Insufficient cerebral venous drainage predicts early edema in acute intracerebral hemorrhage
Citation Manager Formats
Make Comment
See Comments

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Objectives To explore the relationship between insufficient ipsilateral cerebral venous drainage and the development of perihematomal edema (PHE) and functional outcome in patients with acute intracerebral hemorrhage (ICH).
Methods We retrospectively reviewed our prospectively collected database for patients with acute spontaneous supratentorial ICH and analyzed patients who underwent baseline CT perfusion (CTP) within 6 hours of onset and noncontrast CT at 24 hours. Absence of filling of 1 or more of the ipsilateral superficial middle cerebral vein, vein of Trolard, vein of Labbé, basal vein of Rosenthal, and internal cerebral vein, evaluated on venous maps generated from baseline CTP, was identified as absent ipsilateral venous filling (AIVF). Relative PHE (rPHE) was calculated as the ratio of PHE volume to hematoma volume on follow-up CT.
Results A total of 138 patients were included. Median absolute PHE volume on follow-up CT was 3.5 (1.0–9.3) mL and rPHE was 24.3% (9.0%–49.4%). One absent ipsilateral vein was observed in 38 (27.5%) patients, and 2 absent veins were observed in 5 (3.6%) patients. Multivariate analysis showed that AIVF was independently associated with large rPHE at 24 hours (odds ratio [OR] 4.032, 95% confidence interval [CI] 1.739–9.347, p < 0.001). Large PHE volume was independently associated with poor outcome (OR 1.109, 95% CI 1.009–1.218, p = 0.031).
Conclusion AIVF was observed in about one-third of patients with acute ICH, which might be attributed to hypoperfusion after ICH and was strongly related to the development of PHE. Identification of cerebral venous filling status might be a promising imaging marker for PHE and a potential therapeutic target in ICH.
Glossary
- AIVF=
- absent ipsilateral venous filling;
- ATACH-II=
- Antihypertensive Treatment of Acute Cerebral Hemorrhage-II;
- BVR=
- basal vein of Rosenthal;
- CBF=
- cerebral blood flow;
- CBV=
- cerebral blood volume;
- CI=
- confidence interval;
- CTP=
- CT perfusion;
- GCS=
- Glasgow Coma Scale;
- ICH=
- intracerebral hemorrhage;
- ICP=
- intracranial pressure;
- ICV=
- internal cerebral vein;
- INTERACT2=
- Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial 2;
- JVR=
- jugular venous reflux;
- mRS=
- modified Rankin Scale;
- NIHSS=
- NIH Stroke Scale;
- ONSD=
- optic nerve sheath diameter;
- OR=
- odds ratio;
- PHE=
- perihematomal edema;
- rCBF=
- relative CBF;
- rCBV=
- relative CBV;
- ROI=
- region of interest;
- rPHE=
- relative PHE;
- SMCV=
- superficial middle cerebral vein;
- VOL=
- vein of Labbé;
- VOT=
- vein of Trolard
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
- Received January 11, 2019.
- Accepted in final form May 10, 2019.
- © 2019 American Academy of Neurology
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)
Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here
Purchase
Individual access to articles is available through the Add to Cart option on the article page. Access for 1 day (from the computer you are currently using) is US$ 39.00. Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means. The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use. Distributing copies (electronic or otherwise) of the article is not allowed.
Disputes & Debates: Rapid online correspondence
NOTE: All authors' disclosures must be entered and current in our database before comments can be posted. Enter and update disclosures at http://submit.neurology.org. Exception: replies to comments concerning an article you originally authored do not require updated disclosures.
- Stay timely. Submit only on articles published within the last 8 weeks.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- 200 words maximum.
- 5 references maximum. Reference 1 must be the article on which you are commenting.
- 5 authors maximum. Exception: replies can include all original authors of the article.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Related Articles
- No related articles found.