Predictors of hematoma expansion and cerebral edema in patients with spontaneous intracerebral hemorrhage

• Grant number: 11/09336-6
• Support Opportunities: Scholarships abroad - Research
• Start date: September 15, 2011
• End date: September 14, 2012
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Octávio Marques Pontes-Neto
• Grantee: Octávio Marques Pontes-Neto
• Host Investigator: Steven Mark Greenberg
• Host Institution: Faculdade de Medicina de Ribeirão Preto (FMRP). Universidade de São Paulo (USP). Ribeirão Preto , SP, Brazil
• Institution abroad: Massachusetts General Hospital, United States

Abstract

Cerebrovascular diseases are the second leading cause of death worldwide and the leading cause of disability. Intracerebral hemorrhage (ICH) is the subtype of stroke with a poor prognosis. About 85% of cases of ICH are attributed to hypertension or amyloid angiopathy. The so-called primary ICH has not yet a scientifically proven treatment. Progression of mass effect, caused by expansion of the hematoma and peri-hematomal edema may lead to clinical deterioration and may be a therapeutic target.Up to 38% of patients with ICH, evaluated early (within 3 hours of symptom onset) with neuroimaging, have a significant expansion of the cerebral hematoma on the subsequent CT, performed after 24 hours. Despite the great variability in its definition, some studies indicate that the occurrence of hematoma expansion in the first 24 hours would increase by at least three times the chance of death or severe disability. Recently, points of contrast extravasation inside the hematoma (Spot Signs) on AngioCT have been identified as independent predictors of the expansion of cerebral hematoma and a prognosis in these patients. Despite this, there is still controversy over the definition, frequency, and clinical significance of the Spot Sign in detecting the hematoma expansion in different subtypes of ICH (hypertension, associated with amyloid angiopathy, etc.) and different populations (Caucasians, Asians, Latin Americans , etc.). The development of peri-hematomal edema has also been implicated as a cause of secondary neuronal injury after ICH. There is still, however, much controversy about the causes, mechanisms, evolution and clinical impact of peri-hematoma edema in humans. In this study we aim to analyze the frequency and magnitude of the expansion of the hematoma and progression of peri-hematomal edema in patients with ICH. We also aim to identify clinical and radiological predictors of their occurrence and their clinical impact among patients of two ICH registry: Ribeirão Preto/Brazil (marked predominance of hypertensive vasculopathy) and Boston / USA (predominance of cerebral amyloid angiopathy). We are going to conduct a retrospective and comparative analysis of demographic, clinical and neuroimaging data from two databases of cerebral hemorrhage: Registry of Stroke in Ribeirão Preto (USP-HCFMRP) and Massachusetts General Hospital ICH Registry (MGH -Harvard). The MGH Stroke group is well recognized as a center of excellence on translational research about intracerebral hemorrhage. We believe that this project will help to consolidate translational stroke research at our Institution and will increase future collaborative research about stroke among our centers. (AU)