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1. Endovascular Versus Medical Therapy in Posterior Cerebral Artery Stroke: Role of Baseline NIHSS Score and Occlusion Site.

Author

Strambo, Davide, Michel, Patrik, Nguyen, Thanh N., Abdalkader, Mohamad, Qureshi, Muhammad M., Strbian, Daniel, Herweh, Christian, Möhlenbruch, Markus A., Räty, Silja, Olivé-Gadea, Marta, Ribo, Marc, Psychogios, Marios, Fischer, Urs, Nguyen, Anh, Kuramatsu, Joji B., Haupenthal, David, Köhrmann, Martin, Deuschl, Cornelius, Kühne Escolà, Jordi, and Demeestere, Jelle

Published
2024
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2. Endovascular Versus Medical Therapy in Posterior Cerebral Artery Stroke: Role of Baseline NIHSS Score and Occlusion Site

Author

Strambo, Davide, Michel, Patrik, Nguyen, Thanh N., Abdalkader, Mohamad, Qureshi, Muhammad M., Strbian, Daniel, Herweh, Christian, Möhlenbruch, Markus A., Räty, Silja, Olivé-Gadea, Marta, Ribo, Marc, Psychogios, Marios, Fischer, Urs, Nguyen, Anh, Kuramatsu, Joji B., Haupenthal, David, Köhrmann, Martin, Deuschl, Cornelius, Kühne Escolà, Jordi, Demeestere, Jelle, Lemmens, Robin, Vandewalle, Lieselotte, Yaghi, Shadi, Shu, Liqi, Puetz, Volker, Kaiser, Daniel P.O., Kaesmacher, Johannes, Mujanovic, Adnan, Marterstock, Dominique Cornelius, Engelhorn, Tobias, Requena, Manuel, Dasenbrock, Hormuzdiyar H., Klein, Piers, Haussen, Diogo C., Mohammaden, Mahmoud H., Abdelhamid, Hend, Souza Viana, Lorena, Cunha, Bruno, Fragata, Isabel, Romoli, Michele, Diana, Francesco, Hu, Wei, Zhang, Chao, Virtanen, Pekka, Lauha, Riikka, Jesser, Jessica, Clark, Judith, Matsoukas, Stavros, Fifi, Johanna T., Sheth, Sunil A., Salazar-Marioni, Sergio, Marto, João Pedro, Ramos, João Nuno, Miszczuk, Milena, Riegler, Christoph, Poli, Sven, Poli, Khouloud, Jadhav, Ashutosh P., Desai, Shashvat M., Maus, Volker, Kaeder, Maximilian, Siddiqui, Adnan H., Monteiro, Andre, Masoud, Hesham E., Suryadareva, Neil, Mokin, Maxim, Thanki, Shail, Alpay, Kemal, Ylikotila, Pauli, Siegler, James E., Linfante, Italo, Dabus, Guilherme, Asdaghi, Negar, Saini, Vasu, Nolte, Christian H., Siebert, Eberhard, Serrallach, Bettina L., Weyland, Charlotte S., Hanning, Uta, Meyer, Lukas, Berberich, Anne, Ringleb, Peter A., Nogueira, Raul G., and Nagel, Simon

Published
2024
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3. Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study.

Author

Nguyen, Thanh N., Qureshi, Muhammad M., Strambo, Davide, Strbian, Daniel, Räty, Silja, Herweh, Christian, Abdalkader, Mohamad, Olive-Gadea, Marta, Ribo, Marc, Psychogios, Marios, Fischer, Urs, Nguyen, Anh, Kuramatsu, Joji B., Haupenthal, David, Köhrmann, Martin, Deuschl, Cornelius, Kühne Escola, Jordi, Yaghi, Shadi, Shu, Liqi, and Puetz, Volker

Published
2023
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4. Endovascular Versus Medical Management of Posterior Cerebral Artery Occlusion Stroke: The PLATO Study

Author

Nguyen, Thanh N., Qureshi, Muhammad M., Strambo, Davide, Strbian, Daniel, Räty, Silja, Herweh, Christian, Abdalkader, Mohamad, Olive-Gadea, Marta, Ribo, Marc, Psychogios, Marios, Fischer, Urs, Nguyen, Anh, Kuramatsu, Joji B., Haupenthal, David, Köhrmann, Martin, Deuschl, Cornelius, Kühne Escola, Jordi, Yaghi, Shadi, Shu, Liqi, Puetz, Volker, Kaiser, Daniel P.O., Kaesmacher, Johannes, Mujanovic, Adnan, Marterstock, Dominique Cornelius, Engelhorn, Tobias, Klein, Piers, Haussen, Diogo C., Mohammaden, Mahmoud H., Abdelhamid, Hend, Souza Viana, Lorena, Cunha, Bruno, Fragata, Isabel, Romoli, Michele, Diana, Francesco, Virtanen, Pekka, Lappalainen, Kimmo, Clark, Judith, Matsoukas, Stavros, Fifi, Johanna T., Sheth, Sunil A., Salazar-Marioni, Sergio, Marto, João Pedro, Ramos, João Nuno, Miszczuk, Milena, Riegler, Christoph, Jadhav, Ashutosh P., Desai, Shashvat M., Maus, Volker, Kaeder, Maximilian, Siddiqui, Adnan H., Monteiro, Andre, Masoud, Hesham E., Suryadevara, Neil, Mokin, Maxim, Thanki, Shail, Siegler, James E., Khalife, Jane, Linfante, Italo, Dabus, Guilherme, Asdaghi, Negar, Saini, Vasu, Nolte, Christian H., Siebert, Eberhard, Meinel, Thomas R., Finitsis, Stefanos, Möhlenbruch, Markus A., Ringleb, Peter A., Berberich, Anne, Nogueira, Raul G., Hanning, Uta, Meyer, Lukas, Michel, Patrik, and Nagel, Simon

