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. 2021 Mar;6(1):36-43.
doi: 10.1177/2396987320975736. Epub 2020 Nov 25.

Clinical usefulness of Edinburgh CT criteria in patients with lobar intracerebral hemorrhage

Raffaele Ornello  1 , Enrico Colangeli  1 , Emanuele Tommasino  1 , Cindy Tiseo  1 , Giulia Perrotta  1 , Ciro Scarpato  1 , Martina Gentile  2 , Leondino Mammarella  3 , Carmine Marini  2 , Francesca Pistoia  1 , Alessandra Splendiani  1 , Simona Sacco  1
Affiliations

Clinical usefulness of Edinburgh CT criteria in patients with lobar intracerebral hemorrhage

Raffaele Ornello et al. Eur Stroke J. 2021 Mar.

Abstract

Background: Identifying the cause of intracerebral hemorrhage (ICH) is relevant to optimize its management. We aimed to assess the applicability and utility of the Edinburgh CT criteria for cerebral amyloid angiopathy (CAA) in an unselected cohort of hospitalized patients.

Patients and methods: We retrospectively applied the Edinburgh criteria to the first available brain CTs of patients hospitalized for a first-ever lobar ICH in the district of L'Aquila from 2011 to 2017. ICH characteristics and outcomes were compared according to the presence of the Edinburgh CT criteria, including associated subarachnoid hemorrhage (aSAH) and finger-like projections (FLPs). The outcome of ICH in-hospital mortality was assessed with multivariate logistic regression analysis. We adopted the Edinburgh criteria, age, NIHSS and Glasgow Coma Scale scores, systolic blood pressure, antiplatelet treatment, ICH volume, and intraventricular extension on admission as covariates.

Results: Of 178 patients with lobar ICH, 52 (29.2%) had aSAH+FLPs, 60 (33.7%) aSAH only, 1 (0.6%) FLPs, and 65 (36.5%) none. Patients with aSAH+FLPs were older (79.0 ± 9.2 years) than those with only one criterion or none (74.0 ± 15.3 and 72.2 ± 13.8 years, respectively; P = 0.020). Patients with aSAH+FLPs also had more severe ICH at onset, higher in-hospital case-fatality (log rank test P = 0.003) and higher mRS scores at discharge (P < 0.001) as compared to those fulfilling one or none of the Edinburgh criteria. Low Glasgow Coma Scale score was the only factor independently associated to in-hospital case-fatality (odds ratio per point increase 0.51; 95% confidence interval, 0.32-0.91; P = 0.021).

Discussion: Our data suggest the applicability of the Edinburgh CT criteria in a hospital setting. The presence of those criteria reflects ICH clinical severity.

Conclusions: Applying the Edinburgh CT criteria might help refining the diagnosis and improving the management of patients with lobar ICH.

Keywords: Intracerebral hemorrhage; amyloid angiopathy; computed tomography; imaging; prognosis; stroke.

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Conflict of interest statement

Declaration of conflicting interests: RThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: O reports non-financial relationships with Novartis, Allergan, and Teva outside the submitted work; SS reports Dr Sacco reports personal fees and non-financial support from Allergan, personal fees and nonfinancial support from Abbott, personal fees and non-financial support from Eli Lilly, personal fees and non-financial support from Novartis, personal fees and non-financial support from TEVA, personal fees from Medscape, other from Bayer, other from Pfizer, other from Medtronic, other from Starmed, other from Bristol-Myers Squibb, and other from Daiichi-Sankyo outside the submitted work; all the other Authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Overlap between associated subarachnoid hemorrhage (aSAH) and finger-like projections (FLPs) in patients with lobar intracerebral hemorrhage (ICH).
Figure 2.
Figure 2.
Distribution of (a) National Institutes of Health Stroke Scale score categories on hospital admission and (b) modified Rankin Scale scores at hospital discharge according to the presence of Edinburgh criteria for probable cerebral amyloid angiopathy.
Figure 3.
Figure 3.
Box plot of intracerebral hemorrhage volume according to the presence of Edinburgh criteria for probable cerebral amyloid angiopathy in patients with lobar intracerebral hemorrhage. Boxes indicate interquartile ranges.
Figure 4.
Figure 4.
Kaplan-Meier curves of cumulative case-fatality according to the presence of Edinburgh criteria for probable cerebral amyloid angiopathy in patients with lobar intracerebral hemorrhage.
See this image and copyright information in PMC

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