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Dierksen F, Tran AT, Zeevi T, Maier IL, Qureshi AI, Sanelli PC, Werring DJ, Malhotra A, Falcone GJ, Sheth KN, Payabvash S. Peri-hematomal edema shape features related to 3-month outcome in acute supratentorial intracerebral hemorrhage. Eur Stroke J 2024; 9:383-390. [PMID: 38179883 DOI: 10.1177/23969873231223814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION Perihematomal edema (PHE) represents secondary brain injury and a potential treatment target in intracerebral hemorrhage (ICH). However, studies differ on optimal PHE volume metrics as prognostic factor(s) after spontaneous, non-traumatic ICH. This study examines associations of baseline and 24-h PHE shape features with 3-month outcomes. PATIENTS AND METHODS We included 796 patients from a multicentric trial dataset and manually segmented ICH and PHE on baseline and follow-up CTs, extracting 14 shape features. We explored the association of baseline, follow-up, difference (baseline/follow-up) and temporal rate (difference/time gap) of PHE shape changes with 3-month modified Rankin Score (mRS) - using Spearman correlation. Then, using multivariable analysis, we determined if PHE shape features independently predict outcome adjusting for patients' age, sex, NIH stroke scale (NIHSS), Glasgow Coma Scale (GCS), and hematoma volume. RESULTS Baseline PHE maximum diameters across various planes, main axes, volume, surface, and sphericity correlated with 3-month mRS adjusting for multiple comparisons. The 24-h difference and temporal change rates of these features had significant association with outcome - but not the 24-h absolute values. In multivariable regression, baseline PHE shape sphericity (OR = 2.04, CI = 1.71-2.43) and volume (OR = 0.99, CI = 0. 98-1.0), alongside admission NIHSS (OR = 0.86, CI = 0.83-0.88), hematoma volume (OR = 0.99, CI = 0. 99-1.0), and age (OR = 0.96, CI = 0.95-0.97) were independent predictors of favorable outcomes. CONCLUSION In acute ICH patients, PHE shape sphericity at baseline emerged as an independent prognostic factor, with a less spherical (more irregular) shape associated with worse outcome. The PHE shape features absolute values over the first 24 h provide no added prognostic value to baseline metrics.
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Affiliation(s)
- Fiona Dierksen
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
- Department of Neurology, Georg-August University Göttingen, Göttingen, Germany
| | - Anh T Tran
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Tal Zeevi
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Ilko L Maier
- Department of Neurology, Georg-August University Göttingen, Göttingen, Germany
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA
| | - Pina C Sanelli
- Department of Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - David J Werring
- Stroke Research Centre, University College London, Queen Square Institute of Neurology, London, UK
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Guido J Falcone
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Center for Brain & Mind Health, Yale School of Medicine, New Haven, CT, USA
| | - Kevin N Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Center for Brain & Mind Health, Yale School of Medicine, New Haven, CT, USA
| | - Seyedmehdi Payabvash
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
- Center for Brain & Mind Health, Yale School of Medicine, New Haven, CT, USA
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Zhou Z, Wu X, Chen Y, Tan Y, Zhou Y, Huang T, Zhou H, Lai Q, Guo D. The relationship between perihematomal edema and hematoma expansion in acute spontaneous intracerebral hemorrhage: an exploratory radiomics analysis study. Front Neurosci 2024; 18:1394795. [PMID: 38745941 PMCID: PMC11091303 DOI: 10.3389/fnins.2024.1394795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024] Open
Abstract
Background The relationship between early perihematomal edema (PHE) and hematoma expansion (HE) is unclear. We investigated this relationship in patients with acute spontaneous intracerebral hemorrhage (ICH), using radiomics. Methods In this multicenter retrospective study, we analyzed 490 patients with spontaneous ICH who underwent non-contrast computed tomography within 6 h of symptom onset, with follow-up imaging at 24 h. We performed HE and PHE image segmentation, and feature extraction and selection to identify HE-associated optimal radiomics features. We calculated radiomics scores of hematoma (Radscores_HEA) and PHE (Radscores_PHE) and constructed a combined model (Radscore_HEA_PHE). Relationships of the PHE radiomics features or Radscores_PHE with clinical variables, hematoma imaging signs, Radscores_HEA, and HE were assessed by univariate, correlation, and multivariate analyses. We compared predictive performances in the training (n = 296) and validation (n = 194) cohorts. Results Shape_VoxelVolume and Shape_MinorAxisLength of PHE were identified as optimal radiomics features associated with HE. Radscore_PHE (odds ratio = 1.039, p = 0.032) was an independent HE risk factor after adjusting for the ICH onset time, Glasgow Coma Scale score, baseline hematoma volume, hematoma shape, hematoma density, midline shift, and Radscore_HEA. The areas under the receiver operating characteristic curve of Radscore_PHE in the training and validation cohorts were 0.808 and 0.739, respectively. After incorporating Radscore_PHE, the integrated discrimination improvements of Radscore_HEA_PHE in the training and validation cohorts were 0.009 (p = 0.086) and -0.011 (p < 0.001), respectively. Conclusion Radscore_PHE, based on Shape_VoxelVolume and Shape_MinorAxisLength of PHE, independently predicts HE, while Radscore_PHE did not add significant incremental value to Radscore_HEA.
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Affiliation(s)
- Zhiming Zhou
- Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Medical Imaging Artificial Intelligence Lab, Chongqing, China
| | - Xiaojia Wu
- Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Medical Imaging Artificial Intelligence Lab, Chongqing, China
| | - Yuanyuan Chen
- Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Medical Imaging Artificial Intelligence Lab, Chongqing, China
| | - Yuanxin Tan
- Department of Radiology, Fifth People's Hospital of Chongqing, Chongqing, China
| | - Yu Zhou
- Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Medical Imaging Artificial Intelligence Lab, Chongqing, China
| | - Tianxing Huang
- Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Medical Imaging Artificial Intelligence Lab, Chongqing, China
| | - Hongli Zhou
- Department of Radiology, Nanchong Central Hospital, Nanchong, Sichuan, China
| | - Qi Lai
- Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Medical Imaging Artificial Intelligence Lab, Chongqing, China
| | - Dajing Guo
- Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Medical Imaging Artificial Intelligence Lab, Chongqing, China
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Sobowale OA, Hostettler IC, Wu TY, Heal C, Wilson D, Shah DG, Strbian D, Putaala J, Tatlisumak T, Vail A, Sharma G, Davis SM, Werring DJ, Meretoja A, Allan SM, Parry-Jones AR. Baseline perihematomal edema, C-reactive protein, and 30-day mortality are not associated in intracerebral hemorrhage. Front Neurol 2024; 15:1359760. [PMID: 38645743 PMCID: PMC11026700 DOI: 10.3389/fneur.2024.1359760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Background The relationship between baseline perihematomal edema (PHE) and inflammation, and their impact on survival after intracerebral hemorrhage (ICH) are not well understood. Objective Assess the association between baseline PHE, baseline C-reactive protein (CRP), and early death after ICH. Methods Analysis of pooled data from multicenter ICH registries. We included patients presenting within 24 h of symptom onset, using multifactorial linear regression model to assess the association between CRP and edema extension distance (EED), and a multifactorial Cox regression model to assess the association between CRP, PHE volume and 30-day mortality. Results We included 1,034 patients. Median age was 69 (interquartile range [IQR] 59-79), median baseline ICH volume 11.5 (IQR 4.3-28.9) mL, and median baseline CRP 2.5 (IQR 1.5-7.0) mg/L. In the multifactorial analysis [adjusting for cohort, age, sex, log-ICH volume, ICH location, intraventricular hemorrhage (IVH), statin use, glucose, and systolic blood pressure], baseline log-CRP was not associated with baseline EED: for a 50% increase in CRP the difference in expected mean EED was 0.004 cm (95%CI 0.000-0.008, p = 0.055). In a further multifactorial analysis, after adjusting for key predictors of mortality, neither a 50% increase in PHE volume nor CRP were associated with higher 30-day mortality (HR 0.97; 95%CI 0.90-1.05, p = 0.51 and HR 0.98; 95%CI 0.93-1.03, p = 0.41, respectively). Conclusion Higher baseline CRP is not associated with higher baseline edema, which is also not associated with mortality. Edema at baseline might be driven by different pathophysiological processes with different effects on outcome.