Published
2023
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5. Association of Intraventricular Fibrinolysis With Clinical Outcomes in Intracerebral Hemorrhage: An Individual Participant Data Meta-Analysis.

Author

Kuramatsu, Joji B., Gerner, Stefan T., Ziai, Wendy, Bardutzky, Jürgen, Sembill, Jochen A., Sprügel, Maximilian I., Mrochen, Anne, Kölbl, Kathrin, Ram, Malathi, Avadhani, Radhika, Falcone, Guido J., Selim, Magdy H., Lioutas, Vasileios-Arsenios, Endres, Matthias, Zweynert, Sarah, Vajkoczy, Peter, Ringleb, Peter A., Purrucker, Jan C., Volkmann, Jens, and Neugebauer, Hermann

Published
2022
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7. Association of Intraventricular Fibrinolysis With Clinical Outcomes in Intracerebral Hemorrhage: An Individual Participant Data Meta-Analysis

Author

Kuramatsu, Joji B., Gerner, Stefan T., Ziai, Wendy, Bardutzky, Jürgen, Sembill, Jochen A., Sprügel, Maximilian I., Mrochen, Anne, Kölbl, Kathrin, Ram, Malathi, Avadhani, Radhika, Falcone, Guido J., Selim, Magdy H., Lioutas, Vasileios-Arsenios, Endres, Matthias, Zweynert, Sarah, Vajkoczy, Peter, Ringleb, Peter A., Purrucker, Jan C., Volkmann, Jens, Neugebauer, Hermann, Erbguth, Frank, Schellinger, Peter D., Knappe, Ulrich J., Fink, Gereon R., Dohmen, Christian, Minnerup, Jens, Reichmann, Heinz, Schneider, Hauke, Röther, Joachim, Reimann, Gernot, Schwarz, Michael, Bäzner, Hansjörg, Claßen, Joseph, Michalski, Dominik, Witte, Otto W., Günther, Albrecht, Hamann, Gerhard F., Lücking, Hannes, Dörfler, Arnd, Ishfaq, Muhammad Fawad, Chang, Jason J., Testai, Fernando D., Woo, Daniel, Alexandrov, Andrei V., Staykov, Dimitre, Goyal, Nitin, Tsivgoulis, Georgios, Sheth, Kevin N., Awad, Issam A., Schwab, Stefan, Hanley, Daniel F., and Huttner, Hagen B.

Published
2022
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8. Akutmanagement intrazerebraler Blutungen

Author

Sekita, A. and Kuramatsu, Joji B.

Abstract

Die intrazerebrale Blutung (ICB) ist eine der schwerwiegendsten Formen des akuten Schlaganfalls. Im Gegensatz zum ischämischen Schlaganfall gibt es nur wenige effektive, nachweislich den klinischen Zustand nach ICB verbessernde Interventionen. Wichtigstes Ziel der Akuttherapie ist die Verhinderung eines Hämatomwachstums durch umgehende aggressive und kontrollierte systolische Blutdrucksenkung sowie sofortige Hämostase, meist sind zudem intensivmedizinische Maßnahmen indiziert. Chirurgische Strategien beinhalten oft eine externe Ventrikeldrainage bei okklusivem Hydrozephalus. Die Hämatomevakuation, dekompressive Verfahren oder minimalinvasive Ansätze stellen individuelle Therapieentscheidungen dar. Die intraventrikuläre Fibrinolyse und die überlappende Lumbaldrainage scheinen mit einem besseren funktionellen Zustand nach ICB assoziiert zu sein. Dennoch ist die ICB-Mortalität nach wie vor hoch, sodass eine präzise Prognoseabschätzung wichtig ist, um voreilige Therapieeinschränkungen zu vermeiden.

Published
2022
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9. Hematoma Expansion and Clinical Outcomes in Patients With Factor-Xa Inhibitor-Related Atraumatic Intracerebral Hemorrhage Treated Within the ANNEXA-4 Trial Versus Real-World Usual Care.

