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journal article Jan 01, 2011

Natural History of Perihematomal Edema After Intracerebral Hemorrhage Measured by Serial Magnetic Resonance Imaging

Chitra Venkatasubramanian Michael Mlynash ORCID Anna Finley-Caulfield Irina Eyngorn Rajalakshmi Kalimuthu R.W. Snider Christine Anne Wijman
Stroke Vol. 42 No. 1 pp. 73-80 · Ovid Technologies (Wolters Kluwer Health)
View at Publisher Save 10.1161/strokeaha.110.590646
Abstract
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.
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Citations
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References
Details
Published
Jan 01, 2011
Vol/Issue
42(1)
Pages
73-80
Authors
C
Chitra Venkatasubramanian

From the Stanford Neurocritical Care Program (C.V., A.F.-C., C.A.W, M.M., I.E., R.K., R.W.S.), Stanford Stroke Center, Stanford University Medical Center, and Department of Neurology and Neurological Sciences (C.V., A.F.-C., C.A.W.), Stanford University, Palo Alto, Calif.

M
Michael Mlynash

From the Stanford Neurocritical Care Program (C.V., A.F.-C., C.A.W, M.M., I.E., R.K., R.W.S.), Stanford Stroke Center, Stanford University Medical Center, and Department of Neurology and Neurological Sciences (C.V., A.F.-C., C.A.W.), Stanford University, Palo Alto, Calif.

A
Anna Finley-Caulfield

From the Stanford Neurocritical Care Program (C.V., A.F.-C., C.A.W, M.M., I.E., R.K., R.W.S.), Stanford Stroke Center, Stanford University Medical Center, and Department of Neurology and Neurological Sciences (C.V., A.F.-C., C.A.W.), Stanford University, Palo Alto, Calif.

I
Irina Eyngorn

From the Stanford Neurocritical Care Program (C.V., A.F.-C., C.A.W, M.M., I.E., R.K., R.W.S.), Stanford Stroke Center, Stanford University Medical Center, and Department of Neurology and Neurological Sciences (C.V., A.F.-C., C.A.W.), Stanford University, Palo Alto, Calif.

R
Rajalakshmi Kalimuthu

From the Stanford Neurocritical Care Program (C.V., A.F.-C., C.A.W, M.M., I.E., R.K., R.W.S.), Stanford Stroke Center, Stanford University Medical Center, and Department of Neurology and Neurological Sciences (C.V., A.F.-C., C.A.W.), Stanford University, Palo Alto, Calif.

R
R.W. Snider

From the Stanford Neurocritical Care Program (C.V., A.F.-C., C.A.W, M.M., I.E., R.K., R.W.S.), Stanford Stroke Center, Stanford University Medical Center, and Department of Neurology and Neurological Sciences (C.V., A.F.-C., C.A.W.), Stanford University, Palo Alto, Calif.

C
Christine Anne Wijman

From the Stanford Neurocritical Care Program (C.V., A.F.-C., C.A.W, M.M., I.E., R.K., R.W.S.), Stanford Stroke Center, Stanford University Medical Center, and Department of Neurology and Neurological Sciences (C.V., A.F.-C., C.A.W.), Stanford University, Palo Alto, Calif.

Cite This Article
Chitra Venkatasubramanian, Michael Mlynash, Anna Finley-Caulfield, et al. (2011). Natural History of Perihematomal Edema After Intracerebral Hemorrhage Measured by Serial Magnetic Resonance Imaging. Stroke, 42(1), 73-80. https://doi.org/10.1161/strokeaha.110.590646
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