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Affiliation(s)
- Oluwaseun A. Sobowale
- Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Center, University of Manchester, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Center, Manchester Academic Health Science Center, Northern Care Alliance NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
| | - Isabel C. Hostettler
- Stroke Research Center, UCL Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Teddy Y. Wu
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Calvin Heal
- Center for Biostatistics, The University of Manchester, Manchester Academic Health Science Center, Manchester, United Kingdom
| | - Duncan Wilson
- Stroke Research Center, UCL Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
- New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Darshan G. Shah
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Department of Medicine, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andy Vail
- Center for Biostatistics, The University of Manchester, Manchester Academic Health Science Center, Manchester, United Kingdom
| | - Gagan Sharma
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Stephen M. Davis
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - David J. Werring
- Stroke Research Center, UCL Queen Square Institute of Neurology, and the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Atte Meretoja
- Department of Medicine and Neurology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
- Department of Neurology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Stuart M. Allan
- Geoffrey Jefferson Brain Research Center, Manchester Academic Health Science Center, Northern Care Alliance NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Adrian R. Parry-Jones
- Division of Cardiovascular Sciences, School of Medical Sciences, Manchester Academic Health Science Center, University of Manchester, Manchester, United Kingdom
- Geoffrey Jefferson Brain Research Center, Manchester Academic Health Science Center, Northern Care Alliance NHS Foundation Trust and University of Manchester, Manchester, United Kingdom
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Mao Y, Huang L, Ji G, Wang L, Wang X, Zheng X. Neutrophil-to-lymphocyte ratio on admission predicts early perihematomal edema growth after intracerebral hemorrhage. Medicine (Baltimore) 2024; 103:e37585. [PMID: 38518026 PMCID: PMC10957013 DOI: 10.1097/md.0000000000037585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/22/2024] [Indexed: 03/24/2024] Open
Abstract
Poor functional outcome is associated with perihematomal edema (PHE) expansion after intracerebral hemorrhage (ICH). The inflammatory response is crucial for the onset and progression of PHE. This study aimed to determine the connection between admission neutrophil-lymphocyte ratio (NLR) and early PHE development. We retrospectively analyzed patients with ICH admitted to the Chaohu Affiliated Hospital of Anhui Medical University from January 2021 to December 2022. The primary outcome measure was absolute PHE, defined as the volume of the follow-up PHE minus admission PHE. A semiautomated measurement tool (3D Slicer) was used to calculate the volumes of cerebral hematoma and cerebral edema. Spearman's correlation analysis determined the relationship between NLR and absolute PHE. The multiple linear regression model was constructed to analyze the predictive relation of admission NLR on early PHE expansion. A total of 117 patients were included. The median hematoma and PHE volumes on admission were 9.38 mL (interquartile range [IQR], 4.53-19.54) and 3.54 mL (IQR, 1.33-7.1), respectively. The median absolute PHE was 2.26 mL (IQR, 1.25-4.23), and the median NLR was 3.10 (IQR, 2.26-3.86). Spearman's correlation test showed a positive correlation between admission NLR and absolute PHE (r = .548, P < .001). Multiple linear regression analyses suggested that for every 1-unit increase in admission NLR (B = .176, SE = .043, Beta = .275, P < .001), there was a 0.176 mL increase in absolute PHE. Admission neutrophil-to-lymphocyte ratio (NLR) significantly and positively predicted early perihematomal edema (PHE) expansion.
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Affiliation(s)
- Yirong Mao
- Department of Neurosurgery, The Chaohu Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lumao Huang
- Department of Neurosurgery, The Chaohu Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Gengsheng Ji
- Department of Radiology, The Chaohu Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Liang Wang
- Department of Neurosurgery, The Chaohu Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiang Wang
- Department of Neurosurgery, The Chaohu Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xinyi Zheng
- Department of Neurosurgery, The Chaohu Affiliated Hospital of Anhui Medical University, Hefei, China
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Wu X, Liu H, Zhang R, Du Y, Cai Y, Tan Z, Liu F, Gao F, Zhang H, Zhou G, Sun F, Fan R, Wang P, Wang L, Ge S, Zhao T, Xie G, Li D, Qu Y, Guo W. Prognostic significance of perihematomal edema in basal ganglia hemorrhage after minimally invasive endoscopic evacuation. J Neurosurg 2023; 139:1784-1791. [PMID: 37209077 DOI: 10.3171/2023.4.jns222910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/07/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Spontaneous basal ganglia hemorrhage is a common type of intracerebral hemorrhage (ICH) with no definitive treatment. Minimally invasive endoscopic evacuation is a promising therapeutic approach for ICH. In this study the authors examined prognostic factors associated with long-term functional dependence (modified Rankin Scale [mRS] score ≥ 4) in patients who had undergone endoscopic evacuation of basal ganglia hemorrhage. METHODS In total, 222 consecutive patients who underwent endoscopic evacuation between July 2019 and April 2022 at four neurosurgical centers were enrolled prospectively. Patients were dichotomized into functionally independent (mRS score ≤ 3) and functionally dependent (mRS score ≥ 4) groups. Hematoma and perihematomal edema (PHE) volumes were calculated using 3D Slicer software. Predictors of functional dependence were assessed using logistic regression models. RESULTS Among the enrolled patients, the functional dependence rate was 45.50%. Factors independently associated with long-term functional dependence included female sex, older age (≥ 60 years), Glasgow Coma Scale score ≤ 8, larger preoperative hematoma volume (OR 1.02), and larger postoperative PHE volume (OR 1.03, 95% CI 1.01-1.05). A subsequent analysis evaluated the effect of stratified postoperative PHE volume on functional dependence. Specifically, patients with large (≥ 50 to < 75 ml) and extra-large (≥ 75 to 100 ml) postoperative PHE volumes had 4.61 (95% CI 0.99-21.53) and 6.75 (95% CI 1.20-37.85) times greater likelihood of long-term dependence, respectively, than patients with a small postoperative PHE volume (≥ 10 to < 25 ml). CONCLUSIONS A large postoperative PHE volume is an independent risk factor for functional dependence among basal ganglia hemorrhage patients after endoscopic evacuation, especially with postoperative PHE volume ≥ 50 ml.
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Affiliation(s)
- Xun Wu
- 1Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an
| | - Haixiao Liu
- 1Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an
- 6Shaanxi Clinical Research Center for Neurosurgical Diseases, Xi'an, China
| | - Rongjun Zhang
- 2Department of Neurosurgery, the 987 Hospital of PLA Joint Logistic Support Force, Baoji
- 6Shaanxi Clinical Research Center for Neurosurgical Diseases, Xi'an, China
| | - Yong Du
- 1Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an
| | - Yaning Cai
- 1Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an
| | - Zhijun Tan
- 3Department of Health Statistics, the Fourth Military Medical University, Xi'an, China
| | - Feng Liu
- 4Department of Neurosurgery, Ankang Central Hospital, Ankang
- 6Shaanxi Clinical Research Center for Neurosurgical Diseases, Xi'an, China
| | - Fei Gao
- 2Department of Neurosurgery, the 987 Hospital of PLA Joint Logistic Support Force, Baoji
- 6Shaanxi Clinical Research Center for Neurosurgical Diseases, Xi'an, China
| | - Hui Zhang
- 5Department of Neurosurgery, Nuclear Industry 215 Hospital of Shaanxi Province, Xianyang; and
- 6Shaanxi Clinical Research Center for Neurosurgical Diseases, Xi'an, China
| | - Gaoyang Zhou
- 1Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an
| | - Feifei Sun
- 1Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an
| | - Ruixi Fan
- 1Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an
| | - Ping Wang
- 1Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an
| | - Lei Wang
- 1Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an
| | - Shunnan Ge
- 1Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an
- 6Shaanxi Clinical Research Center for Neurosurgical Diseases, Xi'an, China
| | - Tianzhi Zhao
- 1Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an
- 6Shaanxi Clinical Research Center for Neurosurgical Diseases, Xi'an, China
| | - Guoqiang Xie
- 5Department of Neurosurgery, Nuclear Industry 215 Hospital of Shaanxi Province, Xianyang; and
- 6Shaanxi Clinical Research Center for Neurosurgical Diseases, Xi'an, China
| | - Dongbo Li
- 4Department of Neurosurgery, Ankang Central Hospital, Ankang
- 6Shaanxi Clinical Research Center for Neurosurgical Diseases, Xi'an, China
| | - Yan Qu
- 1Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an
- 6Shaanxi Clinical Research Center for Neurosurgical Diseases, Xi'an, China
| | - Wei Guo
- 1Department of Neurosurgery, Tangdu Hospital, the Fourth Military Medical University, Xi'an
- 6Shaanxi Clinical Research Center for Neurosurgical Diseases, Xi'an, China
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Lv XN, Li ZQ, Li Q. Blood-Based Biomarkers in Intracerebral Hemorrhage. J Clin Med 2023; 12:6562. [PMID: 37892701 PMCID: PMC10607631 DOI: 10.3390/jcm12206562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Intracerebral hemorrhage (ICH) is one of the most lethal subtypes of stroke, associated with high morbidity and mortality. Prevention of hematoma growth and perihematomal edema expansion are promising therapeutic targets currently under investigation. Despite recent improvements in the management of ICH, the ideal treatments are still to be determined. Early stratification and triage of ICH patients enable the adjustment of the standard of care in keeping with the personalized medicine principles. In recent years, research efforts have been concentrated on the development and validation of blood-based biomarkers. The benefit of looking for blood candidate markers is obvious because of their acceptance in terms of sample collection by the general population compared to any other body fluid. Given their ease of accessibility in clinical practice, blood-based biomarkers have been widely used as potential diagnostic, predictive, and prognostic markers. This review identifies some relevant and potentially promising blood biomarkers for ICH. These blood-based markers are summarized by their roles in clinical practice. Well-designed and large-scale studies are required to validate the use of all these biomarkers in the future.
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Affiliation(s)
- Xin-Ni Lv
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; (X.-N.L.); (Z.-Q.L.)
| | - Zuo-Qiao Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; (X.-N.L.); (Z.-Q.L.)
| | - Qi Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China; (X.-N.L.); (Z.-Q.L.)
- Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
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Chen F, Zhang S, Li B, Zhang J, Ran M, Qi B. A review of invasive intracranial pressure monitoring following surgery for hypertensive cerebral hemorrhage. Front Neurol 2023; 14:1108722. [PMID: 37470003 PMCID: PMC10353852 DOI: 10.3389/fneur.2023.1108722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/07/2023] [Indexed: 07/21/2023] Open
Abstract
Hypertensive cerebral hemorrhage, the most common prevalent of spontaneous cerebral hemorrhage, poses a significant threat to patient mortality and morbidity, while therapeutic options remain limited, making the disease a burden not only for patients' families but also a major challenge for national healthcare systems. The elevation of intracranial pressure subsequent to hypertensive cerebral hemorrhage is a critical contributor to mortality. However, it often manifests before the onset of clinical symptoms, which are typically atypical, leading to delayed treatment and irreversible consequences for the patient. Hence, early detection of intracranial pressure variations can aid in timely, efficient, and precise treatment, reducing patient mortality. Invasive intracranial pressure monitoring enables real-time, accurate monitoring of intracranial pressure changes, providing clinicians with therapeutic guidance and overcoming the limitations of empirical treatment. This article aims to review the use of invasive intracranial pressure monitoring in postoperative hypertensive cerebral hemorrhage and hopes to contribute to clinical and scientific research.