Author

Huttner, Hagen B., Gerner, Stefan T., Kuramatsu, Joji B., Connolly, Stuart J., Beyer-Westendorf, Jan, Demchuk, Andrew M., Middeldorp, Saskia, Zotova, Elena, Altevers, Julia, Andersohn, Frank, Christoph, Mary J., Yue, Patrick, Stross, Leonhard, and Schwab, Stefan

Published
2022
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11. Hematoma Expansion and Clinical Outcomes in Patients With Factor-Xa Inhibitor–Related Atraumatic Intracerebral Hemorrhage Treated Within the ANNEXA-4 Trial Versus Real-World Usual Care

Author

Huttner, Hagen B., Gerner, Stefan T., Kuramatsu, Joji B., Connolly, Stuart J., Beyer-Westendorf, Jan, Demchuk, Andrew M., Middeldorp, Saskia, Zotova, Elena, Altevers, Julia, Andersohn, Frank, Christoph, Mary J., Yue, Patrick, Stross, Leonhard, and Schwab, Stefan

Abstract

Supplemental Digital Content is available in the text.

Published
2022
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12. Amantadine treatment is associated with improved consciousness in patients with non-traumatic brain injury

Author

Ru¨hl, Lena, Kuramatsu, Joji B, Sembill, Jochen A, Kallmu¨nzer, Bernd, Madzar, Dominik, Gerner, Stefan T, Giede-Jeppe, Antje, Balk, Stefanie, Mueller, Tamara, Ja¨ger, Jakob, Schwab, Stefan, Huttner, Hagen B, and Spru¨gel, Maximilian I

Abstract

ObjectiveThis study determined the effect of amantadine treatment on consciousness in patients with non-traumatic brain injury.MethodsWe pooled individual patient data of five single-centre observational studies to determine the effect of amantadine treatment among patients with ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, community-acquired bacterial meningitis and status epilepticus, admitted between January 2012 and December 2015 and ventilated ≥7 days. Patient selection and multivariable regression modelling were used to adjust for differences in intergroup comparison and for parameters associated with consciousness. Improvement of consciousness 5 days after treatment initiation was defined as primary outcome. Secondary outcomes included Glasgow Coma Scale (GCS) at day 5 and GCS at day 10, rate of ICU delirium, epileptic seizures and all-cause mortality at 90 days.ResultsOverall, 84 of 294 (28.6%) eligible patients received amantadine. Amantadine treatment was associated with improvement of consciousness at day 5 (amantadine: 86.9% vs control: 54.0%; absolute difference: 32.9 (20.0–44.2); adjusted OR (aOR): 5.71 (2.50–13.05), p<0.001). Secondary outcomes showed differences in GCS 5 days (9 (8–11) vs 6 (3–9), p<0.001) and GCS 10 days (10(8–11) vs 9(6–11),p=0.003) after treatment initiation. There were no significant differences regarding all-cause mortality (aOR: 0.89 (0.44–1.82), p=0.758) and ICU delirium (aOR: 1.39 (0.58–3.31), p=0.462). Rate of epileptic seizures after initiation of amantadine treatment was numerically higher in the amantadine group (amantadine: 10.7% vs control: 3.0%; absolute difference: 7.7 (0.3–16.4); aOR: 3.68 (0.86–15.71), p=0.079).ConclusionsAmantadine treatment is associated with improved consciousness among patients with different types of non-traumatic brain injury in this observational cohort analysis. Epileptic seizures should be considered as potential side effects and randomised controlled trials are needed to confirm these findings.

Published
2022
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13. Perihemorrhagic edema: Revisiting hematoma volume, location, and surface.

Author

Sprugel, Maximilian I. MD, Kuramatsu, Joji B. MD, Volbers, Bastian MD, Gerner, Stefan T. MD, Sembill, Jochen A. MD, Madzar, Dominik MD, Bobinger, Tobias MD, Kolbl, Kathrin MS, Hoelter, Philip MD, Lucking, Hannes MD, Dorfler, Arnd MD, Schwab, Stefan MD, Huttner, Hagen B. MD, PhD, Sprügel, Maximilian I, Kuramatsu, Joji B, Volbers, Bastian, Gerner, Stefan T, Sembill, Jochen A, Madžar, Dominik, and Bobinger, Tobias

Published
2019
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14. Neues beim Schlaganfall: Prävention

Author

Diener, Hans-Christoph, Endres, Matthias, Fiehler, Jens, Gerloff, Christian, Häusler, Karl Georg, Kuramatsu, Joji B., Pfeilschifter, Waltraud, Poli, Sven, Purrucker, Jan Christoph, Bonin-Schnabel, Renate, Sembill, Jochen A., Veltkamp, Roland, and Weimar, Christian

Published
2021
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19. Influence of new versus traditional antiepileptic drugs on course and outcome of status epilepticus.

