External ventricular drainage for acute obstructive hydrocephalus developing following spontaneous intracerebral haemorrhages

There is no consensus in the literature on the effects of the development of hydrocephalus on survival and disability after intracerebral haemorrhage (ICH) and the benefits of external ventricular drainage (EVD). In this open, prospective study, we investigated the clinical courses, radiological findings and outcome scores of 47 consecutive patients who were admitted to our clinic with spontaneous ICH. Hydrocephalus developed in 6 (12.8%) of the 47 patients, and EVD was applied in these 6 cases. In one of the 6 patients, the lesion was additionally excised due to the large cerebellar haematoma. Intraventricular haemorrhage was more common in patients developing hydrocephalus (83.3% vs. 29.3% in patients without hydrocephalus; p<0.05) and the lesions of all the patients were in the proximity of the ventricular system. Hospital mortality and functional outcome were not significantly different between patients with and without hydrocephalus. Our results shown that acute obstructive hydrocephalus should be anticipated if haematoma is near the ventricle or if it is opening to the ventricle. EVD is a life-saving and effective procedure that should be performed in patients who develop hydrocephalus following spontaneous intracerebral haemorrhage. Received: 20 July 2001 / Accepted in revised form: 30 January 2002     

微创开颅四脑室血肿清除联合脑室外引流治疗重型脑室出血临床观察

目的探讨微创开颅四脑室血肿清除联合脑室外引流治疗重型脑室出血的临床疗效。方法筛选2016-01—2018-01新乡市中心医院收治的58例自发性重型脑室出血患者,随机分为开颅组(行微创开颅四脑室血肿清除联合脑室外引流术)和对照组(单纯行双侧脑室外引流术)各29例。比较2组患者术前与术后24 h GCS评分、术后3 d脑室内血肿清除率、脑室引流管带管时间、术后并发症(再出血、颅内感染、脑积水)发生率、术后6个月存活患者日常生活能力(ADL)评分。结果开颅组患者术前与术后24 h GCS评分比较,差异有统计学意义(P<0.05);开颅组术后3 d脑室内血肿清除率、脑室引流管带管时间、术后并发症发生率及术后6个月存活患者ADL评分与对照组比较,差异均有统计学意义(P<0.05),开颅组治疗效果优于对照组。结论采用微创开颅四脑室血肿清除联合脑室外引流术治疗重型脑室出血,能明显改善患者预后。     

Vision,Aphasia, Neglect Assessment to Predict Neurosurgical Intervention in Patients with Nontraumatic Intracerebral Hemorrhage

Background and PurposeThe Vision, Aphasia, and Neglect (VAN) screening tool is a simple bedside test developed to identify patients with large vessel occlusion stroke. In the setting of intracerebral hemorrhage (ICH), there are very few bedside predictors of need for neurosurgical interventions other than age and Glasgow Coma Scale (GCS). We aimed to assess the utility of the VAN screening tool in predicting the need for neurosurgical intervention in patients with ICH.MethodsWe accessed sensitivity, specificity, positive predictive value, negative predictive value (NPV), and area under receiver operating characteristics curve of VAN for identifying ICH patients who require neurosurgical intervention.ResultsAmong 228 ICH patients, 176 were VAN positive and 52 were VAN negative. On unadjusted analyses, VAN positive patients had a significantly higher ICH volume, GCS score, and National Institutes of Health Stroke Scale score (P < .001 for all). As compared to VAN negative patients, significantly higher proportion of VAN positive ICH patients (15.4% versus 32.4%) underwent a neurosurgical procedure such as external ventricular drain (EVD) and/or hematoma evacuation with craniotomy or craniectomy. The VAN screening tool had high sensitivity and NPV (100%) in predicting the need for craniectomy or hematoma evacuation, but had lower sensitivity (87.7%) for any neurosurgical procedure, as 15.4% of VAN negative patients received EVD.ConclusionsOur study suggests that VAN screening tool can identify high-risk ICH patients who are more likely to undergo craniotomy or craniectomy but is less sensitive to rule out need for EVD.     

