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Impact of Perihemorrhagic Edema on Short-Term Outcome After Intracerebral Hemorrhage

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Abstract

Background

Intracerebral hemorrhage (ICH) is a devastating disease with ICH volume being the main predictor of poor outcome. The prognostic role of perihemorrhagic edema (PHE) is still unclear; however, available data are mainly derived from analyses during the first days after symptom onset. As PHE growth may continue up to 14 days after ICH, we evaluated PHE over a longer period of time and investigated its impact on short-term clinical outcome.

Methods

In this monocentric retrospective cohort study, patients with spontaneous supratentorial ICH were identified from our institutional data base. Different time points of CT scans were merged to time clusters for better comparison (day 1, 2–3, 4–6, 7–9, 10–12). Absolute volumes of ICH and PHE were obtained using a validated semiautomatic volumetric algorithm. Clinical outcome at discharge was assessed using the modified Rankin Scale (0–3 = favorable, 4–6 = poor).

Results

220 patients (83 with favorable, 137 with poor outcome) were included in the final analysis. Mean ICH volume on admission was 22.8 [standard deviation (SD) 24.6] cm3. Mean absolute PHE volume on admission was 22.5 (SD 20.8) cm3 and increased to a mean peak volume of 38.1 (SD 31.4) cm3 during 6.7 (SD 4.1) days on average. Besides GCS on admission, functional status before ICH, peak hematoma volume, lobar localization and fever burden, and high peak PHE volume predicted poor outcome at discharge [OR 0.977 (95 % CI 0.957–0.998)] in the multivariable analysis.

Conclusions

PHE may have a negative impact on short-term functional outcome after ICH and therefore represent a possible treatment target.

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Authors and Affiliations

  1. Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany

    Bastian Volbers, Wolfgang Willfarth, Joji B. Kuramatsu, Hagen B. Huttner, Stefan Schwab & Dimitre Staykov

  2. Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany

    Tobias Struffert & Arnd Dörfler

  3. Department of Neurology, Hospital of the Brothers of St. John, Eisenstadt, Austria

    Dimitre Staykov

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  1. Bastian Volbers
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  2. Wolfgang Willfarth
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  3. Joji B. Kuramatsu
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Correspondence to Bastian Volbers.

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Volbers, B., Willfarth, W., Kuramatsu, J.B. et al. Impact of Perihemorrhagic Edema on Short-Term Outcome After Intracerebral Hemorrhage. Neurocrit Care 24, 404–412 (2016). https://doi.org/10.1007/s12028-015-0185-y

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