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Affiliation(s)
- Fu Chen
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Shukui Zhang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Bingzhen Li
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
| | - Jin Zhang
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Maoxin Ran
- Department of Hepatobiliary Surgery, Zhijin County People's Hospital, Bijie, China
| | - Bin Qi
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, China
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Nawabi J, Orth T, Schulze-Weddige S, Baumgaertner GL, Tietze A, Thaler C, Penzkofer T. External validation of the diagnostic value of perihematomal edema characteristics in neoplastic and non-neoplastic intracerebral hemorrhage. Eur J Neurol 2023; 30:1686-1695. [PMID: 36847734 DOI: 10.1111/ene.15760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND AND PURPOSE Neoplastic intracerebral hemorrhage (ICH) may be incorrectly identified as non-neoplastic ICH on imaging. Relative perihematomal edema (relPHE) on computed tomography (CT) has been proposed as a marker to discriminate neoplastic from non-neoplastic ICH but has not been externally validated. The purpose of this study was to evaluate the discriminatory power of relPHE in an independent cohort. METHODS A total of 291 patients with acute ICH on CT and follow-up magnetic resonance imaging (MRI) were included in this single-center retrospective study. ICH subjects were dichotomized into non-neoplastic or neoplastic ICH based on the diagnosis on the follow-up MRI. ICH and PHE volumes and density values were derived from semi-manually segmented CT scans. Calculated PHE characteristics for discriminating neoplastic ICH were evaluated using receiver-operating characteristic (ROC) curves. ROC curve-associated cut-offs were calculated and compared between the initial and the validation cohort. RESULTS A total of 116 patients (39.86%) with neoplastic ICH and 175 (60.14%) with non-neoplastic ICH were included. Median PHE volumes, relPHE, and relPHE adjusted for hematoma density were significantly higher in subjects with neoplastic ICH (all p values <0.001). ROC curves for relPHE had an area under the curve (AUC) of 0.72 (95% confidence interval [CI] 0.66-0.78) and an AUC of 0.81 (95% CI 0.76-0.87) for adjusted relPHE. The cut-offs were identical in the two cohorts, with >0.70 for relPHE and >0.01 for adjusted relPHE. CONCLUSIONS Relative perihematomal edema and adjusted relPHE accurately discriminated neoplastic from non-neoplastic ICH on CT imaging in an external patient cohort. These results confirmed the findings of the initial study and may improve clinical decision making.
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Affiliation(s)
- Jawed Nawabi
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin Institute of Health, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany
| | - Tobias Orth
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin Institute of Health, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Sophia Schulze-Weddige
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin Institute of Health, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Georg Lukas Baumgaertner
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin Institute of Health, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Anna Tietze
- Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin Institute of Health, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Christian Thaler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - Tobias Penzkofer
- Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany
- Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin Institute of Health, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
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Vogt E, Vu LH, Cao H, Speth A, Desser D, Schlunk F, Dell’Orco A, Nawabi J. Multilesion Segmentations in Patients with Intracerebral Hemorrhage: Reliability of ICH, IVH and PHE Masks. Tomography 2023; 9:89-97. [PMID: 36648995 PMCID: PMC9844445 DOI: 10.3390/tomography9010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
Background and Purpose: Fully automated methods for segmentation and volume quantification of intraparenchymal hemorrhage (ICH), intraventricular hemorrhage extension (IVH), and perihematomal edema (PHE) are gaining increasing interest. Yet, reliabilities demonstrate considerable variances amongst each other. Our aim was therefore to evaluate both the intra- and interrater reliability of ICH, IVH and PHE on ground-truth segmentation masks. Methods: Patients with primary spontaneous ICH were retrospectively included from a German tertiary stroke center (Charité Berlin; January 2016−June 2020). Baseline and follow-up non-contrast Computed Tomography (NCCT) scans were analyzed for ICH, IVH, and PHE volume quantification by two radiology residents. Raters were blinded to all demographic and outcome data. Inter- and intrarater agreements were determined by calculating the Intraclass Correlation Coefficient (ICC) for a randomly selected set of patients with ICH, IVH, and PHE. Results: 100 out of 670 patients were included in the analysis. Interrater agreements ranged from an ICC of 0.998 for ICH (95% CI [0.993; 0.997]), to an ICC of 0.979 for IVH (95% CI [0.984; 0.993]), and an ICC of 0.886 for PHE (95% CI [0.760; 0.938]), all p-values < 0.001. Intrarater agreements ranged from an ICC of 0.997 for ICH (95% CI [0.996; 0.998]), to an ICC of 0.995 for IVH (95% CI [0.992; 0.996]), and an ICC of 0.980 for PHE (95% CI [0.971; 0.987]), all p-values < 0.001. Conclusion Manual segmentations of ICH, IVH, and PHE demonstrate good-to-excellent inter- and intrarater reliabilities, with the highest agreement for ICH and IVH and lowest for PHE. Therefore, the degree of variances reported in fully automated quantification methods might be related amongst others to variances in ground-truth masks.
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Affiliation(s)
- Estelle Vogt
- Department of Radiology, Charité School of Medicine and University Hospital Berlin, 10117 Berlin, Germany
- Correspondence:
| | - Ly Huong Vu
- Department of Radiology, Charité School of Medicine and University Hospital Berlin, 10117 Berlin, Germany
| | - Haoyin Cao
- Department of Radiology, Charité School of Medicine and University Hospital Berlin, 10117 Berlin, Germany
| | - Anna Speth
- Department of Neuroradiology, Charité School of Medicine and University Hospital Berlin, 10117 Berlin, Germany
| | - Dmitriy Desser
- Department of Neuroradiology, Charité School of Medicine and University Hospital Berlin, 10117 Berlin, Germany
| | - Frieder Schlunk
- Department of Neuroradiology, Charité School of Medicine and University Hospital Berlin, 10117 Berlin, Germany
- Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, 10178 Berlin, Germany
| | - Andrea Dell’Orco
- Department of Neuroradiology, Charité School of Medicine and University Hospital Berlin, 10117 Berlin, Germany
| | - Jawed Nawabi
- Department of Radiology, Charité School of Medicine and University Hospital Berlin, 10117 Berlin, Germany
- Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, 10178 Berlin, Germany
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Guo W, Meng L, Lin A, Lin Y, Fu Y, Chen W, Li S. Implication of Cerebral Small-Vessel Disease on Perihematomal Edema Progress in Patients With Hypertensive Intracerebral Hemorrhage. J Magn Reson Imaging 2023; 57:216-224. [PMID: 35749634 DOI: 10.1002/jmri.28240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 05/08/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Perihematomal edema (PHE) is an important determinant of outcome in spontaneous intracerebral hemorrhage (ICH) due to cerebral small vessel disease (CSVD). However, it is not known to date whether the severity of CSVD is associated with the extent of PHE progression in the acute phase. PURPOSE To investigate the association between the magnetic resonance imaging (MRI) marker of severe chronic-ischemia cerebral small vessel changes (sciSVC) and PHE growth or hematoma absorption among ICH patients with hypertension. STUDY TYPE Retrospective. POPULATION Three hundred and sixty-eight consecutive hypertensive ICH patients without surgical treatment. FIELD STRENGTH/SEQUENCE 3 T; spin-echo echo-planar imaging-diffusion-weighted imaging (DWI); T2-weighted, fluid-attenuated inversion recovery (FLAIR), T2*-weighted gradient-recalled echo and T1-weighted. ASSESSMENT The hematoma and PHE volumes at 24 hours and 5 days after symptom onset were measured in 121 patients with spontaneous ICH who had been administered standard medical treatment. Patients were grouped into two categories: those with sciSVC and those without. The imaging marker of sciSVC was defined as white matter hyperintensities (WMHs) Fazekas 2-3 combined cavitating lacunes. STATISTICAL TESTS Univariable analyses, χ2 test, Mann-Whitney U test, and multiple linear regression. RESULTS The presence of sciSVC (multiple lacunes and confluent WMH) had a significant negative influence on PHE progress (Beta = -5.3 mL, 95% CI = -10.3 mL to -0.3 mL), and hematoma absorption (Beta = -3.2 mL, 95% CI = -5.9 mL to -0.4 mL) compared to that observed in the absence of sciSVC, as determined by multivariate linear regression analysis. DATA CONCLUSIONS The presence of sciSVC (multiple lacunes and confluent WMH) negatively influenced hematoma absorption and PHE progress in ICH patients. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Wenliang Guo
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Lanxi Meng
- Department of Neuroimaging, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aiyu Lin
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Yi Lin
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Ying Fu
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - WanJin Chen
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, China
| | - Shaowu Li
- Department of Neuroimaging, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Jeon JP, Han SW, Kim TY, Lim SH, Youn DH, Rhim JK, Park JJ, Ahn JH, Kim HC, Yang J. Association of Haptoglobin Phenotypes with Outcomes in Patients with Spontaneous Intracerebral Hemorrhage. Life (Basel) 2022; 12:life12071001. [PMID: 35888091 PMCID: PMC9318044 DOI: 10.3390/life12071001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/25/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022]
Abstract
Object. We aimed to investigate the association of Haptoglobin (Hp) phenotypes with perihematomal edema (PHE) and neurological outcomes after intracerebral hemorrhage (ICH). Methods. This prospective multicenter study enrolled patients that suffered ICH from March 2017 to February 2020. Hp phenotypes were determined using Western blotting; relative α1 intensity was calculated in patients with Hp2-1. A multivariable logistic regression analysis was then conducted to identify risk factors for increased relative PHE at 96 h and 3-month poor outcomes. Results. In total, 120 patients were ultimately enrolled: Hp1-1 (n = 15, 12.5%); Hp2-1 (n = 51, 42.5%); and Hp2-2 (n = 54, 45.0%). Hp phenotype was significantly associated with PHE (p = 0.028). With Hp1-1 as a reference value, Hp2-2 significantly increased the likelihood of increased rPHE (OR = 6.294, 95% CI: 1.283–30.881), while Hp2-1 did not (OR = 2.843, 95% CI: 0.566–14.284). Poor outcomes were found to be closely associated with hematoma volume at admission (OR = 1.057, 95% CI: 1.015–1.101) and surgical treatment (OR = 5.340, 95% CI: 1.665–17.122) but not Hp phenotypes (p = 0.190). Further, a high level of relative α1 intensity was identified to be significantly associated with decreased rPHE (OR = 0.020, 95% CI: 0.001–0.358). However, the relative α1 intensity was not associated with poor outcomes (OR = 0.057, 95% CI: 0.001–11.790). Conclusions: ICH patients with Hp2-2 exhibited a higher likelihood of increased rPHE than those with Hp1-1. Higher relative α1 intensities were identified to be closely associated with rPHE in patients with Hp2-1.