Determinants of External Ventricular Drain Placement and Associated Outcomes in Patients with Spontaneous Intraventricular Hemorrhage

Background

External ventricular drain (EVD) usage in patients with intraventricular hemorrhage (IVH) is variable in current practice and in clinical trials, and its impact on outcome remains controversial. The objective of this study was to identify the clinical predictors of EVD utilization, and associated outcome in adults with spontaneous IVH with or without intracerebral hemorrhage (ICH).

Methods

Retrospective review of 183 consecutive IVH patients admitted to a University Hospital between 2003 and 2010. Clinical and radiographic data were analyzed for associations between EVD placement and mortality, poor outcome, and improvement in Glasgow Coma Scale score (GCS) using multivariate logistic regression models.

Results

Average age was 62 ± 15.6 years, and average ICH and IVH volumes were 35.8 ± 40.9 cc and 19.7 ± 25.3 cc, respectively. Independent predictors of EVD placement within first 5 days of admission were GCS ≤ 8 (OR 11.5; P < 0.001), Graeb score >5 (OR 4.6; P = 0.001), and non-lobar ICH ≤ 30 cc (OR 9.7; P < 0.001). Median GCS increased from 5 (IQR 3–7) 48 h post-EVD (P < 0.001). EVD placement was an independent predictor of reduced mortality (OR 0.31; P = 0.04) and modified Rankin score 0–3 (OR 15.7; P = 0.01) at hospital discharge. In patients with hydrocephalus on presentation, EVD was associated with reduced mortality for patients with GCS > 3 after controlling for ICH and IVH severity (OR 0.02; P = 0.01).

Conclusions

Patients with lower GCS, higher IVH severity, and lower ICH volume are more likely to have an EVD placed. EVD placement is associated with reduced mortality and improved short-term outcomes in patients with IVH after adjusting for known severity factors. EVD use should be protocolized in clinical trials of ICH management where IVH is included.     

Hematology and coagulation parameters predict outcome in Taiwanese patients with spontaneous intracerebral hemorrhage

Volume of intracerebral hemorrhage (ICH), Glasgow Coma Scale (GCS) score, peripheral edema around the hematoma, and hydrocephalus are good predictors of mortality in patients with spontaneous ICH from western countries. However, the significance of hematologic and biochemical parameters associated with spontaneous ICH has not been extensively studied. This study was designed to determine prognostic factors for spontaneous ICH in Taiwanese patients. We prospectively studied 109 consecutive patients with spontaneous ICH admitted to Changhua Christian Medical Center. Clinical and laboratory data were collected and analyzed. Mean age was 62.3 years. There were 63 men (58%) and 46 women (42%). Differences in GCS score, ICH score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score between the survival and non-survival groups were statistically significant. Laboratory data were statistically different using multivariate analysis for platelet count, prothrombin time, and white cell count. This is the first study providing information on predictors of spontaneous ICH mortality in Taiwanese patients. The prothrombin time and platelet count on the first day were good early predictors of mortality. This finding in ethnically Chinese patients appears to be different from the profile for patients from western countries.     

脑室出血并发脑积水的风险评估与治疗

脑室出血（IVH）约占自发性颅内出血患者的1／3。脑室出血并发出血后脑积水（PHH）是导致不良预后的独立危险因素。在建立修订的Graeb评分标准之后,结合logistic回归分析法建立预测PHH发生概率的数学模型,发现修订的Graeb评分标准比原Graeb评分标准预测不同类型的IVH并发PHH发生更加科学适用。按PHH发生几率大小进行分组,比较各组外科引流与内科保守治疗的病死率,建立了IVH的临床三级治疗方案,即评分1～4分行内科治疗,5～9分者在做好外科引流准备的条件下保守治疗,10～12分者积极引流。同时还对脑室外引流的时间、并发症、引流管拔除等相关问题进行了讨论。     

Comparison of ventricular drainage in poor grade patients after intracranial hemorrhage

