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Increased Brain Volume Among Good Grade Patients with Intracerebral Hemorrhage. Results from the Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) Study

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Abstract

Background

We ascertained the occurrence of global cerebral edema manifesting as increased brain volume in subjects with intracerebral hemorrhage (ICH) and explored the relationship between subject characteristics and three month outcomes.

Methods

A post-hoc analysis of a multicenter prospective study that recruited patients with ICH, elevated SBP ≥170 mm Hg, and Glasgow Coma Scale (GCS) score ≥8, who presented within 6 h of symptom onset was performed. Computed tomographic (CT) scans at baseline and 24 h, submitted to a core image laboratory, were analyzed to measure total brain, hematoma, and perihematoma edema volumes from baseline and 24-h CT scans using image analysis software. The increased brain volume was determined by subtracting the hematoma and perihematomal edema volumes from the total brain volume.

Results

A total of 18 (44 %) of 41 subjects had increased brain volume that developed between initial CT scan and 24-h CT scan. The median increase in brain volume among the 18 subjects was 35 cc ranging from 0.12 to 296 cc. The median baseline GCS score was 15 in both groups of subjects who experienced increased brain volume and those who did not, and the median hematoma volume was 10.18 and 6.73, respectively. Three of the 18 subjects with increased brain volume underwent concurrent neurological deterioration and one subject died during hospitalization.

Conclusions

We found preliminary evidence of increased cerebral brain volume in subjects with good grade and small ICHs, which may be suggestive of global cerebral edema.

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Disclosure

Dr. Qureshi has received funding from the National Institutes of Health RO1-NS44976-01A2 (medication provided by ESP Parma), American Heart Association Established Investigator Award 0840053N, National Institute of Health U01-NS062091-01A2, and the Minnesota Medical Foundation, Minneapolis, MN.

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Authors and Affiliations

  1. Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, MN, USA

    Adnan I. Qureshi, Shahram Majidi, Waqas I. Gilani, Jill Novitzke, M. Fareed K. Suri & Nauman Tariq

  2. Division of Biostatistics and Epidemiology, Medical University of South Carolina, Charleston, SC, USA

    Yuko Y. Palesch & Renee Martin

  3. St. Louis University Health Sciences Center, St. Louis, MO, USA

    Salvador Cruz-Flores

  4. Department of Neurology, University of Mississippi Medical Center, Jackson, MS, USA

    Asad Ehtisham

  5. Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA

    Joshua N. Goldstein

  6. Neuroscience Institute, John F. Kennedy Medical Center, Edison, NJ, USA

    Jawad F. Kirmani

  7. Department of Neurology, Baylor College of Medicine, Houston, TX, USA

    Haitham M. Hussein

  8. Zeenat Qureshi Stroke Research Center, University of Minnesota, 420 Delaware Street SE, MMC 295, Minneapolis, MN, 55455, USA

    Adnan I. Qureshi

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  1. Adnan I. Qureshi
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  2. Shahram Majidi
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  3. Waqas I. Gilani
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  7. Salvador Cruz-Flores
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  8. Asad Ehtisham
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  10. Jawad F. Kirmani
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  11. Haitham M. Hussein
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  12. M. Fareed K. Suri
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  13. Nauman Tariq
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Antihypertensive Treatment of Acute Cerebral Hemorrhage Study Investigators

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Correspondence to Adnan I. Qureshi.

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Qureshi, A.I., Majidi, S., Gilani, W.I. et al. Increased Brain Volume Among Good Grade Patients with Intracerebral Hemorrhage. Results from the Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) Study. Neurocrit Care 20, 470–475 (2014). https://doi.org/10.1007/s12028-013-9842-1

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  • DOI: https://doi.org/10.1007/s12028-013-9842-1

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