Author

Reindl, Caroline, Sprügel, Maximilian I., Sembill, Jochen A., Mueller, Tamara M., Hagen, Manuel, Gerner, Stefan T., Kuramatsu, Joji B., Hamer, Hajo M., Huttner, Hagen B., and Madžar, Dominik

Abstract

Purpose: New antiepileptic drugs (AEDs) are increasingly applied in second-line therapy of status epilepticus (SE). In our study, we analyzed the impact of the choice of second-line AEDs on the course and prognosis of SE.Methods: This retrospective single- center study used data of an 8 year cohort of SE in adults from 2007 to 2014. Based on the year of market introduction with a cutoff at 1990, we classified AEDs as traditional or new. Prescription pattern associated differences in prognosis were measured through univariate and multivariable analysis of 3 endpoints: occurrence of refractory SE (RSE), functional outcome in survivors to discharge (good: mRS at discharge <3 or identical to admission mRS; otherwise poor), and in-hospital mortality.Results: From 362 SE episodes during the study period, 222 episodes were included into the study, among those 150 episodes treated with new and 72 with traditional AEDs. Use of new AEDs increased during the study period. After adjustment for confounders, treatment with new AEDs was on the one hand associated with higher rate of RSE occurrence (OR 1.95, 95 % CI 1.05-3.62, p = 0.03), but, on the other hand, also with better functional outcome at discharge (OR 2.64, 95 % CI 1.16-6.00, p = 0.02), while it was not an independent predictor of in- hospital mortality (OR 0.88, 95 % CI 0.33-2.33, p = 0.80).Conclusion: Our observation that new AEDs may be associated with a higher rate of RSE development and relatively better functional outcome when adjusted for the premorbid mRS needs confirmation in prospective studies. [ABSTRACT FROM AUTHOR]

Published
2020
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20. Neues beim Schlaganfall – Teil 2: Prävention

Author

Diener, Hans-Christoph, Endres, Matthias, Fiehler, Jens, Gerloff, Christian, Häusler, Hans Georg, Kuramatsu, Joji B, Pfeilschifter, Waltraud, Poli, Sven, Purrucker, Jan, Schnabel, Renate, Sembill, Jochen, Veltkamp, Roland, and Weimar, Christian

Published
2021
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21. Impact of Statins on Hematoma, Edema, Seizures, Vascular Events, and Functional Recovery After Intracerebral Hemorrhage

Author

Sprügel, Maximilian I., Kuramatsu, Joji B., Volbers, Bastian, Saam, Justina I., Sembill, Jochen A., Gerner, Stefan T., Balk, Stefanie, Hamer, Hajo M., Lücking, Hannes, Hölter, Philip, Nolte, Christian H., Scheitz, Jan F., Rocco, Andrea, Endres, Matthias, and Huttner, Hagen B.

Abstract

Supplemental Digital Content is available in the text.

Published
2021
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23. Consensus statements and recommendations from the ESO-Karolinska Stroke Update Conference, Stockholm 11–13 November 2018

Author

Ahmed, Niaz, Audebert, Heinrich, Turc, Guillaume, Cordonnier, Charlotte, Christensen, Hanne, Sacco, Simona, Sandset, Else Charlotte, Ntaios, George, Charidimou, Andreas, Toni, Danilo, Pristipino, Christian, Köhrmann, Martin, Kuramatsu, Joji B, Thomalla, Götz, Mikulik, Robert, Ford, Gary A, Martí-Fàbregas, Joan, Fischer, Urs, Thoren, Magnus, Lundström, Erik, Rinkel, Gabriel JE, Worp, H Bart van der, Matusevicius, Marius, Tsivgoulis, Georgios, Milionis, Haralampos, Rubiera, Marta, Hart, Robert, Moreira, Tiago, Lantz, Maria, Sjöstrand, Christina, Andersen, Grethe, Schellinger, Peter, Kostulas, Konstantinos, Sunnerhagen, Katharina Stibrant, Keselman, Boris, Korompoki, Eleni, Purrucker, Jan, Khatri, Pooja, Whiteley, William, Berge, Eivind, Mazya, Michael, Dippel, Diederik WJ, Mustanoja, Satu, Rasmussen, Mads, Söderqvist, Åsa Kuntze, Escudero-Martínez, Irene, and Steiner, Thorsten