OBJECTIVES: The selection of patients and treatment criteria for acute hydrocephalus and intracranial pressure (ICP) after intracranial hemorrhage remains unclear. In general neurosurgical practice, there is a tendency to use external ventricular drainage (EVD) for the patients. This study was undertaken to analyse the complications and efficiency of the different treatment modalities.METHODS: The effects, complications and outcome of ventricular drainage on high ICP and hydrocephalus were analysed retrospectively in 109 patients with intracranial hemorrhage. All the patients were assessed using the Glasgow Coma Scale, computed tomography and ICP monitoring. We excluded patients over the GCS of 8. All patients underwent a procedure for ICP monitoring plus ventricular cerebrospinal fluid (CSF) drainage. Sixty-one patients were managed with one (single) EVD system; 12 patients needed two EVD systems consecutively, while 23 patients underwent an EVD procedure followed by permanent ventriculoperitoneal (VP) shunt insertion. Thirteen patients were treated only by VP shunt for ventricular drainage. The infection rate and outcome 9 months after hemorrhage were analysed.RESULTS: The infection rates were 8.1% in the one-EVD group, 33.3% in the two-EVD group (one EVD versus two EVD, p<0.05), 8.6% in the EVD-VP group and 7.7% in the VP shunt group. The mortality rates were 73.7% in the one-EVD group, 83.8% in the two-EVD group, 47.8% (p<0.05) in the EVD-VP group and 53.8% (p<0.01) in the VP shunt group.DISCUSSION: This study indicates that single and short-term use of EVD and/or early VP shunting are associated with a low risk of infection. Furthermore, early VP shunting may protect the brain from the irregular control of intracranial hypertension and may allow more time for resolution of CSF circulation and significantly lowers the mortality rates.     

Prediction of Shunt Dependency After Intracerebral Hemorrhage and Intraventricular Hemorrhage

Background

Spontaneous intracerebral hemorrhage is a disease with high morbidity and mortality. Extension of the hemorrhage into the ventricles is associated with the development of acute hydrocephalus and a poor outcome. Although it can be managed by external ventricular drainage (EVD), a subset of these patients require placement of permanent ventricular shunts. This study aimed to examine the factors on admission that can predict shunt dependency after EVD management.

Methods

Seventy-two patients who underwent EVD were included in this study. Seventeen of these patients underwent placement of a ventriculoperitoneal shunt. Variables analyzed included age, intraventricular hemorrhage (IVH) score, bicaudate index, acute hydrocephalus, initial Glasgow Coma Scale scores, and blood volume in each ventricle.

Results

In univariate analysis, IVH score (p?=?0.020), bicaudate index (p?<?0.001), blood volume in lateral ventricles (p?=?0.025), blood volume in the fourth ventricle (p?=?0.038), and the ratio of blood volume in lateral ventricles to that in third and fourth ventricles (p?=?0.003) were significantly associated with persistent hydrocephalus. The best multiple logistic regression model included blood volume parameters and bicaudate index as predictors with the area under a receiver operating characteristic curve of 0.849. The variance inflation factor (VIF) showed that collinearity was not found among predictors. Patients diagnosed with acute hydrocephalus had less blood volume in the lateral ventricles (OR?=?0.910) and had more blood volume in the third ventricle (OR?=?3.174) and fourth ventricle (OR?=?2.126).

Conclusions

These findings may promote more aggressive monitoring and earlier interventions for persistent hydrocephalus after intraventricular hemorrhage in patients at risk.

     

External Ventricular Drainage for Intraventricular Hemorrhage

Hemorrhagic stroke accounts for only 10% to 15% of all strokes; however, it is associated with devastating outcomes. Extension of intracranial hemorrhage (ICH) into the ventricles or intraventricular hemorrhage (IVH) has been consistently demonstrated as an independent predictor of poor outcome. In most circumstances the increased intracranial pressure and acute hydrocephalus caused by ICH is managed by placement of an external ventricular drain (EVD). We present a systematic review of the literature on the topic of EVD in the setting of IVH hemorrhage, articulating the scope of the problem and prognostic factors, clinical indications, surgical adjuncts, and other management issues.     

