Time Course of Early Postadmission Hematoma Expansion in Spontaneous Intracerebral Hemorrhage

TY - JOUR

T1 - Time Course of Early Postadmission Hematoma Expansion in Spontaneous Intracerebral Hemorrhage

AU - Ovesen, Christian

AU - Christensen, Anders Fogh

AU - Krieger, Derk W

AU - Rosenbaum, Sverre

AU - Havsteen, Inger

AU - Christensen, Hanne

PY - 2014/4

Y1 - 2014/4

N2 - 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 - : URL: http://www.clinicaltrials.gov.

AB - 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 - : URL: http://www.clinicaltrials.gov.

KW - Acute Disease

KW - Aged

KW - Aged, 80 and over

KW - Cerebral Hemorrhage

KW - Disease Progression

KW - Female

KW - Follow-Up Studies

KW - Hematoma

KW - Humans

KW - Male

KW - Middle Aged

KW - Prospective Studies

KW - Reproducibility of Results

KW - Stroke

KW - Time Factors

KW - Tomography, X-Ray Computed

KW - Ultrasonography, Doppler, Transcranial

U2 - 10.1161/STROKEAHA.113.003608

DO - 10.1161/STROKEAHA.113.003608

M3 - Journal article

C2 - 24627116

SN - 0039-2499

VL - 45

SP - 994

EP - 999

JO - Stroke

JF - Stroke

IS - 4

ER -