Impact of intraventricular hemorrhage upon intracerebral hematoma expansion

Michael Moussouttas, Rishi Malhotra, Luis Fernandez, Mitchell Maltenfort, Melissa Holowecki, Jennifer Delgado, Nadine Lawson, Neeraj Badjatia

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: The purpose of this study is to determine whether intraventricular hemorrhage (IVH) exerts a "decompressive" effect that limits intracerebral hemorrhage (ICH) enlargement. Methods: Retrospective review of patients with spontaneous supratentorial ICH diagnosed within 6 h of onset, who underwent follow-up head CT approximately 48 h later. Digital imaging analysis of CT scans was performed to compare hematoma volume changes between patients with and without IVH. Hemorrhage locations were classified as paraventricular (PV) or non-PV. Regression analyses were employed to identify predictors of IVH, hematoma expansion, and mortality. Results: Of the 70 patients included 57% developed IVH, 85% of which occurred before initial CT. 71% of PV hemorrhages developed IVH, all before initial CT, and 48% of non-PV hemorrhages developed IVH, 29% of which occurred after initial CT. IVH was associated with PV location (P = 0.04), and among IVH patients PV location was associated with early IVH (P = 0.003). Predictors of mortality included age (P = 0.037), initial hematoma volume (P <0.04), absolute volume change (P = 0.01), and final hematoma volume (P <0.001). Variables predicting IVH included PV location (P <0.0001), larger initial hematoma volume (P = 0.002), and greater absolute volume increase (P = 0.01). Hematoma expansion was greatest for non-PV with IVH (P = 0.08), and graphic inspection suggested that ICH volume tended to decrease with PV location and increase with IVH. Final hematoma volume was associated with initial volume (P <0.0001), non-PV location (P = 0.02), and IVH (P = 0.04). Conclusions: IVH was not associated with less hematoma volume expansion, and for non-PV hemorrhages IVH was linked to greater volume increase.

Original languageEnglish (US)
Pages (from-to)50-54
Number of pages5
JournalNeurocritical Care
Volume14
Issue number1
DOIs
StatePublished - Feb 2011
Externally publishedYes

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Cerebral Hemorrhage
Hematoma
Hemorrhage
Mortality

Keywords

  • Decompression
  • Digital image analysis
  • Enlargement
  • Expansion
  • Hematoma
  • Intracerebral hemorrhage
  • Intraventricular hemorrhage
  • Mortality

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Moussouttas, M., Malhotra, R., Fernandez, L., Maltenfort, M., Holowecki, M., Delgado, J., ... Badjatia, N. (2011). Impact of intraventricular hemorrhage upon intracerebral hematoma expansion. Neurocritical Care, 14(1), 50-54. https://doi.org/10.1007/s12028-010-9452-0

Impact of intraventricular hemorrhage upon intracerebral hematoma expansion. / Moussouttas, Michael; Malhotra, Rishi; Fernandez, Luis; Maltenfort, Mitchell; Holowecki, Melissa; Delgado, Jennifer; Lawson, Nadine; Badjatia, Neeraj.

In: Neurocritical Care, Vol. 14, No. 1, 02.2011, p. 50-54.

Research output: Contribution to journalArticle

Moussouttas, M, Malhotra, R, Fernandez, L, Maltenfort, M, Holowecki, M, Delgado, J, Lawson, N & Badjatia, N 2011, 'Impact of intraventricular hemorrhage upon intracerebral hematoma expansion', Neurocritical Care, vol. 14, no. 1, pp. 50-54. https://doi.org/10.1007/s12028-010-9452-0
Moussouttas M, Malhotra R, Fernandez L, Maltenfort M, Holowecki M, Delgado J et al. Impact of intraventricular hemorrhage upon intracerebral hematoma expansion. Neurocritical Care. 2011 Feb;14(1):50-54. https://doi.org/10.1007/s12028-010-9452-0
Moussouttas, Michael ; Malhotra, Rishi ; Fernandez, Luis ; Maltenfort, Mitchell ; Holowecki, Melissa ; Delgado, Jennifer ; Lawson, Nadine ; Badjatia, Neeraj. / Impact of intraventricular hemorrhage upon intracerebral hematoma expansion. In: Neurocritical Care. 2011 ; Vol. 14, No. 1. pp. 50-54.
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AU - Delgado, Jennifer

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AB - Background: The purpose of this study is to determine whether intraventricular hemorrhage (IVH) exerts a "decompressive" effect that limits intracerebral hemorrhage (ICH) enlargement. Methods: Retrospective review of patients with spontaneous supratentorial ICH diagnosed within 6 h of onset, who underwent follow-up head CT approximately 48 h later. Digital imaging analysis of CT scans was performed to compare hematoma volume changes between patients with and without IVH. Hemorrhage locations were classified as paraventricular (PV) or non-PV. Regression analyses were employed to identify predictors of IVH, hematoma expansion, and mortality. Results: Of the 70 patients included 57% developed IVH, 85% of which occurred before initial CT. 71% of PV hemorrhages developed IVH, all before initial CT, and 48% of non-PV hemorrhages developed IVH, 29% of which occurred after initial CT. IVH was associated with PV location (P = 0.04), and among IVH patients PV location was associated with early IVH (P = 0.003). Predictors of mortality included age (P = 0.037), initial hematoma volume (P <0.04), absolute volume change (P = 0.01), and final hematoma volume (P <0.001). Variables predicting IVH included PV location (P <0.0001), larger initial hematoma volume (P = 0.002), and greater absolute volume increase (P = 0.01). Hematoma expansion was greatest for non-PV with IVH (P = 0.08), and graphic inspection suggested that ICH volume tended to decrease with PV location and increase with IVH. Final hematoma volume was associated with initial volume (P <0.0001), non-PV location (P = 0.02), and IVH (P = 0.04). Conclusions: IVH was not associated with less hematoma volume expansion, and for non-PV hemorrhages IVH was linked to greater volume increase.

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