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Perihemorrhagic edema: Revisiting hematoma volume, location, and surface.

Authors :
Sprügel MI
Kuramatsu JB
Volbers B
Gerner ST
Sembill JA
Madžar D
Bobinger T
Kölbl K
Hoelter P
Lücking H
Dörfler A
Schwab S
Huttner HB
Source :
Neurology [Neurology] 2019 Sep 17; Vol. 93 (12), pp. e1159-e1170. Date of Electronic Publication: 2019 Aug 16.
Publication Year :
2019

Abstract

Objective: To determine the influence of intracerebral hemorrhage (ICH) location and volume and hematoma surface on perihemorrhagic edema evolution.<br />Methods: Patients with ICH of the prospective Universitätsklinikum Erlangen Cohort of Patients With Spontaneous Intracerebral Hemorrhage (UKER-ICH) cohort study (NCT03183167) between 2010 and 2013 were analyzed. Hematoma and edema volume during hospital stay were volumetrically assessed, and time course of edema evolution and peak edema correlated to hematoma volume, location, and surface to verify the strength of the parameters on edema evolution.<br />Results: Overall, 300 patients with supratentorial ICH were analyzed. Peak edema showed a high correlation with hematoma surface ( R <superscript>2</superscript> = 0.864, p < 0.001) rather than with hematoma volumes, regardless of hematoma location. Smaller hematomas with a higher ratio of hematoma surface to volume showed exponentially higher relative edema ( R <superscript>2</superscript> = 0.755, p < 0.001). Multivariable logistic regression analysis revealed a cutoff ICH volume of 30 mL, beyond which an increase of total mass lesion volume (combined volume of hematoma and edema) was not associated with worse functional outcome. Specifically, peak edema was associated with worse functional outcome in ICH <30 mL (odds ratio [OR] 2.63, 95% confidence interval [CI] 1.68-4.12, p < 0.001), contrary to ICH ≥30 mL (OR 1.20, 95% CI 0.88-1.63, p = 0.247). There were no significant differences between patients with lobar and those with deep ICH after adjustment for hematoma volumes.<br />Conclusions: Peak perihemorrhagic edema, although influencing mortality, is not associated with worse functional outcomes in ICH volumes >30 mL. Although hematoma volume correlates with peak edema extent, hematoma surface is the major parameter for edema evolution. The effect of edema on functional outcome is therefore more pronounced in smaller and irregularly shaped hematomas, and these patients may particularly benefit from edema-modifying therapies.<br /> (© 2019 American Academy of Neurology.)

Details

Language :
English
ISSN :
1526-632X
Volume :
93
Issue :
12
Database :
MEDLINE
Journal :
Neurology
Publication Type :
Academic Journal
Accession number :
31420462
Full Text :
https://doi.org/10.1212/WNL.0000000000008129