Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2022 Oct;37(2):455-462.
doi: 10.1007/s12028-022-01532-0. Epub 2022 Jun 8.

The Prognostic Roles of Perihematomal Edema and Ventricular Size in Patients with Intracerebral Hemorrhage

Kun He Lee  1 , Vasileios-Arsenios Lioutas  2 , Sarah Marchina  2 , Magdy Selim  2 ; iDEF Investigators
Affiliations
Randomized Controlled Trial

The Prognostic Roles of Perihematomal Edema and Ventricular Size in Patients with Intracerebral Hemorrhage

Kun He Lee et al. Neurocrit Care. 2022 Oct.

Abstract

Background: Conflicting data exist regarding the association of perihematomal edema (PHE) with outcomes after intracerebral hemorrhage (ICH). We performed a post hoc analysis of the ICH Deferoxamine trial to examine whether an early change in ventricular size (VS), as a composite measure of PHE growth and mass effect, intraventricular hemorrhage, and hydrocephalus, is a more accurate predictor of outcome than PHE measures alone.

Methods: Computerized tomography scans were performed at baseline and after 72-96 h. We evaluated measures of PHE and change in VS as predictors of outcome, assessed by a dichotomized modified Rankin Scale score (0-2 versus 3-6), primarily at 90 days and secondarily at 30 days. A multivariable logistic regression model was fitted for each predictor, with adjustment for the same confounders.

Results: A total of 248 participants were included after we excluded those requiring external ventricular drains. On univariate analyses, older age, female sex, lower Glasgow Coma Scale score and baseline temperature, greater ICH volume, absolute PHE volume, edema extension distance at presentation, lesser changes in relative PHE volume and edema extension distance, and an increase in VS were associated with poor outcome. In multivariable analyses, only the increase in VS was associated with lower odds of modified Rankin Scale scores 0-2 at 90 days (odds ratio 0.927, 95% confidence interval 0.866-0.970, p = 0.001) and 30 days (odds ratio 0.931, 95% confidence interval 0.888-0.975, p = 0.003).

Conclusions: Within the context of a randomized controlled trial with standardized imaging and functional assessments, we did not find significant associations between measures of PHE and outcome but documented an independent association between early increase in VS and lower odds of good clinical outcome.

Trial registration: ClinicalTrials.gov NCT02175225.

Keywords: Cerebral hemorrhage; Hemorrhagic stroke; Prognosis; Stroke.

PubMed Disclaimer

References

    1. Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral haemorrhage. A powerful and easy-to-use predictor of 30-day mortality. Stroke. 1993;24(7):987–93. https://doi.org/10.1161/01.str.24.7.987 . - DOI - PubMed
    1. Davis SM, Broderick J, Hennerici M, et al. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology. 2006;66(8):1175. https://doi.org/10.1212/01.wnl.0000208408.98482.99 . - DOI - PubMed
    1. Brian TA, Bennie WC, Walter LO, Lawrence HP. The effect of intracerebral hematoma location on the risk of brain-stem compression and on clinical outcome. J Neurosurg. 1988;69(4):518–22. https://doi.org/10.3171/jns.1988.69.4.0518 . - DOI
    1. Sreekrishnan A, Dearborn JL, Greer DM, et al. Intracerebral Hemorrhage location and functional outcomes of patients: a systematic literature review and meta-analysis. Neurocrit Care. 2016;25(3):384–91. https://doi.org/10.1007/s12028-016-0276-4 . - DOI - PubMed
    1. Christensen Michael C, Mayer S, Ferran J-M. Quality of Life After Intracerebral Hemorrhage. Stroke. 2009;40(5):1677–82. https://doi.org/10.1161/STROKEAHA.108.538967 . - DOI - PubMed

Publication types

Associated data

LinkOut - more resources