(Stroke. 1999;30:1167-1173.)
© 1999 American Heart Association, Inc.
Original Contributions |
Progression of Mass Effect After Intracerebral Hemorrhage
From the Departments of Neurology and Neurological Surgery (A.R.Z., M.N.D., W.J.P.), Anesthesia (M.N.D.), and Radiology (C.P.D., W.J.P.), Lillian Strauss Institute for Neuroscience of the Jewish Hospital of St Louis, and the Neurology/Neurosurgery Intensive Care Unit, Washington University, St Louis, Mo.
Correspondence to Allyson Zazulia, MD, Department of Neurology, Washington University School of Medicine, Box 8111, 660 S Euclid Avenue, St Louis, MO 63110. E-mail zazuliaa{at}neuro.wustl.edu
Background and Purpose—While the evolution of mass effect after cerebral infarction is well characterized, similar data regarding intracerebral hemorrhage (ICH) are scant. Our goal was to determine the time course and cause for progression of mass effect after ICH.
Methods—Patients with spontaneous
supratentorial ICH who underwent 
2 CT scans were
identified in our prospectively collected database. CT lesion size and
midline shift of the pineal and septum pellucidum were retrospectively
measured and correlated with clinical and CT characteristics. Causes
for increased midline shift were determined by 2 independent
observers.
Results—Seventy-six patients underwent 235 scans (3.1±1.3 per patient). Initial CT was obtained within 24 hours of ICH in 66. Twenty-five scans were repeated on day 1, 80 on days 2 through 7, 31 on days 8 through 14, and 24 >14 days after ICH. Midline shift was present on 88% of the initial scans. There were 17 instances of midline shift progression: 10 occurred early (0.2 to 1.7 days) and were associated with hematoma enlargement, and 7 occurred late (9 to 21 days) and were associated with edema progression. Progression of mass effect due to edema occurred with larger hemorrhages (P<0.05). Of 65 scans repeated for clinical deterioration, only 10 were associated with increased mass effect.
Conclusions—Progression of mass effect after ICH occurred at 2 distinct time points: within 2 days, associated with hematoma enlargement, and in the second and third weeks, associated with increase in edema. The clinical significance of later-developing edema is unclear.
Key Words: cerebral hemorrhage • mass effect
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