Document Detail


Natural history of perihematomal edema after intracerebral hemorrhage measured by serial magnetic resonance imaging.
MedLine Citation:
PMID:  21164136     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: knowledge on the natural history and clinical impact of perihematomal edema (PHE) associated with intracerebral hemorrhage is limited. We aimed to define the time course, predictors, and clinical significance of PHE measured by serial magnetic resonance imaging.
METHODS: patients with primary supratentorial intracerebral hemorrhage ≥ 5 cm(3) underwent serial MRIs at prespecified intervals during the first month. Hematoma (H(v)) and PHE (E(v)) volumes were measured on fluid-attenuated inversion recovery images. Relative PHE was defined as E(v)/H(v). Neurologic assessments were performed at admission and with each MRI. Barthel Index, modified Rankin scale, and extended Glasgow Outcome scale scores were assigned at 3 months.
RESULTS: twenty-seven patients with 88 MRIs were prospectively included. Median H(v) and E(v) on the first MRI were 39 and 46 cm(3), respectively. Median peak absolute E(v) was 88 cm(3). Larger hematomas produced a larger absolute E(v) (r(2)=0.6) and a smaller relative PHE (r(2)=0.7). Edema volume growth was fastest in the first 2 days but continued until 12 ± 3 days. In multivariate analysis, a higher admission hematocrit was associated with a greater delay in peak PHE (P=0.06). Higher admission partial thromboplastin time was associated with higher peak rPHE (P=0.02). Edema volume growth was correlated with a decline in neurologic status at 48 hours (81 vs 43 cm(3), P=0.03) but not with 3-month functional outcome.
CONCLUSIONS: PHE volume measured by MRI increases most rapidly in the first 2 days after symptom onset and peaks toward the end of the second week. The timing and magnitude of PHE volume are associated with hematologic factors. Its clinical significance deserves further study.
Authors:
Chitra Venkatasubramanian; Michael Mlynash; Anna Finley-Caulfield; Irina Eyngorn; Rajalakshmi Kalimuthu; R W Snider; Christine Anne Wijman
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-12-16
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  42     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-28     Completed Date:  2011-01-28     Revised Date:  2012-01-04    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  73-80     Citation Subset:  IM    
Affiliation:
Stanford Care program, Stanford University Medical Center, Cali., USA. chitrav@stanford.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Brain Edema* / etiology,  physiopathology,  radiography
Cerebral Hemorrhage* / complications,  physiopathology,  radiography
Female
Humans
Magnetic Resonance Imaging*
Male
Middle Aged
Grant Support
ID/Acronym/Agency:
2R01:NS034866-08/NS/NINDS NIH HHS; R01 NS034866-08A1/NS/NINDS NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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