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Affiliation(s)
- Jin Pyeong Jeon
- Department of Neurosurgery, Hallym University College of Medicine, Chuncheon 24253, Korea;
| | - Sung Woo Han
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.W.H.); (T.Y.K.); (S.H.L.); (D.H.Y.)
| | - Tae Yeon Kim
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.W.H.); (T.Y.K.); (S.H.L.); (D.H.Y.)
| | - Seung Hyuk Lim
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.W.H.); (T.Y.K.); (S.H.L.); (D.H.Y.)
| | - Dong Hyuk Youn
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon 24253, Korea; (S.W.H.); (T.Y.K.); (S.H.L.); (D.H.Y.)
| | - Jong Kook Rhim
- Department of Neurosurgery, Jeju National University College of Medicine, Jeju 63243, Korea;
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Seoul 05030, Korea;
| | - Jun Hyong Ahn
- Department of Neurosurgery, Kangwon National University Hospital, Chuncheon 24289, Korea;
| | - Heung Cheol Kim
- Department of Radiology, Hallym University College of Medicine, Chuncheon 24253, Korea;
| | - Jinseo Yang
- Department of Neurology, Konkuk University Medical Center, Seoul 05030, Korea;
- Correspondence:
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12
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Jingjing Z, Jingjing Z, Bo H, Le W, Jingya W, Dong W, Fang Y, Wen J. Pretreatment of Sulfonylureas Reducing Perihematomal Edema in Diabetic Patients With Basal Ganglia Hemorrhage: A Retrospective Case-Control Study. Front Neurol 2021; 12:736383. [PMID: 34744976 PMCID: PMC8569795 DOI: 10.3389/fneur.2021.736383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The sulfonylurea receptor 1–transient receptor potential melastatin 4 (SUR1–TRPM4) channel is a target key mediator of brain edema. Sulfonylureas (SFUs) are blockers of the SUR1–TRPM4 channel. We made two assessments for the pretreatment of SFUs: (1) whether it associates with lower perihematomal edema (PHE) and (2) whether it associates with improved clinical outcomes in diabetic patients who have acute basal ganglia hemorrhage. Methods: This retrospective case-control study was conducted in diabetic adults receiving regular SFUs before the onset of intracerebral hemorrhage (ICH). All of the patients received the clinical diagnosis of spontaneous basal ganglia hemorrhage. The diagnosis was confirmed by a CT scan within 7 days after hemorrhage. For each case, we selected two matched controls with basal ganglia hemorrhage based on admission time (≤5 years) and age differences (≤5 years), with the same gender and similar hematoma volume. The primary outcome was PHE volume, and the secondary outcomes were relative PHE (rPHE), functional independence according to modified Rankin Scale score and Barthel Index at discharge, and death rate in the hospital. Results: A total of 27 patients (nine cases and 18 matched controls), admitted between January 1, 2009 and October 31, 2018, were included in our study. There was no significant association between SFU patients and non-SFU patients on PHE volumes [15.4 (7.4–50.2 ml) vs. 8.0 (3.1–22.1) ml, p = 0.100]. Compared to non-SFU patients, the SFU patients had significantly lower rPHE [0.8 (0.7–1.3) vs. 1.5 (1.2–1.9), p = 0.006]. After we adjusted the confounding factors, we found that sulfonylureas can significantly reduce both PHE volume (regression coefficient: −13.607, 95% CI: −26.185 to −1.029, p = 0.035) and rPHE (regression coefficient: −0.566, 95% CI: −0.971 to −0.161, p = 0.009). However, we found no significant improvement in clinical outcomes at discharge, in the event of pretreatment of SFUs before the onset of ICH, even after we adjusted the confounding factors. Conclusion: For diabetic patients with acute basal ganglia hemorrhage, pretreatment of sulfonylureas may associate with lower PHE and relative PHE on admission. No significant effect was found on the clinical outcomes when the patients were discharged. Future studies are needed to assess the potential clinical benefits using sulfonylureas for ICH patients.
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Affiliation(s)
- Zhang Jingjing
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Zhao Jingjing
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Hui Bo
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Wang Le
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Wei Jingya
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Wei Dong
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Yang Fang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Jiang Wen
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
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13
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Chen Y, Chen S, Chang J, Wei J, Feng M, Wang R. Perihematomal Edema After Intracerebral Hemorrhage: An Update on Pathogenesis, Risk Factors, and Therapeutic Advances. Front Immunol 2021; 12:740632. [PMID: 34737745 PMCID: PMC8560684 DOI: 10.3389/fimmu.2021.740632] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022] Open
Abstract
Intracerebral hemorrhage (ICH) has one of the worst prognoses among patients with stroke. Surgical measures have been adopted to relieve the mass effect of the hematoma, and developing targeted therapy against secondary brain injury (SBI) after ICH is equally essential. Numerous preclinical and clinical studies have demonstrated that perihematomal edema (PHE) is a quantifiable marker of SBI after ICH and is associated with a poor prognosis. Thus, PHE has been considered a promising therapeutic target for ICH. However, the findings derived from existing studies on PHE are disparate and unclear. Therefore, it is necessary to classify, compare, and summarize the existing studies on PHE. In this review, we describe the growth characteristics and relevant underlying mechanism of PHE, analyze the contributions of different risk factors to PHE, present the potential impact of PHE on patient outcomes, and discuss the currently available therapeutic strategies.
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Affiliation(s)
- Yihao Chen
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengpan Chen
- Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangdong Institute of Neuroscience, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Jianbo Chang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Junji Wei
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ming Feng
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Renzhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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14
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Bautista W, Adelson PD, Bicher N, Themistocleous M, Tsivgoulis G, Chang JJ. Secondary mechanisms of injury and viable pathophysiological targets in intracerebral hemorrhage. Ther Adv Neurol Disord 2021; 14:17562864211049208. [PMID: 34671423 PMCID: PMC8521409 DOI: 10.1177/17562864211049208] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 09/09/2021] [Indexed: 01/18/2023] Open
Abstract
Intracerebral hemorrhage (ICH) can be divided into a primary and secondary phase. In the primary phase, hematoma volume is evaluated and therapies are focused on reducing hematoma expansion. In the secondary, neuroprotective phase, complex systemic inflammatory cascades, direct cellular toxicity, and blood-brain barrier disruption can result in worsening perihematomal edema that can adversely affect functional outcome. To date, all major randomized phase 3 trials for ICH have targeted primary phase hematoma volume and incorporated clot evacuation, intensive blood pressure control, and hemostasis. Reasons for this lack of clinical efficacy in the major ICH trials may be due to the lack of therapeutics involving mitigation of secondary injury and inflexible trial design that favors unilateral mechanisms in a complex pathophysiology. Potential pathophysiological targets for attenuating secondary injury are highlighted in this review and include therapies increasing calcium, antagonizing microglial activation, maintaining macrophage M1 versus M2 balance by decreasing M1 signaling, aquaporin inhibition, NKCCl inhibition, endothelin receptor inhibition, Sur1-TRPM4 inhibition, matrix metalloproteinase inhibition, and sphingosine-1-phosphate receptor modulation. Future clinical trials in ICH focusing on secondary phase injury and, potentially implementing adaptive trial design approaches with multifocal targets, may improve insight into these mechanisms and provide potential therapies that may improve survival and functional outcome.