Lumbar drainage for communicating hydrocephalus after ICH with ventricular hemorrhage

Introduction  

Our objective was to investigate the feasibility of lumbar drainage (LD) as a new therapeutic approach for the treatment of communicating hydrocephalus in patients with supratentorial intracerebral hemorrhage (ICH) and ventricular extension (IVH) who initially required an external ventricular drain (EVD).     

神经内镜在丘脑出血破入脑室手术中的应用

目的 探讨神经内镜下早期脑室内血肿清除联合第三脑室底造瘘术（ETV）治疗丘脑出血破入脑室的疗效。方法 回顾性分析2011年7月至2015年7月收治的68例丘脑出血破入脑室的临床资料。36例（观察组）行神经内镜血肿清除术联合ETV,术后留置脑室外引流管;32例（对照组）行脑室外引流术（EVD）并联合尿激酶血肿腔注入。术后随访12~26个月,平均（23±2.1）个月。结果 观察组有效率（86.1%,31/36）明显高于对照组（62.5%,20/32;P<0.05）。观察组留置脑室外引流管时间[（1.8±1.1） d]较对照组[（4.8±1.8） d]明显缩短（P<0.05）。观察组术后脑积水发生率（12.9%,5/36）明显低于对照组（37.5%,12/32;P<0.05）。观察组术后颅内感染发生率（0%）与对照组（6.3%）无统计学差异（P>0.05）。两组均未发生过度引流、脑疝、再次出血。结论 神经内镜下早期血肿清除联合ETV治疗丘脑出血破入脑室安全有效,可明显降低术后分流依赖性脑积水发生率,显著改善病人预后。     

Antibiotic-Impregnated Versus Silver-Bearing External Ventricular Drainage Catheters: Preliminary Results in a Randomized Controlled Trial

Background

Evaluation of antibiotic-impregnated (AI) and ionized silver particle coated external ventricular drainage catheters (EVD) in patients with subarachnoid (SAH) or intracranial hemorrhage (ICH).

Methods

Between February 2011 and June 2012, 40 patients with acute hydrocephalus due to SAH, ICH or intraventricular hemorrhage were enrolled in a prospective, randomized, mono-center pilot study. Primary endpoints were defined as: number of events of cerebrospinal fluid (CSF) infections. Secondary endpoints were defined as: neurosurgical complications following the placement of the EVD, number of revisions of EVD catheters, and cost effectiveness.

Results

Sixty-one EVD placements in 40 patients, 32 antibiotic-coated (Bactiseal^®), 29 silver-bearing catheters (VentriGuard^®), have been performed. Confirmed or high suspicion of CSF infections occurred in 11 out of 61 events (confirmed infection: p = 0.71, probable infection: p = 0.90). Revisions of EVD were needed in 13 cases (22 %) due to CSF infection, dysfunction, impaired healing, or malplacement (p = 0.37).

Conclusion

Regarding CSF infection rate and dysfunction, no statistical significant differences between the two EVD catheters Bactiseal^® versus VentriGuard^® were found. The silver-bearing catheter might offer a safe and cost-conscious alternative to the AI catheter.     

Predictive factors for tracheostomy in neurocritical care patients with spontaneous supratentorial hemorrhage