Abstract

The purpose of the European Stroke Organisation–Karolinska Stroke Update Conference is to provide updates on recent stroke therapy research and to give an opportunity for the participants to discuss how these results may be implemented into clinical routine. The meeting started 22 years ago as Karolinska Stroke Update, but since 2014 it is a joint conference with European Stroke Organisation. Importantly, it provides a platform for discussion on the European Stroke Organisation guidelines process and on recommendations to the European Stroke Organisation guidelines committee on specific topics. By this, it adds a direct influence from stroke professionals otherwise not involved in committees and work groups on the guideline procedure. The discussions at the conference may also inspire new guidelines when motivated. The topics raised at the meeting are selected by the scientific programme committee mainly based on recent important scientific publications. This year’s European Stroke Organisation–Karolinska Stroke Update Meeting was held in Stockholm on 11–13 November 2018. There were 11 scientific sessions discussed in the meeting including two short sessions. Each session except the short sessions produced a consensus statement (Full version with background, issues, conclusions and references are published as web-material and atwww.eso-karolinska.organdhttp://eso-stroke.org) and recommendations which were prepared by a writing committee consisting of session chair(s), scientific secretary and speakers. These statements were presented to the 250 participants of the meeting. In the open meeting, general participants commented on the consensus statement and recommendations and the final document were adjusted based on the discussion from the general participants Recommendations (grade of evidence) were graded according to the 1998 Karolinska Stroke Update meeting with regard to the strength of evidence. Grade A Evidence: Strong support from randomised controlled trials and statistical reviews (at least one randomised controlled trial plus one statistical review). Grade B Evidence: Support from randomised controlled trials and statistical reviews (one randomised controlled trial or one statistical review). Grade C Evidence: No reasonable support from randomised controlled trials, recommendations based on small randomised and/or non-randomised controlled trials evidence.

Published
2019
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24. Characteristics in Non-Vitamin K Antagonist Oral Anticoagulant-Related Intracerebral Hemorrhage.

Author

Gerner, Stefan T., Kuramatsu, Joji B., Sembill, Jochen A., Sprügel, Maximilian I., Hagen, Manuel, Knappe, Ruben U., Endres, Matthias, Haeusler, Karl Georg, Sobesky, Jan, Schurig, Johannes, Zweynert, Sarah, Bauer, Miriam, Vajkoczy, Peter, Ringleb, Peter A., Purrucker, Jan C., Rizos, Timolaos, Volkmann, Jens, Müllges, Wolfgang, Kraft, Peter, and Schubert, Anna-Lena

Published
2019
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25. Cardioembolic Stroke Risk and Recovery After Anticoagulation-Related Intracerebral Hemorrhage.

Author

Murphy, Meredith P., Kuramatsu, Joji B., Leasure, Audrey, Falcone, Guido J., Kamel, Hooman, Sansing, Lauren H., Kourkoulis, Christina, Schwab, Kristin, Elm, Jordan J., Gurol, M. Edip, Tran, Huy, Greenberg, Steven M., Viswanathan, Anand, Anderson, Christopher D., Schwab, Stefan, Rosand, Jonathan, Shi, Fu-Dong, Kittner, Steven J., Testai, Fernando D., and Woo, Daniel

Published
2018
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27. Influence of Prior Nicotine and Alcohol Use on Functional Outcome in Patients after Intracerebral Hemorrhage.

Author

Sembill, Jochen A., Sprügel, Maximilian I., Gerner, Stefan T., Beuscher, Vanessa D., Giede-Jeppe, Antje, Stocker, Margarete, Hoelter, Philip, Lücking, Hannes, Kuramatsu, Joji B., and Huttner, Hagen B.

Abstract

Background: The influence of prior nicotine or alcohol use (legal drug use [LDU]) on outcome measures after intracerebral hemorrhage (ICH) is insufficiently established. We investigated drug-specific associations with (1) neuroradiologic and clinical parameters and (2) functional long-term outcome after ICH.Methods: This observational cohort study analyzed consecutive spontaneous patients with ICH (n = 554) from our prospective institutional registry over a 5-year study period (January 2010 to December 2014). We compared no-LDU patients with LDU patients, and patients using only nicotine, only alcohol, or both. To account for baseline imbalances, we reanalyzed cohorts after propensity score matching.Results: Prevalence of prior LDU was 197 of 554 (35.6%), comprising 94 of 554 (17.0%) with only nicotine use, 33 of 554 (6.0%) with only alcohol use, and 70 of 554 (12.6%) with alcohol and nicotine use. LDU patients were younger (65 [56-73] versus 75 [67-82], P <.01), less often female (n = 61 of 197 [31.0%] versus n = 188 of 357 [52.7%], P <.01), had more often prior myocardial infarction (n = 29 of 197 [14.7%] versus n = 24 of 357 [6.7%], P <.01), and in-hospital complications (sepsis or systemic inflammatory response syndrome: n = 95 of 197 [48.2%] versus n = 98 of 357 [27.5%], P <.01; pneumonia: n = 89 of 197 [45.2%] versus n = 110 of 357 [30.8%], P <.01). Except for an increased risk of pneumonia (odds ratio 2.22, confidence interval [1.04-4.75], P = .04) in patients using both nicotine and alcohol, we detected no significant differences upon reanalysis after propensity score matching of neuroradiologic or clinical parameters, complications, or long-term outcome between patients with and without LDU (mortality: n = 48 of 150 [32.0%] versus n = 45 of 150 [30.0%], P = .71; favorable outcome [modified Rankin Scale 0-3]: n = 56 of 150 [37.3%] versus n = 53 of 150 [35.3%], P = .72).Conclusions: Prior nicotine use, alcohol use, and their combination were associated with significant differences in baseline characteristics. However, adjusting for unevenly balanced baseline parameters revealed no differences in functional long-term outcome after ICH. [ABSTRACT FROM AUTHOR]