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Affiliation(s)
- Wendy Bautista
- Center for Advanced Preclinical Research (CAPR), National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - P David Adelson
- Division of Pediatric Neurosurgery, Department of Child Health, Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Nathan Bicher
- Department of Neurology, Georgetown University Medical Center, Washington, DC, USA
| | - Marios Themistocleous
- Department of Neurosurgery, Pediatric Hospital of Athens, Agia Sophia, Athens, Greece
| | - Georgios Tsivgoulis
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, 110 Irving Street, NW, Rm 4B42, Washington, DC 20010, USA
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15
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Ye G, Huang S, Chen R, Zheng Y, Huang W, Gao Z, Cai L, Zhao M, Ma K, He Q, Lin F, Lin Y, Wang D, Fang W, Kang D, Wu X. Early Predictors of the Increase in Perihematomal Edema Volume After Intracerebral Hemorrhage: A Retrospective Analysis From the Risa-MIS-ICH Study. Front Neurol 2021; 12:700166. [PMID: 34385972 PMCID: PMC8353085 DOI: 10.3389/fneur.2021.700166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose: Perihematomal edema (PHE) is associated with poor functional outcomes after intracerebral hemorrhage (ICH). Early identification of risk factors associated with PHE growth may allow for targeted therapeutic interventions. Methods: We used data contained in the risk stratification and minimally invasive surgery in acute intracerebral hemorrhage (Risa-MIS-ICH) patients: a prospective multicenter cohort study. Patients' clinical, laboratory, and radiological data within 24 h of admission were obtained from their medical records. The absolute increase in PHE volume from baseline to day 3 was defined as iPHE volume. Poor outcome was defined as modified Rankin Scale (mRS) of 4 to 6 at 90 days. Binary logistic regression was used to assess the relationship between iPHE volume and poor outcome. The receiver operating characteristic curve was used to find the best cutoff. Linear regression was used to identify variables associated with iPHE volume (ClinicalTrials.gov Identifier: NCT03862729). Results: One hundred ninety-seven patients were included in this study. iPHE volume was significantly associated with poor outcome [P = 0.003, odds ratio (OR) 1.049, 95% confidence interval (CI) 1.016-1.082] after adjustment for hematoma volume. The best cutoff point of iPHE volume was 7.98 mL with a specificity of 71.4% and a sensitivity of 47.5%. Diabetes mellitus (P = 0.043, β = 7.66 95% CI 0.26-15.07), black hole sign (P = 0.002, β = 18.93 95% CI 6.84-31.02), and initial ICH volume (P = 0.018, β = 0.20 95% CI 0.03-0.37) were significantly associated with iPHE volume. After adjusting for hematoma expansion, the black hole sign could still independently predict the increase of PHE (P < 0.001, β = 21.62 95% CI 10.10-33.15). Conclusions: An increase of PHE volume >7.98 mL from baseline to day 3 may lead to poor outcome. Patients with diabetes mellitus, black hole sign, and large initial hematoma volume result in more PHE growth, which should garner attention in the treatment.
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Affiliation(s)
- Gengzhao Ye
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shuna Huang
- Department of Clinical Research and Translation Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Renlong Chen
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yan Zheng
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wei Huang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhuyu Gao
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Lueming Cai
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Mingpei Zhao
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ke Ma
- Department of Clinical Research and Translation Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qiu He
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Fuxin Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuanxiang Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Dengliang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wenhua Fang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Dezhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiyue Wu
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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Zhao J, Yang F, Song C, Li L, Yang X, Wang X, Yu L, Guo J, Wang K, Fu F, Jiang W. Glibenclamide Advantage in Treating Edema After Intracerebral Hemorrhage (GATE-ICH): Study Protocol for a Multicenter Randomized, Controlled, Assessor-Blinded Trial. Front Neurol 2021; 12:656520. [PMID: 33986719 PMCID: PMC8110908 DOI: 10.3389/fneur.2021.656520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/25/2021] [Indexed: 01/12/2023] Open
Abstract
Introduction: Brain edema after acute intracerebral hemorrhage (ICH) plays a critical role in the secondary injury of ICH and may heighten the potential for a poor outcome. This trial aims to explore the efficacy of small doses of oral glibenclamide in perihematomal edema (PHE) and the prognosis of patients with ICH. Methods and Analysis: The GATE-ICH trial is a multicenter randomized, controlled, assessor-blinded trial. A total of 220 adult patients with acute primary ICH in 28 study centers in China will be randomized to the glibenclamide group (glibenclamide plus guideline-recommended ICH management) or the control group (guideline-recommended ICH management). Multivariate logistic regression will be used to analyze the relationship between the treatments and primary outcome. Study Outcomes: The primary efficacy outcome is the proportion of poor functional outcomes (modified Rankin Scale ≥3) at 90 days after enrollment. The secondary efficacy outcomes include changes in the volume of ICH and PHE between the baseline and follow-up computed tomography scans as well as the clinical scores between the baseline and follow-up assessments. Discussion: The GATE-ICH trial will assess the effects of small doses of oral glibenclamide in reducing the PHE after ICH and improving the 90-day prognosis of patients. Clinical Trial Registration: www.clinicaltrials.gov., NCT03741530. Registered on November 8, 2018. Trial Status: Protocol version: May 6, 2019, Version 5. Recruitment and follow-up of patients is currently ongoing. This trial will be end in the second quarter of 2021.
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Affiliation(s)
- Jingjing Zhao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Fang Yang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Changgeng Song
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Li Li
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Xiai Yang
- Department of Neurology, Ankang Central Hospital, Ankang, China
| | - Xiaofeng Wang
- Department of Neurosurgery, The PLA 987 Hospital, Baoji, China
| | - Liping Yu
- Department of Neurology, The First Peoples Hospital of Xianyang, Xianyang, China
| | - Jun Guo
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
| | - Kangjun Wang
- Department of Neurology, Hanzhong Central Hospital, Hanzhong, China
| | - Feng Fu
- Department of Neurology, 215 Hospital of Shaanxi NI, Xianyang, China
| | - Wen Jiang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University (Air Force Medical University), Xi'an, China
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17
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Zhao W, Jiang F, Li S, Liu G, Wu C, Wang Y, Ren C, Zhang J, Gu F, Zhang Q, Gao X, Gao Z, Song H, Ma Q, Ding Y, Ji X. Safety and efficacy of remote ischemic conditioning for the treatment of intracerebral hemorrhage: A proof-of-concept randomized controlled trial. Int J Stroke 2021; 17:425-433. [PMID: 33739197 DOI: 10.1177/17474930211006580] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Remote ischemic conditioning can promote hematoma resolution, attenuate brain edema, and improve neurological recovery in animal models of intracerebral hemorrhage. AIMS This study aimed to evaluate the safety and preliminary efficacy of remote ischemic conditioning in patients with intracerebral hemorrhage. METHODS In this multicenter, randomized, controlled trial, 40 subjects with supratentorial intracerebral hemorrhage presenting within 24-48 h of onset were randomly assigned to receive medical therapy plus remote ischemic conditioning for consecutive seven days or medical therapy alone. The primary safety outcome was neurological deterioration within seven days of enrollment, and the primary efficacy outcome was the changes of hematoma volume on CT images. Other outcomes included hematoma resolution rate at 7 days ([hematoma volume at 7 days - hematoma volume at baseline]/hematoma volume at baseline), perihematomal edema (PHE), and functional outcome at 90 days. RESULTS The mean age was 59.3 ± 11.7 years and hematoma volume was 13.9 ± 4.5 mL. No subjects experienced neurological deterioration within seven days of enrollment, and no subject died or experienced remote ischemic conditioning-associated adverse events during the study period. At baseline, the hematoma volumes were 14.19 ± 5.07 mL in the control group and 13.55 ± 3.99 mL in the remote ischemic conditioning group, and they were 8.54 ± 3.99 mL and 6.95 ± 2.71 mL at seven days after enrollment, respectively, which is not a significant difference (p > 0.05 each). The hematoma resolution rate in the remote ischemic conditioning group (49.25 ± 9.17%) was significantly higher than in the control group (41.92 ± 9.14%; MD, 7.3%; 95% CI, 1.51-13.16%; p = 0.015). The absolute PHE volume was 17.27 ± 8.34 mL in the control group and 12.92 ± 7.30 mL in the remote ischemic conditioning group at seven days after enrollment, which is not a significant between-group difference (p = 0.087), but the relative PHE in the remote ischemic conditioning group (1.77 ± 0.39) was significantly lower than in the control group (2.02 ± 0.27; MD, 0.25; 95% CI, 0.39-0.47; p = 0.023). At 90-day follow-up, 13 subjects (65%) in the remote ischemic conditioning group and 12 subjects (60%) in the control group achieved favorable functional outcomes (modified Rankin Scale score ≤ 3), which is not a significant between-group difference (p = 0.744). CONCLUSIONS Repeated daily remote ischemic conditioning for consecutive seven days was safe and well tolerated in patients with intracerebral hemorrhage, and it may be able to improve hematoma resolution rate and reduce relative PHE. However, the effects of remote ischemic conditioning on the absolute hematoma and PHE volume and functional outcomes in this patient population need further investigations.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03930940.
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Affiliation(s)
- Wenbo Zhao
- Department of Neurology, 71044Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fang Jiang
- Department of Neurology, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Sijie Li
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Guiyou Liu
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Chuanjie Wu
- Department of Neurology, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuang Wang
- Department of Neurology, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Changhong Ren
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Neurology, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fei Gu
- Department of Neurology, Ningjin County Hospital, Xingtai, China
| | - Quanzhong Zhang
- Department of Neurosurgery, 523110Heze Municipal Hospital, Heze, China
| | - Xinjing Gao
- Department of Neurosurgery, The Sixth Hospital of Hengshui, Hengshui, China
| | - Zongen Gao
- Department of Neurology, 499782Shengli Oilfield Central Hospital, Dongying, China
| | - Haiqing Song
- Department of Neurology, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qingfeng Ma
- Department of Neurology, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, 12267Wayne State University School of Medicine, Detroit, MI, USA
| | - Xunming Ji
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China.,Department of Neurosurgery, 71044Xuanwu Hospital, Capital Medical University, Beijing, China
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18
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Wang KW, Liang CL, Yeh LR, Liu KY, Chen CC, Chen JS, Chen HJ, Wang HK. Simvastatin-Ezetimibe enhances growth factor expression and attenuates neuron loss in the hippocampus in a model of intracerebral hemorrhage. Fundam Clin Pharmacol 2021; 35:634-644. [PMID: 33278834 PMCID: PMC8451876 DOI: 10.1111/fcp.12635] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 01/02/2023]
Abstract
Intracerebral hemorrhage (ICH) is a common and severe neurological disorder associated with high morbidity and mortality rates. Despite extensive research into its pathology, there are no clinically approved neuroprotective treatments for ICH. Increasing evidence has revealed that inflammatory responses mediate the pathophysiological processes of brain injury following ICH. Experimental ICH was induced by direct infusion of 100 μL fresh (non‐heparinized) autologous whole blood into the right basal ganglia of Sprague–Dawley rats at a constant rate (10 μL/min). The simvastatin group was administered simvastatin (15 mg/kg) and the combination therapy group was administered simvastatin (10 mg/kg) and ezetimibe (10 mg/kg). Magnetic resonance imaging (MRI), the forelimb use asymmetry test, the Morris water maze test, and two biomarkers were used to evaluate the effect of simvastatin and combination therapy. MRI imaging revealed that combination therapy resulted in significantly reduced perihematomal edema. Biomarker analyses revealed that both treatments led to significantly reduced endothelial inflammatory responses. The forelimb use asymmetry test revealed that both treatment groups had significantly improved neurological outcomes. The Morris water maze test revealed improved neurological function after combined therapy, which also led to less neuronal loss in the hippocampal CA1 region. In conclusion, simvastatin–ezetimibe combination therapy can improve neurological function, attenuate the endothelial inflammatory response and lead to less neuronal loss in the hippocampal CA1 region in a rat model of ICH.