BACKGROUND: Up to 30% of patients with supratentorial intracerebral hemorrhage (ICH) require mechanical ventilation during the course of treatment. For these patients, tracheostomy is necessary in cases of protracted weaning. As only limited data exist about predictors for a tracheostomy in patients with ICH, the aim of this study was to investigate the frequency of tracheostomy and clinical findings that increase the risk for a tracheostomy in patients with supratentorial hemorrhage. METHODS: A total of 392 patients with supratentorial ICH were analyzed. The parameters age, gender, chronic obstructive pulmonary disease (COPD), Glasgow Coma Scale on admission, ganglionic or non-ganglionic localization, presence of ventricular hemorrhage, hydrocephalus, hematoma volume, and hematoma evacuation were investigated. The effects on the end-point tracheostomy were analyzed using multivariate regression analyses. RESULTS: The overall need for tracheostomy was 9.9% (16.3% in patients with ganglionic hemorrhage versus 2.8% in patients with non-ganglionic hemorrhages). 31% of the ventilated patients required tracheostomy. The risk for tracheostomy was increased eightfold in patients who developed hydrocephalus. The presence of ventricular blood, in general, showed no significant impact on the need for tracheostomy, whereas hemorrhage extending into the third and fourth ventricles in conjunction with hydrocephalus increased the risk for tracheostomy. The hematoma volume correlated positively with the risk for tracheostomy. CONCLUSIONS: Our study demonstrates that approximately 10% of patients with ICH require tracheostomy during the course of their disease. Presence of COPD, hematoma volume, ganglionic location of the hematoma, and the development of hydrocephalus are predisposing factors for tracheostomy.     

Comparison of ventricular drainage in poor grade patients after intracranial hemorrhage

Abstract

Objectives: The selection of patients and treatment criteria for acute hydrocephalus and intracranial pressure (ICP) after intracranial hemorrhage remains unclear. In general neurosurgical practice, there is a tendency to use external ventricular drainage (EVD) for the patients. This study was undertaken to analyse the complications and efficiency of the different treatment modalities.

Methods: The effects, complications and outcome of ventricular drainage on high ICP and hydrocephalus were analysed retrospectively in 109 patients with intracranial hemorrhage. All the patients were assessed using the Glasgow Coma Scale, computed tomography and ICP monitoring. We excluded patients over the GCS of 8. All patients underwent a procedure for ICP monitoring plus ventricular cerebrospinal fluid (CSF) drainage. Sixty-one patients were managed with one (single) EVD system; 12 patients needed two EVD systems consecutively, while 23 patients underwent an EVD procedure followed by permanent ventriculoperitoneal (VP) shunt insertion. Thirteen patients were treated only by VP shunt for ventricular drainage. The infection rate and outcome 9 months after hemorrhage were analysed.

Results: The infection rates were 8.1% in the one-EVD group, 33.3% in the two-EVD group (one EVD versus two EVD, p<0.05), 8.6% in the EVD-VP group and 7.7% in the VP shunt group. The mortality rates were 73.7% in the one-EVD group, 83.8% in the two-EVD group, 47.8% (p<0.05) in the EVD-VP group and 53.8% (p<0.01) in the VP shunt group.

Discussion: This study indicates that single and short-term use of EVD and/or early VP shunting are associated with a low risk of infection. Furthermore, early VP shunting may protect the brain from the irregular control of intracranial hypertension and may allow more time for resolution of CSF circulation and significantly lowers the mortality rates.     

Extravasation of radiographic contrast is an independent predictor of death in primary intracerebral hemorrhage.

BACKGROUND AND PURPOSE: Hematomas that enlarge following presentation with primary intracerebral hemorrhage (ICH) are associated with increased mortality, but the mechanisms of hematoma enlargement are poorly understood. We interpreted the presence of contrast extravasation into the hematoma after CT angiography (CTA) as evidence of ongoing hemorrhage and sought to identify the clinical significance of contrast extravasation as well as factors associated with the risk of extravasation. METHODS: We reviewed the clinical records and radiographic studies of all patients with intracranial hemorrhage undergoing CTA from 1994 to 1997. Only patients with primary ICH were included in this study. Univariate and multivariate logistic regression analyses were performed to determine the associations between clinical and radiological variables and the risk of hospital death or contrast extravasation. RESULTS: Data were available for 113 patients. Contrast extravasation was seen in 46% of patients at the time of CTA, and the presence of contrast extravasation was associated with increased fatality: 63.5% versus 16.4% in patients without extravasation (P=0.011). There was a trend toward a shorter time (median+/-SD) from symptom onset to CTA in patients with extravasation (4.6+/-19 hours) than in patients with no evidence of extravasation (6.6+/-28 hours; P=0.065). Multivariate analysis revealed that hematoma size (P=0.022), Glasgow Coma Scale (GCS) score (P=0.016), extravasation of contrast (P=0.006), infratentorial ICH (P=0.014), and lack of surgery (P<0.001) were independently associated with hospital death. Variables independently associated with contrast extravasation were hematoma size (P=0.024), MABP >120 mm Hg (P=0.012), and GCS score of 相似文献   

