This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gebel, J. M. Articles by Broderick, J. P. Search for Related Content PubMed PubMed Citation Articles by Gebel, J. M., Jr Articles by Broderick, J. P. Related Collections Acute Cerebral Hemorrhage Computerized tomography and Magnetic Resonance Imaging Intracerebral Hemorrhage

(Stroke. 2002;33:2631.)
© 2002 American Heart Association, Inc.

Original Contributions

Natural History of Perihematomal Edema in Patients With Hyperacute Spontaneous Intracerebral Hemorrhage

James M. Gebel, Jr, MD; Edward C. Jauch, MD; Thomas G. Brott, MD; Jane Khoury, MS; Laura Sauerbeck, MSN; Shelia Salisbury, MS; Judith Spilker, RN; Thomas A. Tomsick, MD; John Duldner, MD Joseph P. Broderick, MD

From the University of Pittsburgh Medical Center, Pittsburgh, Pa (J.M.G.); University of Cincinnati Medical Center, Cincinnati, Ohio (E.C.J., J.K., L.S., S.S., J.S., T.A.T., J.P.B.); Mayo Clinic Foundation, Jacksonville, Fla (T.G.B.); and Akron General Medical Center, Akron, Ohio (J.D.).

Reprint requests to James M. Gebel, MD, University of Pittsburgh Stroke Institute, 200 Lothrop St, PUH Room C420, Pittsburgh, PA 15213. E-mail jgebel{at}stroke.upmc.edu

Background and Purpose— The natural history of perihematomal edema in human hyperacute spontaneous intracerebral hemorrhage (ICH) has not been well described.

Methods— This study was a secondary analysis of a previously reported prospective, population-based study of hematoma growth in 142 patients with spontaneous ICH. Patients were first imaged within 3 hours of onset, then 1 and 20 hours later. We excluded patients with anticoagulant use (n=7), underlying aneurysm/vascular malformation (n=9), trauma (n=1), incomplete data (n=20), infratentorial ICH (n=17), and no consent (n=2), leaving an overall study population of 86 patients. From this overall group we further excluded patients with intraventricular extension (n=38), subsequent surgery (n=5), or death (n=2) before 20-hour postbaseline CT. This second, "restricted" analysis group of 41 patients was relatively devoid of clinical or radiological variables likely to confound edema measurement. Absolute and relative edema volumes (edema volume divided by hematoma volume) were descriptively summarized. Correlations between baseline edema volumes and relevant clinical and radiological variables were then performed.

Results— Overall, median absolute edema volume increased from 6.93 to 14.4 cm³ during the first 24 hours after ICH, and median relative edema volume increased from 0.47 to 0.81. In the restricted group, median absolute edema volume was 7.4 cm³ at baseline and 11.0 cm³ at 24 hours after ICH, and median relative edema volume increased from 0.55 to 0.81. Baseline relative edema volume was significantly negatively correlated with subsequent change in relative edema volume from baseline to 20-hour CT (r=0.57, P=0.0002) but was not significantly correlated with other clinical and radiological variables, including hematoma volume or change in hematoma volume.

Conclusions— Perihematomal edema volume increases by approximately 75% during the first 24 hours after hyperacute spontaneous ICH. Patients with the least amounts of baseline relative edema volume were most likely to develop significant additional amounts of edema during the first 24 hours after spontaneous ICH.

Key Words: computed tomography • intracerebral hemorrhage • natural history

This article has been cited by other articles:

				D. Bereczki, M. Liu, G. F. do Prado, and I. Fekete Response to Letter by Prakash Stroke, May 1, 2008; 39(5): e86 - e87. [Full Text] [PDF]

				G. A. Christoforidis, A. Slivka, Y. Mohammad, C. Karakasis, B. Avutu, and M. Yang Size Matters: Hemorrhage Volume as an Objective Measure to Define Significant Intracranial Hemorrhage Associated With Thrombolysis Stroke, June 1, 2007; 38(6): 1799 - 1804. [Abstract] [Full Text] [PDF]

				G. Y. Chang, S .M. Davis, J . Broderick, M . Hennerici, N .C. Brun, M .N. Diringer, S .A. Mayer, K . Begtrup, and T . Steiner Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage Neurology, February 6, 2007; 68(6): 471 - 472. [Full Text] [PDF]

				J. Sook Kim-Han, S. J. Kopp, L. L. Dugan, and M. N. Diringer Perihematomal Mitochondrial Dysfunction After Intracerebral Hemorrhage Stroke, October 1, 2006; 37(10): 2457 - 2462. [Abstract] [Full Text] [PDF]

				M O McCarron, P McCarron, and M J Alberts Location characteristics of early perihaematomal oedema. J. Neurol. Neurosurg. Psychiatry, March 1, 2006; 77(3): 378 - 380. [Abstract] [Full Text] [PDF]

				NINDS ICH Workshop Participants Priorities for Clinical Research in Intracerebral Hemorrhage: Report From a National Institute of Neurological Disorders and Stroke Workshop Stroke, March 1, 2005; 36(3): e23 - e41. [Abstract] [Full Text] [PDF]

				K. S. Butcher, T. Baird, L. MacGregor, P. Desmond, B. Tress, and S. Davis Perihematomal Edema in Primary Intracerebral Hemorrhage Is Plasma Derived Stroke, August 1, 2004; 35(8): 1879 - 1885. [Abstract] [Full Text] [PDF]

				K. Ohwaki, E. Yano, H. Nagashima, M. Hirata, T. Nakagomi, and A. Tamura Blood Pressure Management in Acute Intracerebral Hemorrhage: Relationship Between Elevated Blood Pressure and Hematoma Enlargement Stroke, June 1, 2004; 35(6): 1364 - 1367. [Abstract] [Full Text] [PDF]

				J. W. Norris Steroids May Have a Role in Stroke Therapy Stroke, January 1, 2004; 35(1): 228 - 229. [Full Text] [PDF]

				Early Edema After Intracerebral Hemorrhage: What Does It Mean? Journal Watch Neurology, March 27, 2003; 2003(327): 4 - 4. [Full Text]

				D. F. Hanley Review of Critical Care and Emergency Approaches to Stroke Stroke, February 1, 2003; 34(2): 362 - 364. [Full Text] [PDF]