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Affiliation(s)
- Kuo-Wei Wang
- I-Shou University School of Medicine, No. 8, Yi-Da road, Kaohsiung, 824, Taiwan.,Department of Neurosurgery, E-Da Cancer Hospital, No. 1, Yi-Da road, Kaohsiung, 824, Taiwan
| | - Cheng-Loong Liang
- I-Shou University School of Medicine, No. 8, Yi-Da road, Kaohsiung, 824, Taiwan.,Department of Neurosurgery, E-DA Hospital, No. 1, Yi-Da road, Kaohsiung, 824, Taiwan
| | - Lee-Ren Yeh
- I-Shou University School of Medicine, No. 8, Yi-Da road, Kaohsiung, 824, Taiwan.,Department of Radiology, E-DA Hospital, No. 1, Yi-Da road, Kaohsiung, 824, Taiwan
| | - Kuo-Ying Liu
- Department of Radiology, E-Da Cancer Hospital, No. 1, Yi-Da road, Kaohsiung, 824, Taiwan
| | - Chao-Chi Chen
- Department of Radiology, E-Da Cancer Hospital, No. 1, Yi-Da road, Kaohsiung, 824, Taiwan
| | - Jui-Sheng Chen
- Department of Neurosurgery, E-DA Hospital, No. 1, Yi-Da road, Kaohsiung, 824, Taiwan
| | - Han-Jung Chen
- I-Shou University School of Medicine, No. 8, Yi-Da road, Kaohsiung, 824, Taiwan.,Department of Neurosurgery, E-DA Hospital, No. 1, Yi-Da road, Kaohsiung, 824, Taiwan
| | - Hao-Kuang Wang
- I-Shou University School of Medicine, No. 8, Yi-Da road, Kaohsiung, 824, Taiwan.,Department of Neurosurgery, E-DA Hospital, No. 1, Yi-Da road, Kaohsiung, 824, Taiwan
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19
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Jiang W, Jin P, Bao Q, Wei W, Jiang W. Prognostic significance of serum translocator protein in patients with spontaneous intracerebral hematoma:preliminary findings. Neurol Res 2020; 43:412-417. [PMID: 33357157 DOI: 10.1080/01616412.2020.1866372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: The aim of this study was to measure the level of translocator protein (TSPO) in patients with intracerebral hematoma (ICH) and to determine whether TSPO can predict ICH outcomes.Method: Patients with ICH were recruited at Wujin Hospital Affiliated with Jiangsu University between January 2018 and May 2020. The level of TSPO and inflammatory factors were analyzed by enzyme-linked immunosorbent assay (ELISA). A receiver operating characteristic curve (ROC) analysis was applied to assess the accuracy of TSPO for predicting patient outcomes.Result: The median of TSPO was 2.26 ng/ml. The lower- (46 cases) and higher-(51 cases) TSPO groups were thus divided based on the median value. The perihematomal edema (PHE) volume in the lower TSPO group was 6.3 ± 1.3 ml which was significantly lower than that in higher-TSPO group (14.8 ± 3.5 ml) (p < 0.05). The serum level of the interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) in the higher-TSPO group was significantly higher than that in the lower TSPO group (p < 0.05). The Spearman's correlation found that TSPO concentrations significantly correlated with PHE volume, modified Rankin Scale score (MRS), IL-1β, IL-6, TNF-α, and CRP concentrations. The area under the ROC (AUC), specificity, sensitivity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and Diagnostic Odds Ratio (DOR) of TSPO was 0.932, 82.1%, 89.9%, 5.02, 0.12, and 40.8, respectively, which was more reliable than other inflammatory factors.Conclusion: The TSPO may a reliable biomarker in predicting the prognosis of ICH patients.
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Affiliation(s)
- Wenqing Jiang
- Department of Neurosurgery, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China.,Department of Neurosurgery, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
| | - Peng Jin
- Department of Neurosurgery, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China.,Department of Neurosurgery, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
| | - Qing Bao
- Department of Neurosurgery, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China.,Department of Neurosurgery, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
| | - Wenfeng Wei
- Department of Neurosurgery, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China.,Department of Neurosurgery, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
| | - Wei Jiang
- Department of Neurosurgery, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China.,Department of Neurosurgery, The Wujin Clinical College of Xuzhou Medical University, Changzhou, Jiangsu, China
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20
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Halstead MR, Mould WA, Sheth KN, Rosand J, Thompson R, Levy A, Hanley DF, Goldstein JN, Nyquist P. Haptoglobin is associated with increased early perihematoma edema progression in spontaneous intracranial hemorrhage. Int J Stroke 2020; 15:899-908. [PMID: 32264796 DOI: 10.1177/1747493020912602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Perihematomal edema in intracranial hemorrhage is influenced by free hemoglobin clearance and inflammation. Serum Haptoglobin (Hp) binds free hemoglobin, affecting heme clearance and free radical production. Of the three Hp phenotypes, Hp 1-1 has the greatest effect on free hemoglobin clearance. AIM To determine if individuals with Hp 1-1 phenotype have different rates of early perihematomal edema formation as compared to those with Hp 2-1 and Hp 2-2. METHODS We determined Hp phenotype, intracranial hemorrhage volume, and rate of early change in perihematomal volume in participants from three prospectively collected intracranial hemorrhage cohorts. The association of Hp phenotypes 1-1, 2-1, 2-2, with early change in perihematomal volume, while controlling for key clinical characteristics was analyzed using a multivariate model. FINDINGS One-hundred and sixty-six participants were included: 73 (44%) female, 41 ( 25%) African Americans, 34 (20%) diabetics, 133 (80%) with hypertension, and 75 (45%) active smokers. There were 15 subjects with Hp phenotype 1-1, 86 with 2-1, and 65 with 2-2. In fully adjusted analysis, Hp 1-1 had a significantly increased estimated mean rate of early change in perihematomal volume at 1.15 (95% confidence interval 0.58-1.71) as compared to all other Hp 2-1 or Hp 2-2 containing phenotypes (0.30, 95% confidence interval 0.06-0.54; 0.29 95% CI 0.02-0.56). Neither mortality nor discharge mRS differed between Hp phenotypes. CONCLUSION Haptoglobin phenotype is associated with early change in perihematomal volume. Hp 1-1 phenotype had significantly increased mean rate of early change in perihematomal volume within the first 96 h, suggesting that haptoglobin phenotype may be a key player in understanding the multiphasic progression of perihematomal volume in spontaneous intracerebral hemorrhage. A larger prospective observational study is warranted.
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Affiliation(s)
- Michael R Halstead
- Departments of Neurology, Anesthesiology Critical Care Medicine and Neurosurgery, Johns Hopkins Hospital, Neurosciences Critical Care Division, Baltimore MD, USA
| | - W Andrew Mould
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin N Sheth
- Department of Neurology, Yale University, New Haven, CT, USA
| | - Jonathan Rosand
- Division of Neurocritical Care and Emergency Neurology, Center for Genomic Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Richard Thompson
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew Levy
- Bruce Rappaport Technion Faculty of Medicine, Haifa, Israel
| | - Daniel F Hanley
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joshua N Goldstein
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Paul Nyquist
- Department of Anesthesiology and Critical Care Medicine, Neurology, Neurosurgery, and General Internal Medicine, Johns Hopkins University, Baltimore, MD, USA
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21
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Chen R, Song Z, Deng M, Zheng W, Liu J, Huang L. TIMP-2 Polymorphisms Define Subtypes of Hypertensive Intracerebral Hemorrhage with Distinct Perihematomal Edema Development Patterns. Curr Neurovasc Res 2019; 17:44-49. [PMID: 31870265 DOI: 10.2174/1567202617666191223145632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/17/2019] [Accepted: 11/20/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Perihematomal edema (PHE) is a major threat leading to poor functional outcomes after intracerebral hemorrhage (ICH). TIMP-2 is considered to participate in the formation of PHE after ICH by antagonizing the damaging effects of MMP-2. In the early study, the polymorphisms of TIMP-2 rs8179090 have shown to influence the expression of TIMP-2. OBJECTIVE To prove that the severity of PHE was different in ICH patients with different TIMP-2 rs8179090 genotypes. METHODS In this prospective study, 130 hypertensive ICH patients were enrolled. The poly phisms of rs8179090 in TIMP-2 were determined. The hematoma volume and PHE volume were measured by computed tomography (CT) scan immediately after the onset of ICH, and were measured again one week and two weeks after the onset. Then, the comparison of TIMP-2 rs8179090 genotypes was made. RESULTS TIMP-2-418 position (rs8179090) had two genotypes in the studied population, GC and GG. Patients with the GC genotype developed more severe PHE, with a higher incidence of delayed cerebral edema in cerebral hemorrhage than those with the GG genotype. CONCLUSION We have found that the GC genotype group may develop more severe PHE, with an increased incidence of delayed cerebral edema in cerebral hemorrhage.