Serum D-dimer as a predictor of mortality in patients with acute spontaneous intracerebral hemorrhage

It has been found that the hemostatic system is activated following a brain injury. To explore the role of D-dimer in spontaneous intracerebral hemorrhage (ICH), this prospective study aimed to evaluate the association between serum D-dimer concentration, clinical outcome and radiographic findings of ICH patients in the emergency department (ED). Patients with acute (<24 hours) spontaneous ICH were enrolled in this study. The D-dimer concentration was related to: baseline ICH volume (r=0.198, p=0.01); Glasgow Coma Scale (GCS) score 3-8 (p=0.01); GCS score 13-15 (p=0.002); midline shift >15 mm (p=0.016); and to subarachnoid extension of the blood (p<0.0001). Diabetes mellitus (odds ratio [OR]: 2.93; 95% confidence interval [CI]: 1.1-7.76, p=0.031), ICH volume (OR: 1.16; 95% CI: 1.07-1.27, p<0.0001) and D-dimer concentration (OR: 2.72; 95% CI: 1.08-6.9, p=0.002) were associated with 30-day mortality. This study shows that in patients with spontaneous ICH, a higher initial D-dimer concentration is associated with higher 30-day mortality.     

自发性小脑出血手术治疗策略

目的探讨自发性小脑出血的外科治疗。方法回顾性分析采用手术治疗的30例自发性小脑出血患者的临床资料。对蚓部出血6~10mL、出现梗阻性脑积水的患者行单纯侧脑室钻孔引流术,对小脑半球出血10~20mL者行后颅窝开颅血肿清除术,对小脑半球出血量20mL或蚓部出血量10mL者行后颅窝开颅血肿清除+寰枕减压术+侧脑室钻孔引流术。结果单纯侧脑室钻孔引流术6例,恢复良好5例;中残1例;后颅窝开颅血肿清除术14例,恢复良好10例,中残2例,重残2例;后颅窝开颅血肿清除+寰枕减压术+侧脑室钻孔引流术10例,恢复良好6例,中残2例,重残1例,死亡1例。结论对自发性小脑出血患者,积极手术治疗,根据出血的部位、出血的量、有无合并梗阻性脑积水等情况,采用不同的手术方式。     

Outcome after traumatic frontal intracerebral haemorrhage: a comparison of unilateral and bilateral haematomas

Frontal intracerebral haemorrhage (ICH) is a common result of cranial trauma. Outcome differences between bilateral and unilateral frontal ICH are not well studied but would be valuable to predict prognosis in clinical practice. Two aims are proposed in this study: first to compare the risk of developing delayed ICH after bilateral or unilateral frontal ICH, and second to determine the variables helpful to predict outcome according to the Glasgow Outcome Scale (GOS). Between January 1993 and December 1997, 694 consecutive patients with traumatic ICH were admitted to the Chang Gung Medical Center within 24 h of the trauma. Patients with ICH in sites other than the frontal lobes were excluded. A total of 161 cases (mean age 46.3+/-20.3 years), including 57 bilateral (mean age 52.5+/-18.7 years) and 104 unilateral (mean age 42.9+/-20.5 years) traumatic frontal ICH were studied. Twenty-eight of 57 patients (49%) with bifrontal ICH versus 17 of 104 patients (16%) with unilateral frontal ICH had a further, delayed ICH. In 42 of 45 patients (93%) with delayed ICH, this occurred within 5 days of the initial trauma. Multivariate logistic regression was used to select significant predictors of outcome. We found that delayed ICH (p<0.001), age (p=0.004) and mechanism of injury (p=0.001) explained the worse outcome in patients with bifrontal ICH. The best-fitting logistic regression model included three variables: delayed ICH (p=0.011), initial GCS (p=0.023), and a sum score of clinical and radiological variables (p=0.003). Bifrontal ICH tended to occur in older patients after a fall and was associated with a higher risk of developing delayed ICH or brain stem compression compared to unilateral ICH damage. Using these three variables - delayed ICH, initial GCS, and the sum score - in a logistical regression model is useful to predict outcome in patients with traumatic frontal ICH and may aid patient management.     