Published
2018
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29. Characteristics in Non–Vitamin K Antagonist Oral Anticoagulant–Related Intracerebral Hemorrhage

Author

Gerner, Stefan T., Kuramatsu, Joji B., Sembill, Jochen A., Sprügel, Maximilian I., Hagen, Manuel, Knappe, Ruben U., Endres, Matthias, Haeusler, Karl Georg, Sobesky, Jan, Schurig, Johannes, Zweynert, Sarah, Bauer, Miriam, Vajkoczy, Peter, Ringleb, Peter A., Purrucker, Jan C., Rizos, Timolaos, Volkmann, Jens, Müllges, Wolfgang, Kraft, Peter, Schubert, Anna-Lena, Erbguth, Frank, Nueckel, Martin, Schellinger, Peter D., Glahn, Jörg, Knappe, Ulrich J., Fink, Gereon R., Dohmen, Christian, Stetefeld, Henning, Fisse, Anna Lena, Minnerup, Jens, Hagemann, Georg, Rakers, Florian, Reichmann, Heinz, Schneider, Hauke, Rahmig, Jan, Ludolph, Albert Christian, Stösser, Sebastian, Neugebauer, Hermann, Röther, Joachim, Michels, Peter, Schwarz, Michael, Reimann, Gernot, Bäzner, Hansjörg, Schwert, Henning, Claßen, Joseph, Michalski, Dominik, Grau, Armin, Palm, Frederick, Urbanek, Christian, Wöhrle, Johannes C., Alshammari, Fahid, Horn, Markus, Bahner, Dirk, Witte, Otto W., Günther, Albrecht, Hamann, Gerhard F., Engelhorn, Tobias, Lücking, Hannes, Dörfler, Arnd, Schwab, Stefan, and Huttner, Hagen B.

Abstract

Supplemental Digital Content is available in the text.

Published
2019
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30. Heparin for prophylaxis of venous thromboembolism in intracerebral haemorrhage

Author

Spru¨gel, Maximilian I, Sembill, Jochen A, Kuramatsu, Joji B, Gerner, Stefan T, Hagen, Manuel, Roeder, Sebastian S, Endres, Matthias, Haeusler, Karl Georg, Sobesky, Jan, Schurig, Johannes, Zweynert, Sarah, Bauer, Miriam, Vajkoczy, Peter, Ringleb, Peter Arthur, Purrucker, Jan Christoph, Rizos, Timolaos, Volkmann, Jens, Muellges, Wolfgang, Kraft, Peter, Schubert, Anna-Lena, Erbguth, Frank, Nueckel, Martin, Schellinger, Peter D, Glahn, Jo¨rg, Knappe, Ulrich J, Fink, Gereon Rudolf, Dohmen, Christian, Stetefeld, Henning, Fisse, Anna Lena, Minnerup, Jens, Hagemann, Georg, Rakers, Florian, Reichmann, Heinz, Schneider, Hauke, Wo¨pking, Sigrid, Ludolph, Albert C, Sto¨sser, Sebastian, Neugebauer, Hermann, Ro¨ther, Joachim, Michels, Peter, Schwarz, Michael, Reimann, Gernot, Ba¨zner, Hansjo¨rg, Schwert, Henning, Classen, Joseph, Michalski, Dominik, Grau, Armin, Palm, Frederick, Urbanek, Christian, Wo¨hrle, Johannes C, Alshammari, Fahid, Horn, Markus, Bahner, Dirk, Witte, Otto W, Guenther, Albrecht, Hamann, Gerhard F, Lu¨cking, Hannes, Do¨rfler, Arnd, Schwab, Stefan, and Huttner, Hagen B

