Time Course of Early Postadmission Hematoma Expansion in Spontaneous Intracerebral Hemorrhage
BACKGROUND AND PURPOSE—Early hematoma expansion (EHE) in patients with intracerebral hematoma is a promising treatment target. To date, the time course of EHE has remained poorly described. We prospectively investigated the time course of EHE. METHODS—We included consecutive patients presenting spon...
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| Veröffentlicht in: | Stroke (1970) 2014-04, Vol.45 (4), p.994-999 |
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| creator | Ovesen, Christian Christensen, Anders Fogh Krieger, Derk W Rosenbaum, Sverre Havsteen, Inger Christensen, Hanne |
| description | BACKGROUND AND PURPOSE—Early hematoma expansion (EHE) in patients with intracerebral hematoma is a promising treatment target. To date, the time course of EHE has remained poorly described. We prospectively investigated the time course of EHE.
METHODS—We included consecutive patients presenting spontaneous intracerebral hematoma within 4.5 hours. On admission, patients underwent noncontrast computed tomography (CT) and CT angiography. Serial hematoma volume estimations by transcranial B-mode ultrasound were effected through the contralateral transtemporal bone window by obtaining sagittal, transversal, and coronal diameter and calculating the ABC/2-formula. National Institute of Health Stroke Scale and transcranial B-mode ultrasound were performed consecutively every 30 minutes during the first 6 hours and from 6 to 12 hours every 2 hours. Follow-up CT and ultrasound were performed after ≈24 hours.
RESULTS—Twenty-five patients with intracerebral hematoma were included; mean (SD) time from onset to CT was 108.6 (45.7) minutes. Ten (40%) patients had EHE. In patients with a final clinically significant hematoma expansion >12.5 mL, all EHE occurred within 6 hours after admission scan. EHE in spot sign positive patients continued during the first 5 hours after CT angiography. In spot sign–negative patients, no significant EHE was observed (Friedman test, P=0.476). Neurological deterioration occurred in 5 (20%) patients and was well temporally correlated with EHE. Transcranial B-mode ultrasound demonstrated good volume estimation compared with the follow-up CT with a maximum absolute volume deviation within 7 mL and minimal systematic error (mean deviation, 1.3 [confidence interval, −0.1 to 2.6] mL).
CONCLUSIONS—EHE was reliably reflected by transcranial B-mode ultrasound and mainly occurred within the first 7 to 8 hours after symptom onset.
CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT01472224. |
| doi_str_mv | 10.1161/STROKEAHA.113.003608 |
| format | Article |
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METHODS—We included consecutive patients presenting spontaneous intracerebral hematoma within 4.5 hours. On admission, patients underwent noncontrast computed tomography (CT) and CT angiography. Serial hematoma volume estimations by transcranial B-mode ultrasound were effected through the contralateral transtemporal bone window by obtaining sagittal, transversal, and coronal diameter and calculating the ABC/2-formula. National Institute of Health Stroke Scale and transcranial B-mode ultrasound were performed consecutively every 30 minutes during the first 6 hours and from 6 to 12 hours every 2 hours. Follow-up CT and ultrasound were performed after ≈24 hours.
RESULTS—Twenty-five patients with intracerebral hematoma were included; mean (SD) time from onset to CT was 108.6 (45.7) minutes. Ten (40%) patients had EHE. In patients with a final clinically significant hematoma expansion >12.5 mL, all EHE occurred within 6 hours after admission scan. EHE in spot sign positive patients continued during the first 5 hours after CT angiography. In spot sign–negative patients, no significant EHE was observed (Friedman test, P=0.476). Neurological deterioration occurred in 5 (20%) patients and was well temporally correlated with EHE. Transcranial B-mode ultrasound demonstrated good volume estimation compared with the follow-up CT with a maximum absolute volume deviation within 7 mL and minimal systematic error (mean deviation, 1.3 [confidence interval, −0.1 to 2.6] mL).
CONCLUSIONS—EHE was reliably reflected by transcranial B-mode ultrasound and mainly occurred within the first 7 to 8 hours after symptom onset.
CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT01472224.</description><identifier>ISSN: 0039-2499</identifier><identifier>EISSN: 1524-4628</identifier><identifier>DOI: 10.1161/STROKEAHA.113.003608</identifier><identifier>PMID: 24627116</identifier><identifier>CODEN: SJCCA7</identifier><language>eng</language><publisher>Hagerstown, MD: American Heart Association, Inc</publisher><subject>Acute Disease ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Cerebral Hemorrhage - diagnostic imaging ; Disease Progression ; Female ; Follow-Up Studies ; Hematologic and hematopoietic diseases ; Hematoma - diagnostic imaging ; Humans ; Male ; Medical sciences ; Middle Aged ; Neurology ; Platelet diseases and coagulopathies ; Prospective Studies ; Reproducibility of Results ; Stroke - diagnostic imaging ; Time Factors ; Tomography, X-Ray Computed ; Ultrasonography, Doppler, Transcranial - methods ; Ultrasonography, Doppler, Transcranial - standards ; Vascular diseases and vascular malformations of the nervous system</subject><ispartof>Stroke (1970), 2014-04, Vol.45 (4), p.994-999</ispartof><rights>2014 American Heart Association, Inc.</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4328-735d7c40c2bd7d0b8f979e04518292af312d2ae8a17f131917a2572d0d1dada43</citedby><cites>FETCH-LOGICAL-c4328-735d7c40c2bd7d0b8f979e04518292af312d2ae8a17f131917a2572d0d1dada43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28440814$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24627116$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ovesen, Christian</creatorcontrib><creatorcontrib>Christensen, Anders Fogh</creatorcontrib><creatorcontrib>Krieger, Derk W</creatorcontrib><creatorcontrib>Rosenbaum, Sverre</creatorcontrib><creatorcontrib>Havsteen, Inger</creatorcontrib><creatorcontrib>Christensen, Hanne</creatorcontrib><title>Time Course of Early Postadmission Hematoma Expansion in Spontaneous Intracerebral Hemorrhage</title><title>Stroke (1970)</title><addtitle>Stroke</addtitle><description>BACKGROUND AND PURPOSE—Early hematoma expansion (EHE) in patients with intracerebral hematoma is a promising treatment target. To date, the time course of EHE has remained poorly described. We prospectively investigated the time course of EHE.
METHODS—We included consecutive patients presenting spontaneous intracerebral hematoma within 4.5 hours. On admission, patients underwent noncontrast computed tomography (CT) and CT angiography. Serial hematoma volume estimations by transcranial B-mode ultrasound were effected through the contralateral transtemporal bone window by obtaining sagittal, transversal, and coronal diameter and calculating the ABC/2-formula. National Institute of Health Stroke Scale and transcranial B-mode ultrasound were performed consecutively every 30 minutes during the first 6 hours and from 6 to 12 hours every 2 hours. Follow-up CT and ultrasound were performed after ≈24 hours.
RESULTS—Twenty-five patients with intracerebral hematoma were included; mean (SD) time from onset to CT was 108.6 (45.7) minutes. Ten (40%) patients had EHE. In patients with a final clinically significant hematoma expansion >12.5 mL, all EHE occurred within 6 hours after admission scan. EHE in spot sign positive patients continued during the first 5 hours after CT angiography. In spot sign–negative patients, no significant EHE was observed (Friedman test, P=0.476). Neurological deterioration occurred in 5 (20%) patients and was well temporally correlated with EHE. Transcranial B-mode ultrasound demonstrated good volume estimation compared with the follow-up CT with a maximum absolute volume deviation within 7 mL and minimal systematic error (mean deviation, 1.3 [confidence interval, −0.1 to 2.6] mL).
CONCLUSIONS—EHE was reliably reflected by transcranial B-mode ultrasound and mainly occurred within the first 7 to 8 hours after symptom onset.
CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT01472224.</description><subject>Acute Disease</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Cerebral Hemorrhage - diagnostic imaging</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Hematoma - diagnostic imaging</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Neurology</subject><subject>Platelet diseases and coagulopathies</subject><subject>Prospective Studies</subject><subject>Reproducibility of Results</subject><subject>Stroke - diagnostic imaging</subject><subject>Time Factors</subject><subject>Tomography, X-Ray Computed</subject><subject>Ultrasonography, Doppler, Transcranial - methods</subject><subject>Ultrasonography, Doppler, Transcranial - standards</subject><subject>Vascular diseases and vascular malformations of the nervous system</subject><issn>0039-2499</issn><issn>1524-4628</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEFP3DAQhS3UChbKP0BVLpV6CXhsZ-McV6uFRSBRle2ximbjSTfgxFs7EeXf4yUL3HoazdM3b54eY2fAzwGmcHG_-nl3s5gtZ3GV55zLKdcHbAKZUKmaCv2JTaJYpEIVxRE7DuGBcy6kzg7ZkYhAHl0m7PeqaSmZu8EHSlydLNDb5-SHCz2atgmhcV2ypBZ712Ky-LfF7lVquuR-67oeO3JDSK673mNFntYe7Y533m_wD31hn2u0gU7384T9ulys5sv09u7qej67TSslhU5zmZm8UrwSa5MbvtZ1kRfEVQZaFAJrCcIIJI2Q1yChgBxFlgvDDRg0qOQJ-z76br37O1Doy5i9ImvHfCVkwBUXmYCIqhGtvAvBU11ufdOify6Bl7tiy_di4yrLsdh49nX_YVi3ZN6P3pqMwLc9gKFCW3vsqiZ8cFoprmEXVY_ck7M9-fBohyfy5YbQ9pv_Z3gBccSTnA</recordid><startdate>201404</startdate><enddate>201404</enddate><creator>Ovesen, Christian</creator><creator>Christensen, Anders