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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
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