Abstract

ObjectiveTo determine the occurrence of intracranial haemorrhagic complications (IHC) on heparin prophylaxis (low-dose subcutaneous heparin, LDSH) in primary spontaneous intracerebral haemorrhage (ICH) (not oral anticoagulation-associated ICH, non-OAC-ICH), vitamin K antagonist (VKA)-associated ICH and non-vitamin K antagonist oral anticoagulant (NOAC)-associated ICH.MethodsRetrospective cohort study (RETRACE) of 22 participating centres and prospective single-centre study with 1702 patients with VKA-associated or NOAC-associated ICH and 1022 patients with non-OAC-ICH with heparin prophylaxis between 2006 and 2015. Outcomes were defined as rates of IHC during hospital stay among patients with non-OAC-ICH, VKA-ICH and NOAC-ICH, mortality and functional outcome at 3 months between patients with ICH with and without IHC.ResultsIHC occurred in 1.7% (42/2416) of patients with ICH. There were no differences in crude incidence rates among patients with VKA-ICH, NOAC-ICH and non-OAC-ICH (log-rank p=0.645; VKA-ICH: 27/1406 (1.9%), NOAC-ICH 1/130 (0.8%), non-OAC-ICH 14/880 (1.6%); p=0.577). Detailed analysis according to treatment exposure (days with and without LDSH) revealed no differences in incidence rates of IHC per 1000 patient-days (LDSH: 1.43 (1.04–1.93) vs non-LDSH: 1.32 (0.33–3.58), conditional maximum likelihood incidence rate ratio: 1.09 (0.38–4.43); p=0.953). Secondary outcomes showed differences in functional outcome (modified Rankin Scale=4–6: IHC: 29/37 (78.4%) vs non-IHC: 1213/2048 (59.2%); p=0.019) and mortality (IHC: 14/37 (37.8%) vs non-IHC: 485/2048 (23.7%); p=0.045) in disfavour of patients with IHC. Small ICH volume (OR: volume <4.4 mL: 0.18 (0.04–0.78); p=0.022) and low National Institutes of Health Stroke Scale (NIHSS) score on admission (OR: NIHSS <4: 0.29 (0.11–0.78); p=0.014) were significantly associated with fewer IHC.ConclusionsHeparin administration for venous thromboembolism (VTE) prophylaxis in patients with ICH appears to be safe regarding IHC among non-OAC-ICH, VKA-ICH and NOAC-ICH in this observational cohort analysis. Randomised controlled trials are needed to verify the safety and efficacy of heparin compared with other methods for VTE prevention.

Published
2019
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31. Cardioembolic Stroke Risk and Recovery After Anticoagulation-Related Intracerebral Hemorrhage

Author

Murphy, Meredith P., Kuramatsu, Joji B., Leasure, Audrey, Falcone, Guido J., Kamel, Hooman, Sansing, Lauren H., Kourkoulis, Christina, Schwab, Kristin, Elm, Jordan J., Gurol, M. Edip, Tran, Huy, Greenberg, Steven M., Viswanathan, Anand, Anderson, Christopher D., Schwab, Stefan, Rosand, Jonathan, Shi, Fu-Dong, Kittner, Steven J., Testai, Fernando D., Woo, Daniel, Langefeld, Carl D., James, Michael L., Koch, Sebastian, Huttner, Hagen B., Biffi, Alessandro, and Sheth, Kevin N.

Abstract

Supplemental Digital Content is available in the text.

Published
2018
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34. Long-term antithrombotic treatment in intracranial hemorrhage survivors with atrial fibrillation.

Author

Korompoki, Eleni, Filippidis, Filippos T., Nielsen, Peter B., Giudice, Angela Del, Lip, Gregory Y. H., Kuramatsu, Joji B., Huttner, Hagen B., Jiming Fang, Schulman, Sam, Martí-Fàbregas, Joan, Gathier, Celine S., Viswanathan, Anand, Biffi, Alessandro, Poli, Daniela, Weimar, Christian, Malzahn, Uwe, Heuschmann, Peter, Veltkamp, Roland, Del Giudice, Angela, and Fang, Jiming

Published
2017
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38. Assessing the value of topiramate in refractory status epilepticus.

Author

Madžar, Dominik, Kuramatsu, Joji B., Gerner, Stefan T., and Huttner, Hagen B.

Abstract

Purpose: The aim of this study was to assess factors associated with the use of topiramate (TPM) in refractory status epilepticus (RSE).Methods: We retrospectively reviewed RSE episodes over a 12-year period. Episodes treated with and without TPM were compared in terms of demographics, RSE characteristics, clinical course, and outcome in univariate and multivariate analyses. Subgroups defined by type of RSE were studied separately. Functional outcome was assessed with the modified Rankin Scale.Results: Among 71 episodes, 17 (23.9%) were treated with TPM and seizure control was achieved in all of these. The results of unadjusted comparisons suggested a use of TPM in younger and healthier patients who received more perseverant treatment indicated by a higher number of antiepileptic drugs applied. In multivariate analysis adjusting for RSE duration, however, these associations lost significance. Furthermore, TPM was not a predictor of successful RSE termination in neither the overall cohort, nor in the subgroup of complex-partial RSE.Conclusion: After multivariate adjustment, no significant differences were observed between episodes treated with and without TPM in baseline characteristics, treatment, and outcome. Regarding the latter, this study does therefore not yield evidence for a particular efficacy of TPM in RSE. [ABSTRACT FROM AUTHOR]

Published
2016
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47. Hyponatremia Is an Independent Predictor of In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage

Author

Kuramatsu, Joji B., Bobinger, Tobias, Volbers, Bastian, Staykov, Dimitre, Lücking, Hannes, Kloska, Stephan P., Köhrmann, Martin, and Huttner, Hagen B.