Fogh</creator><creator>Krieger, Derk W</creator><creator>Rosenbaum, Sverre</creator><creator>Havsteen, Inger</creator><creator>Christensen, Hanne</creator><general>American Heart Association, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201404</creationdate><title>Time Course of Early Postadmission Hematoma Expansion in Spontaneous Intracerebral Hemorrhage</title><author>Ovesen, Christian ; Christensen, Anders Fogh ; Krieger, Derk W ; Rosenbaum, Sverre ; Havsteen, Inger ; Christensen, Hanne</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4328-735d7c40c2bd7d0b8f979e04518292af312d2ae8a17f131917a2572d0d1dada43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Acute Disease</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Cerebral Hemorrhage - diagnostic imaging</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Hematoma - diagnostic imaging</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Neurology</topic><topic>Platelet diseases and coagulopathies</topic><topic>Prospective Studies</topic><topic>Reproducibility of Results</topic><topic>Stroke - diagnostic imaging</topic><topic>Time Factors</topic><topic>Tomography, X-Ray Computed</topic><topic>Ultrasonography, Doppler, Transcranial - methods</topic><topic>Ultrasonography, Doppler, Transcranial - standards</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ovesen, Christian</creatorcontrib><creatorcontrib>Christensen, Anders Fogh</creatorcontrib><creatorcontrib>Krieger, Derk W</creatorcontrib><creatorcontrib>Rosenbaum, Sverre</creatorcontrib><creatorcontrib>Havsteen, Inger</creatorcontrib><creatorcontrib>Christensen, Hanne</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ovesen, Christian</au><au>Christensen, Anders Fogh</au><au>Krieger, Derk W</au><au>Rosenbaum, Sverre</au><au>Havsteen, Inger</au><au>Christensen, Hanne</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Time Course of Early Postadmission Hematoma Expansion in Spontaneous Intracerebral Hemorrhage</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2014-04</date><risdate>2014</risdate><volume>45</volume><issue>4</issue><spage>994</spage><epage>999</epage><pages>994-999</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>BACKGROUND AND PURPOSE—Early hematoma expansion (EHE) in patients with intracerebral hematoma is a promising treatment target. To date, the time course of EHE has remained poorly described. We prospectively investigated the time course of EHE.
METHODS—We included consecutive patients presenting spontaneous intracerebral hematoma within 4.5 hours. On admission, patients underwent noncontrast computed tomography (CT) and CT angiography. Serial hematoma volume estimations by transcranial B-mode ultrasound were effected through the contralateral transtemporal bone window by obtaining sagittal, transversal, and coronal diameter and calculating the ABC/2-formula. National Institute of Health Stroke Scale and transcranial B-mode ultrasound were performed consecutively every 30 minutes during the first 6 hours and from 6 to 12 hours every 2 hours. Follow-up CT and ultrasound were performed after ≈24 hours.
RESULTS—Twenty-five patients with intracerebral hematoma were included; mean (SD) time from onset to CT was 108.6 (45.7) minutes. Ten (40%) patients had EHE. In patients with a final clinically significant hematoma expansion >12.5 mL, all EHE occurred within 6 hours after admission scan. EHE in spot sign positive patients continued during the first 5 hours after CT angiography. In spot sign–negative patients, no significant EHE was observed (Friedman test, P=0.476). Neurological deterioration occurred in 5 (20%) patients and was well temporally correlated with EHE. Transcranial B-mode ultrasound demonstrated good volume estimation compared with the follow-up CT with a maximum absolute volume deviation within 7 mL and minimal systematic error (mean deviation, 1.3 [confidence interval, −0.1 to 2.6] mL).
CONCLUSIONS—EHE was reliably reflected by transcranial B-mode ultrasound and mainly occurred within the first 7 to 8 hours after symptom onset.
CLINICAL TRIAL REGISTRATION—URLhttp://www.clinicaltrials.gov. Unique identifierNCT01472224.</abstract><cop>Hagerstown, MD</cop><pub>American Heart Association, Inc</pub><pmid>24627116</pmid><doi>10.1161/STROKEAHA.113.003608</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Heart Association Journals; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection; Journals@Ovid Complete |
| subjects | Acute Disease Aged Aged, 80 and over Biological and medical sciences Cerebral Hemorrhage - diagnostic imaging Disease Progression Female Follow-Up Studies Hematologic and hematopoietic diseases Hematoma - diagnostic imaging Humans Male Medical sciences Middle Aged Neurology Platelet diseases and coagulopathies Prospective Studies Reproducibility of Results Stroke - diagnostic imaging Time Factors Tomography, X-Ray Computed Ultrasonography, Doppler, Transcranial - methods Ultrasonography, Doppler, Transcranial - standards Vascular diseases and vascular malformations of the nervous system |
| title | Time Course of Early Postadmission Hematoma Expansion in Spontaneous Intracerebral Hemorrhage |
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