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Affiliation(s)
- Ru Chen
- Department of Neurology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Zhi Song
- Department of Neurology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Mingzhu Deng
- Department of Neurology, Brain Hospital of Hunan Province, Changsha, China
| | - Wen Zheng
- Department of Neurology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jia Liu
- Department of Neurology, Traditional Chinese Medicine Hospital of Xinjiang, Urumqi, China
| | - Lihua Huang
- Center for Medical Experiments, The Third Xiangya Hospital of Central South University, Changsha, China
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22
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Haque ME, Gabr RE, George SD, Zhao X, Boren SB, Zhang X, Ting SM, Sun G, Hasan KM, Savitz S, Aronowski J. Serial Metabolic Evaluation of Perihematomal Tissues in the Intracerebral Hemorrhage Pig Model. Front Neurosci 2019; 13:888. [PMID: 31496934 PMCID: PMC6712426 DOI: 10.3389/fnins.2019.00888] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/07/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose Perihematomal edema (PHE) occurs in patients with intracerebral hemorrhage (ICH) and is often used as surrogate of secondary brain injury. PHE resolves over time, but little is known about the functional integrity of the tissues that recover from edema. In a pig ICH model, we aimed to assess metabolic integrity of perihematoma tissues by using non-invasive magnetic resonance spectroscopy (MRS). Materials and Methods Fourteen male Yorkshire pigs with an average age of 8 weeks were intracerebrally injected with autologous blood to produce ICH. Proton MRS data were obtained at 1, 7, and 14 days after ICH using a whole-body 3.0T MRI system. Point-resolved spectroscopy (PRESS)-localized 2D chemical shift imaging (CSI) was acquired. The concentration of N-Acetylaspartate (NAA), Choline (Cho), and Creatine (Cr) were measured within the area of PHE, tissues adjacent to the injury with no or negligible edema (ATNE), and contralesional brain tissue. A linear mixed model was used to analyze the evolution of metabolites in perihematomal tissues, with p-value < 0.05 indicating statistical significance. Results The perihematoma volume gradually decreased from 2.38 ± 1.23 ml to 0.41 ± 0.780 ml (p < 0.001) over 2 weeks. Significant (p < 0.001) reductions in NAA, Cr, and Cho concentrations were found in the PHE and ATNE regions compared to the contralesional hemisphere at day 1 and 7 after ICH. All three metabolites were significantly (p < 0.001) restored in the PHE tissue on day 14, but remained persistently low in the ATNE area, and unaltered in the contralesional voxel. Conclusion This study highlights the potential of MRS to probe salvageable tissues within the perihematoma in the sub-acute phase of ICH. Altered metabolites within the PHE and ATNE regions in addition to edema and hematoma volumes were explored as possible markers for tissue recovery. Perihematomal tissue with PHE demonstrated a more reversible injury compared to the tissue adjacent to the injury without edema, suggesting a potentially beneficial role of edema.
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Affiliation(s)
- Muhammad E Haque
- Institute for Stroke and Cerebrovascular Diseases, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Refaat E Gabr
- Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sarah D George
- Institute for Stroke and Cerebrovascular Diseases, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Xiurong Zhao
- Institute for Stroke and Cerebrovascular Diseases, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Seth B Boren
- Institute for Stroke and Cerebrovascular Diseases, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Xu Zhang
- Biostatistics, Epidemiology, and Research Design Component, Center for Clinical and Translational Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Shun-Ming Ting
- Institute for Stroke and Cerebrovascular Diseases, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Gunghua Sun
- Institute for Stroke and Cerebrovascular Diseases, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Khader M Hasan
- Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sean Savitz
- Institute for Stroke and Cerebrovascular Diseases, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jaroslaw Aronowski
- Institute for Stroke and Cerebrovascular Diseases, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, United States
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23
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Zang Y, Zhang C, Song Q, Zhang J, Li H, Zhang C, Feng S, Gu F. Therapeutic effect of early intensive antihypertensive treatment on rebleeding and perihematomal edema in acute intracerebral hemorrhage. J Clin Hypertens (Greenwich) 2019; 21:1325-1331. [PMID: 31350828 DOI: 10.1111/jch.13629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/24/2019] [Accepted: 05/28/2019] [Indexed: 11/30/2022]
Abstract
To observe the effect of early intensive blood pressure (BP)-lowering treatment on rebleeding and perihematomal edema (PE) in patients with acute intracerebral hemorrhage (ICH). A total of 121 patients with ICH were randomly assigned to an early intensive antihypertensive treatment group (IG) (n = 62) or control group (CG) (n = 59). For both groups, 25 mg of urapidil injection was slowly administered intravenously in 6 hours of the onset. For the IG, 100 mg of urapidil and 30 mL of 0.9% sodium chloride were then slowly administered. Repeat computed tomography imaging was performed at 24 hours, 72 hours, day 7, and day 14 to detect any rebleeding via changes in hematoma volume and the changes in PE. Finally, NIHSS scores and Barthel Index (BI) were calculated at 24 hours, 72 hours, day 7, day 14, day 30, and day 90. The average hematoma volume in IG patients was significantly smaller than that of CG patients after 24 hours (P < .05). The volume of PE in the CG increased more than in the IG within 24 hours of onset, but was not statistically significant (P > .05); however, this trend was statistically significant after 72 hours (P < .05). On day 30 and day 90, the average NIHSS score of IG patients was lower than that of CG patients, and the BI was higher (P < .05) than that of CG patients. There was no significant difference in mortality between the two groups. Early intensive antihypertensive treatment in ICH patients reduces rebleeding and PE, improving short-term quality of life.
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Affiliation(s)
- Yanjing Zang
- Department of Geriatric, The Second Hospital of Baoding City, Baoding, China
| | - Chenhao Zhang
- Department of Neurology, The Second Hospital of Baoding City, Baoding, China
| | - Qin Song
- Department of Neurology, The Second Hospital of Baoding City, Baoding, China
| | - Jing Zhang
- Department of Geriatric, The Second Hospital of Baoding City, Baoding, China
| | - Hongxuan Li
- Department of Neurology, The Second Hospital of Baoding City, Baoding, China
| | - Chunliang Zhang
- Department of Neurology, The Second Hospital of Baoding City, Baoding, China
| | - Shanshan Feng
- Department of Geriatric, The Second Hospital of Baoding City, Baoding, China
| | - Fang Gu
- Fifth Department of Internal Medicine, Baoding Children's Hospital, Baoding, China
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24
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Abstract
Cerebrospinal venous anatomy and hemodynamics changes are associated with many central nervous system disorders.The aim of this study was to detect whether perihematomal edema (PHE) after spontaneous intracerebral hemorrhage (sICH) is associated with cerebral venous outflow volume (CVFV) in the internal jugular veins and vertebral veins.Newly diagnosed cases of sICH between April 2016 and March 2017 were enrolled and patients were grouped to the mean value of PHE according to previous study. On computed tomography, absolute PHE volume was calculated as the difference between total lesion volume and intracerebral hemorrhage (ICH) volume. Relative PHE volume was defined as absolute PHE volume divided by ICH volume. CVFV was determined by Doppler ultrasound. Patients were divided according to mean values of absolute PHE at 3 and 12 days, and relative PHE (rPHE) at 3 and 12 days.Significant differences were observed in smoking, alcohol consumption, glycosylated hemoglobin (GHb), secondary intraventricular hemorrhage (sIVH), and CVFV in PHE at 72 hours. Only sIVH and CVFV were significantly different at 12 days in PHE. In rPHE, GHb and sIVH were significantly differed at 72 hours. No significant difference was observed at 12 days in rPHE. The multivariate analyses showed that CVFV was independently associated with late PHE (PHE at 12 ± 3 days) but not with early PHE (PHE at 72 hours) and rPHE.These results suggest that CVFV may be closely related to PHE after sICH.
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Affiliation(s)
- Hao Feng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases
- Center of Stroke, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
| | - Zhanqiang Jin
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Diseases
- Center of Stroke, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease
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25
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Fischer M, Schiefecker A, Lackner P, Frank F, Helbok R, Beer R, Pfausler B, Schmutzhard E, Broessner G. Targeted Temperature Management in Spontaneous Intracerebral Hemorrhage: A Systematic Review. Curr Drug Targets 2018; 18:1430-1440. [PMID: 27397065 DOI: 10.2174/1389450117666160703161511] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/08/2015] [Accepted: 06/10/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Fever is common in neurocritical care patients and is associated with poor outcome. Targeted temperature management (TTM), i.e. therapeutic hypothermia or controlled normothermia, after acute brain injury has been studied as a neuroprotectant for several decades. In contrast to pharmacological agents with specific targets TTM affects multiple pathophysiological mechanisms and is primarily thought to attenuate secondary brain injury. Most promising results have been obtained from experimental studies on cerebral ischemia or traumatic brain injury showing beneficial effects of hypothermia on structural and functional outcome. OBJECTIVE The aim of this systematic review of the literature is to provide an overview on preclinical and clinical data on the use of TTM for intracerebral hemorrhage (ICH). The impact of TTM on structural changes and functional outcome after induced and spontaneous ICH will be summarized. RESULTS AND DISCUSSION A positive influence of hypothermia has been observed in animal models of spontaneous ICH improving, among others, perihematomal edema, blood-brain barrier integrity, inflammation and thrombin-induced injury. However, results regarding functional outcome are conflicting. Little data is available on the effect of TTM after spontaneous ICH in humans. Single-center observational studies have shown reduced perihematomal edema under mild hypothermia and an association with favorable outcome. However, these beneficial effects on mortality and functional outcome have not been confirmed in randomized studies so far. Thus, results from ongoing, prospective randomized-controlled trials are highly anticipated.