Prior Statin Use Reduces Mortality in Intracerebral Hemorrhage

Objective  To assess the impact of blood glucose, coagulopathy, seizures and prior statin and aspirin use on clinical outcome following intracerebral hemorrhage (ICH). Background  Intracerebral hemorrhage (ICH) accounts for 10–15% of all strokes with mortality rates approaching 50%. Glasgow Coma Scale (GCS), ICH volume, age, pulse pressure, ICH location, intraventricular hemorrhage (IVH) and hydrocephalus are known to impact 30-day survival following ICH and are included in various prediction models. The role of other clinical variables in the long-term outcome of these patients is less clear. Methods  Records of consecutive ICH patients admitted to The Johns Hopkins Hospital from 1999 to 2006 were reviewed. Patients with ICH related to trauma or underlying lesions (e.g. brain tumors, aneurysms, arterio-venous malformations) and of infratentorial location were excluded. The impact of admission blood glucose, coagulopathy, seizures on presentation and prior statin and aspirin use on 30-day mortality and functional outcomes at discharge was assessed using dichotomized Modified Rankin Scale (dMRS) and Glasgow Outcomes scale (dGOS). Other variables known to impact outcomes that were included in the multiple logistic regression analysis were age, admission GCS, pulse pressure, ICH volume, ICH location, volume of IVH and hydrocephalus. Results  A total of 314 patients with ICH were identified, 125 met inclusion criteria. Patients’ age ranged from 34 to 90 years (mean 63.5), 57.6 % were male. Mean ICH volume was 32.09 cc (range 1–214 cc). Following multiple logistic regression analysis, prior statin use (P = 0.05) was found to be associated with decreased mortality with a greater than 12-fold odds of survival while admission blood glucose (P = 0.023) was associated with increased 30-day mortality. Coagulopathy, seizures on presentation, and prior aspirin use had no significant impact on 30-day mortality or outcomes at discharge in our study cohort. Conclusions  The significant association of prior statin use with decreased mortality warrants prospective evaluation of the use of statins following ICH.     

Oxidative stress through activation of NAD(P)H oxidase in hypertensive mice with spontaneous intracranial hemorrhage.

We have developed an experimental model of spontaneous intracranial hemorrhage (ICH) in transgenic mice expressing human renin and human angiotensinogen (R+/A+) treated with high-salt diet and N(omega)-nitro-L-arginine methyl ester (L-NAME). We investigated whether oxidative stress is associated with spontaneous ICH in R+/A+ mice. R+/A+ mice on high-salt diet and L-NAME presented neurologic signs 57+/-13 (mean+/-s.e.m.) days after the start of treatment. Intracranial hemorrhage was shown with histologic examination. Levels of superoxide in brain homogenate were significantly increased in R+/A+ mice with ICH (118+/-10 RLU per sec per mg; RLU, relative light unit) compared with age-matched control mice (19+/-1) and R+/A+ mice without ICH (53+/-3). NAD(P)H oxidase activity was significantly higher in R+/A+ mice with ICH (34,933+/-2,420 RLU per sec per mg) than in control mice (4,984+/-248) and R+/A+ mice without ICH (15,069+/-917). These results suggest that increased levels of superoxide are due, at least in part, to increased NAD(P)H oxidase activity. Increased NAD(P)H oxidase activity preceded signs of ICH, and increased further when R+/A+ mice developed ICH. These findings suggest that oxidative stress may contribute to spontaneous ICH in chronic hypertension.