Abstract

Hyponatremia is the most frequent electrolyte disturbance in critical care. Across various disciplines, hyponatremia is associated with increased mortality and longer hospital stay, yet in intracerebral hemorrhage (ICH) no data are available. This the first study that investigated the prevalence and clinical associations of hyponatremia in patients with ICH.

Published
2014
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48. Chronic Kidney Disease and Clinical Outcomes in Patients with Intracerebral Hemorrhage.

Author

Beuscher, Vanessa D., Sprügel, Maximilian I., Gerner, Stefan T., Sembill, Jochen A., Madzar, Dominik, Reindl, Caroline, Lücking, Hannes, Lang, Stefan, Hoelter, Philip, Kuramatsu, Joji B., and Huttner, Hagen B.

Abstract

Background and Purpose: The influence of chronic kidney disease (CKD) on functional outcome in intracerebral hemorrhage (ICH) is scarcely investigated and reported findings are conflicting mostly because of nonaccounting for imbalances. Aim of the present study was to determine the impact of CKD on functional long-term outcome in ICH-patients.Methods: In this observational cohort study of spontaneous ICH-patients admitted to our Department of Neurology between 2006 and 2015 we investigated retrospectively as primary outcome the dichotomized functional status (modified-Rankin-Scale = 0-3-versus-4-6) at 12 months according to renal function (CKD versus non-CKD), including categorial estimates of the glomerular filtration rate subanalyses. Confounding was addressed by propensity-score(ps)-matching and adjusted multivariable regression analyses.Results: We identified 1076 eligible ICH-patients, of which 131 (12.2%) suffered from CKD on hospital admission. Confounders associated with CKD consisted of hypertension (P = .023), Diabetes mellitus (P = .001), prior ischemic stroke and/or transitory ischemic attack (TIA) (P = .021), congestive heart failure (P < .01), impaired liver function (P < .01), antiplatelet therapy (P = .01), poorer premorbid functional status (P < .01), and deep ICH-location (P = .006). After balancing for confounding, patients with CKD showed a significantly decreased rate of favorable functional outcome at 12 months (CKD:29 of 111(26.1%)-versus-non-CKD:78 of 206 (37.9%); P = .035). Subanalyses showed that stages of CKD were evenly associated with mortality at 12 months (GFR category G3a, OR:2.811; CI (1.130-6.994); P = .026; GFR category G3b, OR:1.874; CI (.694-5.058); P = .215; GFR category G4, OR:10.316; CI (1.976-53.856); P = .006; GFR category G5, OR:8.989; CI (1.900-42.518); P = .006).Conclusions: As compared to ICH-patients without CKD, those with CKD show increased rates of mortality and worse functional outcomes even after statistical correction for imbalanced baseline characteritsics. This finding is presumably linked to comorbidity and warrants further investigation in prospective studies. [ABSTRACT FROM AUTHOR]

Published
2020
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49. Invasiveness and Clinical Outcomes of Off-Hour Admissions in Patients with Intracerebral Hemorrhage.

Author

Mrochen, Anne, Sprügel, Maximilian I., Gerner, Stefan T., Madžar, Dominik, Kuramatsu, Joji B., Hoelter, Philip, Lücking, Hannes, Schwab, Stefan, and Huttner, Hagen B.

Abstract

Background: Whether time of hospital admission-during or outside regular working hours-affects functional outcome in intracerebral hemorrhage (ICH) is unestablished as previous analyses have focused on mortality only. We here investigate whether on- versus off-hour hospital admission in ICH is associated with levels of invasiveness and clinical outcomes.Methods: Based on the UKER registry (NCT03183167) we grouped ICH-patients according to on- versus off-hour hospital admission. Primary outcome measures was functional outcome after 3 months using the modified Rankin scale (mRS) dichotomized into favorable (mRS = 0-3) and unfavorable (mRS = 4-6). Multivariate regression analyses were used to adjust for baseline imbalances, and subgroup analyses were performed to explore associations of on- versus off-hour admission with invasiveness of therapeutic interventions.Results: A total of 438/1269 (34.5%) of ICH-patients were admitted during regular working hours. Mortality rates were not significantly different among patients with on- versus off-hour admission. On-hour patients showed a significantly larger proportion of patients with favorable outcome (on-hour: mRS = 0-3 after 3 months: 176/416 (42.3%) versus off-hour: 265/784 (33.8%); P = .004). Analysis of invasive therapeutic interventions revealed that likelihood of favorable outcome was significantly increased among on-hour admitted patients who did not require neurosurgical interventions (no external ventricular drain n = 349, OR: 1.67[1.13-2.48], P < .05; no hematoma evacuation surgery n = 423, OR: 1.51[1.07-2.14], P < .05).Conclusion: This study verified an "off-hour effect" in ICH that relates to functional outcome, rather than mortality, and which may be linked to different levels of invasive therapeutic interventions in patients admitted during off-hour. [ABSTRACT FROM AUTHOR]

Published
2020
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