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Affiliation(s)
- Marlene Fischer
- Medical University Hamburg-Eppendorf, Department of Anesthesiology, Hamburg. Germany
| | - Alois Schiefecker
- Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria
| | - Peter Lackner
- Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria
| | - Florian Frank
- Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria
| | - Raimund Helbok
- Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria
| | - Ronny Beer
- Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria
| | - Bettina Pfausler
- Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria
| | - Erich Schmutzhard
- Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria
| | - Gregor Broessner
- Medical University of Innsbruck, Department of Neurology, Innsbruck, Austria
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Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is a common type of stroke associated with high mortality and morbidity. Recent randomized controlled trials could not prove that the current strategies are effective at improving the final outcome of the ICH patients. METHODS Here we want to explore potential intervention targets for ICH based on the framework of the vascular neural network (VNN). In this review, a brief history of the evolution of stroke pathophysiology from humoral theory to VNN is discussed. RESULTS As current literature on pathophysiology of ICH is mainly focused on neuroprotection, here we want to evolve the central paradigm towards VNN. We stress mechanisms of vascular disruption and impaired blood flow harmony, which are clinically relevant but have received less attention in basic research. CONCLUSION We propose that VNN could be a robust and practical paradigm in both ICH basic research and clinical practice.
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Affiliation(s)
- Yi Yin
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Hongfei Ge
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - John H Zhang
- Department of Physiology and Pharmacology, Loma Linda University, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92350, United States
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, 38 Gaotanyan Street, Chongqing 400038, China
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Helbok R, Schiefecker AJ, Friberg C, Beer R, Kofler M, Rhomberg P, Unterberger I, Gizewski E, Hauerberg J, Möller K, Lackner P, Broessner G, Pfausler B, Ortler M, Thome C, Schmutzhard E, Fabricius M. Spreading depolarizations in patients with spontaneous intracerebral hemorrhage: Association with perihematomal edema progression. J Cereb Blood Flow Metab 2017; 37:1871-1882. [PMID: 27207168 PMCID: PMC5435285 DOI: 10.1177/0271678x16651269] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 04/05/2016] [Accepted: 04/26/2016] [Indexed: 11/16/2022]
Abstract
Pathophysiologic mechanisms of secondary brain injury after intracerebral hemorrhage and in particular mechanisms of perihematomal-edema progression remain incompletely understood. Recently, the role of spreading depolarizations in secondary brain injury was established in ischemic stroke, subarachnoid hemorrhage and traumatic brain injury patients. Its role in intracerebral hemorrhage patients and in particular the association with perihematomal-edema is not known. A total of 27 comatose intracerebral hemorrhage patients in whom hematoma evacuation and subdural electrocorticography was performed were studied prospectively. Hematoma evacuation and subdural strip electrode placement was performed within the first 24 h in 18 patients (67%). Electrocorticography recordings started 3 h after surgery (IQR, 3-5 h) and lasted 157 h (median) per patient and 4876 h in all 27 patients. In 18 patients (67%), a total of 650 spreading depolarizations were observed. Spreading depolarizations were more common in the initial days with a peak incidence on day 2. Median electrocorticography depression time was longer than previously reported (14.7 min, IQR, 9-22 min). Postoperative perihematomal-edema progression (85% of patients) was significantly associated with occurrence of isolated and clustered spreading depolarizations. Monitoring of spreading depolarizations may help to better understand pathophysiologic mechanisms of secondary insults after intracerebral hemorrhage. Whether they may serve as target in the treatment of intracerebral hemorrhage deserves further research.
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Affiliation(s)
- Raimund Helbok
- Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria
| | | | - Christian Friberg
- Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | - Ronny Beer
- Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria
| | - Mario Kofler
- Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria
| | - Paul Rhomberg
- Department of Neuroradiology, Medical University Innsbruck, Austria
| | - Iris Unterberger
- Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria
| | - Elke Gizewski
- Department of Neuroradiology, Medical University Innsbruck, Austria
| | - John Hauerberg
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Kirsten Möller
- Department of Neuroanesthesiology, Rigshospitalet, Copenhagen, Denmark
| | - Peter Lackner
- Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria
| | - Gregor Broessner
- Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria
| | - Bettina Pfausler
- Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria
| | - Martin Ortler
- Department of Neurosurgery, Medical University Innsbruck, Austria
| | - Claudius Thome
- Department of Neurosurgery, Medical University Innsbruck, Austria
| | - Erich Schmutzhard
- Department of Neurology, Neurocritical Care Unit, Medical University Innsbruck, Austria
| | - Martin Fabricius
- Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
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Tan Q, Chen Q, Niu Y, Feng Z, Li L, Tao Y, Tang J, Yang L, Guo J, Feng H, Zhu G, Chen Z. Urokinase, a promising candidate for fibrinolytic therapy for intracerebral hemorrhage. J Neurosurg 2017; 126:548-557. [PMID: 27104852 DOI: 10.3171/2016.1.jns152287] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intracerebral hemorrhage (ICH) is associated with a high rate of mortality and severe disability, while fibrinolysis for ICH evacuation is a possible treatment. However, reported adverse effects can counteract the benefits of fibrinolysis and limit the use of tissue-type plasminogen activator (tPA). Identifying appropriate fibrinolytics is still needed. Therefore, the authors here compared the use of urokinase-type plasminogen activator (uPA), an alternate thrombolytic, with that of tPA in a preclinical study. METHODS Intracerebral hemorrhage was induced in adult male Sprague-Dawley rats by injecting autologous blood into the caudate, followed by intraclot fibrinolysis without drainage. Rats were randomized to receive uPA, tPA, or saline within the clot. Hematoma and perihematomal edema, brain water content, Evans blue fluorescence and neurological scores, matrix metalloproteinases (MMPs), MMP mRNA, blood-brain barrier (BBB) tight junction proteins, and nuclear factor-κB (NF-κB) activation were measured to evaluate the effects of these 2 drugs in ICH. RESULTS In comparison with tPA, uPA better ameliorated brain edema and promoted an improved outcome after ICH. In addition, uPA therapy more effectively upregulated BBB tight junction protein expression, which was partly attributed to the different effects of uPA and tPA on the regulation of MMPs and its related mRNA expression following ICH. CONCLUSIONS This study provided evidence supporting the use of uPA for fibrinolytic therapy after ICH. Large animal experiments and clinical trials are required to further explore the efficacy and safety of uPA in ICH fibrinolysis.
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Affiliation(s)
- Qiang Tan
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing; and
| | - Qianwei Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing; and
| | - Yin Niu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing; and
| | - Zhou Feng
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing; and
| | - Lin Li
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing; and
| | - Yihao Tao
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing; and
| | - Jun Tang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing; and
| | - Liming Yang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing; and
| | - Jing Guo
- Department of Neurosurgery, 211st Hospital of PLA, Harbin, People's Republic of China
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing; and
| | - Gang Zhu
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing; and
| | - Zhi Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing; and
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29
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Chang JJ, Emanuel BA, Mack WJ, Tsivgoulis G, Alexandrov AV. Matrix metalloproteinase-9: dual role and temporal profile in intracerebral hemorrhage. J Stroke Cerebrovasc Dis 2014; 23:2498-2505. [PMID: 25306400 DOI: 10.1016/j.jstrokecerebrovasdis.2014.07.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/20/2014] [Accepted: 07/02/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Clinical outcome after intracerebral hemorrhage (ICH) remains poor. Recent trials in ICH, focusing on hematoma reduction, have not yielded significant clinical improvement. The modulation of matrix metalloproteinase (MMP)-9 may represent a potential therapeutic target for reducing perihematomal edema (PHE) and improving clinical outcome. METHODS We searched Cochrane Library, Ovid/Medline, and PubMed databases using combinations of the following MeSH search terms: "intracerebral hemorrhage," "matrix metalloproteinase," "minocycline," "inhibition," and "neuroprotection". RESULTS MMP-9 levels in animal models have largely shown detrimental correlations with mortality, clinical outcome, hematoma volume, and PHE. Animal models and clinical studies have established a timeline for MMP-9 expression and corresponding PHE that include an initial peak on days 1-3 and a secondary peak on day 7. Clinical studies evaluating MMP-9 levels in the acute phase (days 1-3) and subacute phase (day 7) of ICH suggest that MMP-9 may be detrimental in the acute phase through destruction of basal lamina, activation of vascular endothelial growth factor, and activation of apoptosis but assist in recovery in the subacute phase through angiogenesis. CONCLUSIONS MMP-9 inhibition represents a potentially effective target for neuroprotection in ICH. However, as a ubiquitous protein, the inhibition of pathologic processes must be balanced against the preservation of neuroprotective angiogenesis. As the opposing roles of MMP-9 may have similar mechanisms, the most important factor may be the timing of MMP-9 inhibition. Further studies are necessary to delineate these mechanisms and their temporal relationship.
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Affiliation(s)
- Jason J Chang
- Department of Neurology, University of Southern California, Los Angeles, California.
| | - Benjamin A Emanuel
- Department of Neurology, University of Southern California, Los Angeles, California
| | - William J Mack
- Department of Neurosurgery, University of Southern California, Los Angeles, California
| | - Giorgios Tsivgoulis
- Department of Neurology, University of Athens School of Medicine, Athens, Greece; International Clinical Research Center, St. Anne's University, Brno, Czech Republic
| | - Andrei V Alexandrov
- Department of Neurology, The University of Tennessee Health Sciences Center, Memphis, TN
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