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Predictors and Prognostic Impact of Hematoma Expansion in Infratentorial Cerebral Hemorrhage

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Abstract

Background

Hematoma expansion (HE) is common and predicts poor outcome in patients with supratentorial intracerebral hemorrhage (ICH). We investigated the predictors and prognostic impact of HE in infratentorial ICH.

Methods

We conducted a retrospective analysis of patients with brainstem and cerebellar ICH admitted at seven sites. Noncontrast computed tomography images were analyzed for the presence of hypodensities according to validated criteria, defined as any hypodense region strictly encapsulated within the hemorrhage with any shape, size, and density. Occurrence of HE (defined as > 33% and/or > 6-mL growth) and mortality at 90 days were the outcomes of interest. Their predictors were investigated using logistic regression with backward elimination at p < 0.1. Logistic regression models for HE were adjusted for baseline ICH volume, antiplatelet and anticoagulant treatment, onset to computed tomography time, and presence of hypodensities. The logistic regression model for mortality accounted for the ICH score and HE.

Results

A total of 175 patients were included (median age 75 years, 40.0% male), of whom 38 (21.7%) had HE and 43 (24.6%) died within 90 days. Study participants with HE had a higher frequency of hypodensities (44.7 vs. 24.1%, p = 0.013), presentation within 3 h from onset (39.5 vs. 24.8%, p = 0.029), and 90-day mortality (44.7 vs. 19.0%, p = 0.001). Hypodensities remained independently associated with HE after adjustment for confounders (odds ratio 2.44, 95% confidence interval 1.13–5.25, p = 0.023). The association between HE and mortality remained significant in logistic regression (odds ratio 3.68, 95% confidence interval 1.65–8.23, p = 0.001).

Conclusion

Early presentation and presence of noncontrast computed tomography hypodensities were independent predictors of HE in infratentorial ICH, and the occurrence of HE had an independent prognostic impact in this population.

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Authors and Affiliations

  1. Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy

    Debora Pezzini & Alessandro Padovani

  2. Department of Radiology (CCM), Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin Institute of Health, Humboldt-Universitätzu Berlin, FreieUniversität Berlin, Berlin, Germany

    Jawed Nawabi

  3. Berlin Institute of Health (BIH), BIH Biomedical Innovation Academy, Berlin, Germany

    Jawed Nawabi & Frieder Schlunk

  4. Department of Neuroradiology, Charité–Universitätsmedizin Berlin, FreieUniversität Berlin, Humboldt-Universitätz Berlin, Berlin, Germany

    Frieder Schlunk

  5. Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

    Qi Li

  6. U.C. Malattie Cerebrovascolari e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy

    Federico Mazzacane & Anna Cavallini

  7. Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy

    Giorgio Busto & Elisa Scola

  8. Stroke Unit, Careggi University Hospital, Florence, Italy

    Francesco Arba

  9. IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Neurologia e Rete Stroke Metropolitana, Ospedale Maggiore, Bologna, Italy

    Laura Brancaleoni, Sebastiano Giacomozzi & Andrea Zini

  10. IRCCS Istituto delle Scienze Neurologiche di Bologna, UO (SSI) di Neuroradiologia, Ospedale Maggiore, Bologna, Italy

    Luigi Simonetti

  11. Clinica Neurologica, Dipartimento di Scienze Biomediche e Chirurgico Specialistiche, Università degli Studi di Ferrara, Ospedale Universitario S. Anna, Ferrara, Italy

    Michele Laudisi & Ilaria Casetta

  12. Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada

    Aristeidis H. Katsanos & Ashkan Shoamanesh

  13. Second Department of Neurology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

    Aristeidis H. Katsanos

  14. Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy

    Enrico Fainardi

  15. Neurology Unit, Department of Neurological Sciences and Vision, ASST Spedali Civili, Brescia, Italy

    Andrea Morotti & Alessandro Padovani

Authors
  1. Debora Pezzini
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  2. Jawed Nawabi
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  3. Frieder Schlunk
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  4. Qi Li
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  5. Federico Mazzacane
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  6. Giorgio Busto
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  7. Elisa Scola
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  8. Francesco Arba
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  9. Laura Brancaleoni
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  10. Sebastiano Giacomozzi
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  11. Luigi Simonetti
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  12. Michele Laudisi
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  13. Anna Cavallini
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  14. Aristeidis H. Katsanos
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  15. Ashkan Shoamanesh
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  16. Andrea Zini
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  17. Ilaria Casetta
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  18. Enrico Fainardi
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  19. Andrea Morotti
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  20. Alessandro Padovani
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Contributions

DP: data collection, statistical analysis, manuscript drafting and revision; AM: data collection, statistical analysis, manuscript drafting and revision; AP: study supervision, manuscript revision; all other authors: data collection, manuscript revision.

Corresponding author

Correspondence to Debora Pezzini.

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Conflict of interest

Dr. Katsanos is supported by a McMaster University Department of Medicine Career Research Award. All other authors declare that they have no conflicts of interest.

Ethical Approval/Informed Consent

All the study procedures were approved by local institutional review boards at each participating site. Informed consent was acquired from patients or family members or waived by the institutional review board.

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Pezzini, D., Nawabi, J., Schlunk, F. et al. Predictors and Prognostic Impact of Hematoma Expansion in Infratentorial Cerebral Hemorrhage. Neurocrit Care 40, 707–714 (2024). https://doi.org/10.1007/s12028-023-01819-w

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  • DOI: https://doi.org/10.1007/s12028-023-01819-w

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