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Rapidly progressive cerebral atrophy following a posterior cranial fossa stroke: Assessment with semiautomatic CT volumetry

  • Original Article
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Acta Neurochirurgica Aims and scope

Abstract

Background

The effect of posterior cranial fossa stroke on changes in cerebral volume is not known. We assessed cerebral volume changes in patients with acute posterior fossa stroke using CT scans, and looked for risk factors for cerebral atrophy.

Methods

Patients with cerebellar or brainstem hemorrhage/infarction admitted to the ICU, and who underwent at least two subsequent inpatient head CT scans during hospitalization were included (n = 60). The cerebral volume was estimated using an automatic segmentation method. Patients with cerebral volume reduction > 0% from the first to the last scan were defined as the “cerebral atrophy group (n = 47),” and those with ≤ 0% were defined as the “no cerebral atrophy group (n = 13).”

Results

The cerebral atrophy group showed a significant decrease in cerebral volume (first CT scan: 0.974 ± 0.109 L vs. last CT scan: 0.927 ± 0.104 L, P < 0.001). The mean percentage change in cerebral volume between CT scans in the cerebral atrophy group was –4.7%, equivalent to a cerebral volume of 46.8 cm3, over a median of 17 days. The proportions of cases with a history of hypertension, diabetes mellitus, and median time on mechanical ventilation were significantly higher in the cerebral atrophy group than in the no cerebral atrophy group.

Conclusions

Many ICU patients with posterior cranial fossa stroke showed signs of cerebral atrophy. Those with rapidly progressive cerebral atrophy were more likely to have a history of hypertension or diabetes mellitus and required prolonged ventilation.

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Data availability

The data that support the findings of this study are available from the corresponding author, RN, upon reasonable request.

Abbreviations

CSF:

Cerebrospinal fluid

DM:

Diabetes mellitus

GCS:

Glasgow Coma Scale

GM:

Gray matter

ICU:

Intensive care unit

IQR:

Interquartile range

MNI:

Montreal Neurological Institute

mRS:

Modified Rankin Scale

PEEP:

Positive end-expiratory pressure

SPECT:

Single-photon emission computed tomography

SPM:

Statistical parametric mapping

WM:

White matter

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Acknowledgements

We thank Libby Cone, MD, MA, from Dmed (www.dmed.co.jp) for editing drafts of this manuscript.

Author information

Authors and Affiliations

  1. Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5, Sendagi, Bunkyo-Ku, Tokyo, 113-8603, Japan

    Yoshiyuki Matsumoto, Ryuta Nakae, Yutaka Igarashi & Shoji Yokobori

  2. Department of Radiology, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan

    Tetsuro Sekine & Eigo Kodani

  3. PMOD Technologies Ltd, Zurich, Switzerland

    Geoffrey Warnock

  4. Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan

    Takashi Tagami

  5. Department of Neurological Surgery, Nippon Medical School Hospital, Tokyo, Japan

    Yasuo Murai

  6. Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan

    Kensuke Suzuki

Authors
  1. Yoshiyuki Matsumoto
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  2. Ryuta Nakae
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  3. Tetsuro Sekine
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  4. Eigo Kodani
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  8. Yasuo Murai
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  10. Shoji Yokobori
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Contributions

Conception and design: YM, RN. Acquisition of data: YM, TS, EK. Analysis and interpretation of data: YM, RN, YI, TT, YM. Drafting the article: YM, RN, TS. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: RN. Statistical analysis: YM, RN. Study supervision: GW, KS, SY.

Corresponding author

Correspondence to Ryuta Nakae.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of Nippon Medical School Hospital and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The Institutional Review Board of Nippon Medical School Hospital approved this study (B-2022–552) and waived the need for informed consent due to the observational nature of the study.

Conflict of interest

One author (Geoffrey Warnock) is an employee of PMOD Technologies Ltd. Only PMOD non-employees had control of inclusion of data and other information.

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Matsumoto, Y., Nakae, R., Sekine, T. et al. Rapidly progressive cerebral atrophy following a posterior cranial fossa stroke: Assessment with semiautomatic CT volumetry. Acta Neurochir 165, 1575–1584 (2023). https://doi.org/10.1007/s00701-023-05609-3

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  • DOI: https://doi.org/10.1007/s00701-023-05609-3

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