142 patients.Univariate analysis of the END versus non-END cases showed that hyperglycemia (29.03 vs 11.71%, P=0.018), neutrophil count ([11.8 ±1.2] vs [7.8 ±7.7] ×109/L, P=0.019), CRP (P=0.001), hematoma expansion (54.83 vs 19.81%, P=0.001), hematoma volume ([23.6 ±21.9] vs [14.8 ±12.7] mL, P=0.005), and intraventricular hemorrhage (68.75 vs 28.83%, P<0.001) were significantly associated with END .Logistic regression a-nalysis indicated that the CRP level (OR=1.072, 95%CI:1.034-1.112, P=0.001), intraventricular hemorrhage (OR=4.162, 95%CI: 1.498 -11.564, P =0.006), and hematoma expansion (OR=5.297, 95%CI:1.906-14.723, P=0.001) were correlated with END in the patients during their hospital stay .ROC analysis man-ifested the predictive value of the CRP level for END in basal ganglia hemorrhage (OR=0.812, 95%CI: 0.732 -0.891, P <0.001). Conclusion The elevated level of CRP is significantly correlated with END in patients with basal ganglia hemorrhage and therefore can be re-garded as a predictive factor for this condition .
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Objective To study the preventive and therapeutic effects of blood pressure control on hematoma expansion and neurological function in patients with ultra-early basal ganglia intracerebral hemorrhage.Methods From November 2009 to November 2011,120 patients with ultra-early basal ganglia intracerebral hemorrhage from our Hospital were enrolled and randomly divided into intensive blood pressure reduction group and general blood pressure reduction group in equal numbers (n =60).The antihypertensive agent were used intravenously to reduce the systolic blood pressure by 130-140 mm Hg within l hour after treatment in patients of intensive blood pressure reduction group; and the general blood pressure reduction group was control by 160-180 mm Hg.The blood pressure of patients in both groups was maintained for 24 hours.The volume of haematoma in CT was measured before and 24 hours after treatment.The National Institutes of Health Stroke Scale (NIHSS) score was assessed 24 hours before and after treatmentand 14 days after treatment respectively.Statistical analyses were conducted.Results Between 24 hours before and after treatment,therewere significant difference in the hematoma volume((11.99 ± 6.90) ml vs.(14.74 ± 7.75) ml,t =2.049,P =0.043) and the number of cases of hematoma enlargement(5 vs.14,x2 =5.07,P =0.024) between the two groups.Between 24 hours before and after treatment,there was no significant difference in NIHSS scale in intensive blood pressure reduction group ((9.74 ± 4.49) vs.(9.25 ± 4.10),P ＞ 0.05).Between 24 hours before and 2 weeks after treatment,there were significant difference in NIHSS scale in both groups ((9.74 ± 4.49) vs.(6.28 ± 3.68),P ＜ 0.05 ; (9.50 ± 4.81) vs.(7.82 ± 4.28),P ＜ 0.05,respectively).At two weeks after treatment,there was significant difference in NIHSS scale between two groups ((6.28 ± 3.68) vs.(7.82 ± 4.28),P ＜ 0.05).Conclusion Intensive reduction of blood pressure is safe for the treatment of ultra-early basal ganglia intracerebral hemorrhage and reduce the incidence of hematoma enlargement and improve patient's early neurological function.
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OBJECTIVE: Patients with spontaneous intracerebral hemorrhage (ICH) presenting within 24 hours of symptom onset are known to be increased risk of hematoma expansion which is closely correlated with morbidity and mortality. We investigated whether tiny enhancing foci ('Spot sign') on axial view of 3-dimensional computed tomography angiography (3D-CTA) source images can predict subsequent hematoma expansion in spontaneous ICH. METHODS: During a 2-year period (March 2007-March 2009), we prospectively evaluated 3D-CTA of 110 patients with spontaneous ICH. Based on source images of 3D-CTA, patients were classified according to presence or absence of 'Spot sign'; 'Spot sign' (+) group, 'Spot sign' (-) group. Radiological factors and clinical outcomes were compared between two groups. RESULTS: Hematoma expansion occurred in 16 patients (15%). Mean Glasgow Coma Scale (GCS) score of patients with hematoma expansion was significantly different compared to score of patients without hematoma expansion (5 vs. 9, p < 0.001). Nineteen patients (16%) of 110 ICH patients demonstrated 'spot sign' on 3D-CTA. Among the 'spot sign' (+) group, 53% of patients developed hematoma expansion. Conversely 7% of patients without 'spot sign' demonstrated the hematoma expansion (p < 0.001). Initial volume and location of hematoma were significantly not associated with hematoma expansion except shape of hematoma. CONCLUSION: Our study showed that patients with hematoma expansion of spontaneous ICH had significant clinical deterioration. And the fact that 'spot sign' (+) group have higher risk of hematoma expansion suggests the presence of 'spot sign' on source images of 3D-CTA can give a clue to predict hematoma expansion in spontaneous ICH.