Differences in bleeding patterns and outcome after intracerebral hemorrhage due to vascular malformations.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2019
2019
Historique:
received:
12
12
2018
accepted:
02
05
2019
entrez:
24
5
2019
pubmed:
24
5
2019
medline:
6
2
2020
Statut:
epublish
Résumé
Atypical intracerebral hemorrhage is a common form of primary manifestation of vascular malformations. The aim of the present study is to determine clues to the cause of bleeding according to hemorrhage pattern (lobar, basal ganglia, infratentorial). We retrospectively evaluated 343 consecutive neurosurgical patients with intracerebral hemorrhage (ICH), who were admitted to our neurosurgical department between 2006 and 2016. The study cohort includes only neurosurgical patients. Patients who underwent treatment by neurologists are not represented in this study. We assessed location of hemorrhage, hematoma volumes to rule out differences and predicitve variables for final outcome. In 171 cases (49.9%) vascular malformations, such as arteriovenous malformations (AVMs), cavernomas, dural fistulas and aneurysms were the cause of bleeding. 172 (50.1%) patients suffered from an intracerebral hemorrhage due to amyloid angiopathy or long standing hypertension. In patients with infratentorial hemorrhage a malformation was more frequently detected as in patients with supratentorial hemorrhage (36% vs. 16%, OR 2.9 [1.8;4.9], p<0.001). Among the malformations AVMs were most common (81%). Hematoma expansion was smaller in vascular malformation than non-malformation caused bleeding (24.1 cm3 vs. 64.8 cm3, OR 0.5 [0.4;0.7], p < 0.001,). In 6 (2.1%) cases diagnosis remained unclear. Final outcome was more favorable in patients with vascular malformations (63% vs. 12%, OR 12.8 [4.5;36.2], p<0.001). Localization and bleeding patterns are predictive factors for origin of the hemorrhage. These predictive factors should quickly lead to appropriate vascular diagnostic measures. However, due to the inclusion criteria the validity of the study is limited and multicentre studies with further testing in general ICH patients are required.
Sections du résumé
BACKGROUND
Atypical intracerebral hemorrhage is a common form of primary manifestation of vascular malformations.
OBJECTIVE
The aim of the present study is to determine clues to the cause of bleeding according to hemorrhage pattern (lobar, basal ganglia, infratentorial).
METHODS
We retrospectively evaluated 343 consecutive neurosurgical patients with intracerebral hemorrhage (ICH), who were admitted to our neurosurgical department between 2006 and 2016. The study cohort includes only neurosurgical patients. Patients who underwent treatment by neurologists are not represented in this study. We assessed location of hemorrhage, hematoma volumes to rule out differences and predicitve variables for final outcome.
RESULTS
In 171 cases (49.9%) vascular malformations, such as arteriovenous malformations (AVMs), cavernomas, dural fistulas and aneurysms were the cause of bleeding. 172 (50.1%) patients suffered from an intracerebral hemorrhage due to amyloid angiopathy or long standing hypertension. In patients with infratentorial hemorrhage a malformation was more frequently detected as in patients with supratentorial hemorrhage (36% vs. 16%, OR 2.9 [1.8;4.9], p<0.001). Among the malformations AVMs were most common (81%). Hematoma expansion was smaller in vascular malformation than non-malformation caused bleeding (24.1 cm3 vs. 64.8 cm3, OR 0.5 [0.4;0.7], p < 0.001,). In 6 (2.1%) cases diagnosis remained unclear. Final outcome was more favorable in patients with vascular malformations (63% vs. 12%, OR 12.8 [4.5;36.2], p<0.001).
CONCLUSION
Localization and bleeding patterns are predictive factors for origin of the hemorrhage. These predictive factors should quickly lead to appropriate vascular diagnostic measures. However, due to the inclusion criteria the validity of the study is limited and multicentre studies with further testing in general ICH patients are required.
Identifiants
pubmed: 31120937
doi: 10.1371/journal.pone.0217017
pii: PONE-D-18-35546
pmc: PMC6532871
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0217017Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
Neurosurgery. 2008 Nov;63(5):823-9; discussion 829-31
pubmed: 19005371
J Clin Neurosci. 2018 Jul;53:171-176
pubmed: 29685412
Stroke. 2010 Sep;41(9):2108-29
pubmed: 20651276
Lancet. 1974 Jul 13;2(7872):81-4
pubmed: 4136544
Neurology. 2006 May 9;66(9):1350-5
pubmed: 16682666
Neurocrit Care. 2014 Oct;21(2):192-9
pubmed: 23839705
J Neurol Neurosurg Psychiatry. 2018 Mar;89(3):263-270
pubmed: 29030422
Lancet. 2005 Jan 29-Feb 4;365(9457):387-97
pubmed: 15680453
Stroke. 2015 Nov;46(11):3088-92
pubmed: 26396030
Neurology. 2017 May 16;88(20):1882-1888
pubmed: 28424275
Neurocrit Care. 2007;6(1):56-66
pubmed: 17356194
J Neurosurg. 1986 Oct;65(4):476-83
pubmed: 3760956
PLoS One. 2017 Jun 1;12(6):e0178886
pubmed: 28570698
Neurosurgery. 1994 May;34(5):801-7; discussion 807-8
pubmed: 7914356
Cerebrovasc Dis. 2009;27(4):353-60
pubmed: 19218801
Lancet. 2013 Aug 3;382(9890):397-408
pubmed: 23726393
J Neurosurg Pediatr. 2016 Feb;17(2):134-140
pubmed: 26517058
J Stroke Cerebrovasc Dis. 2018 Jan;27(1):53-60
pubmed: 29103863
Stroke. 2009 May;40(5):1677-82
pubmed: 19265046
Stroke. 2006 May;37(5):1243-7
pubmed: 16614321
Stroke. 2009 Jan;40(1):100-5
pubmed: 19008469
Neurology. 1978 Aug;28(8):754-62
pubmed: 567291
Brain. 2009 Feb;132(Pt 2):537-43
pubmed: 19042932
J Neurosurg. 1992 Jun;76(6):918-23
pubmed: 1588424
Stroke. 1993 Jul;24(7):987-93
pubmed: 8322400
Stroke. 2015 Jul;46(7):2032-60
pubmed: 26022637
World Neurosurg. 2017 May;101:577-583
pubmed: 28242488
Acta Neurochir Suppl. 2005;94:111-4
pubmed: 16060249
J Neurol Neurosurg Psychiatry. 2017 Nov;88(11):982-994
pubmed: 28844070
J Neurol Neurosurg Psychiatry. 2017 Jan;88(1):70-75
pubmed: 27919055
J Neurol Neurosurg Psychiatry. 2018 Nov;89(11):1163-1166
pubmed: 28986471
Mayo Clin Proc. 2005 Feb;80(2):269-81
pubmed: 15704783
Stroke. 1998 May;29(5):931-4
pubmed: 9596237
Stroke. 2007 Jun;38(6):2001-23
pubmed: 17478736
J Vasc Surg. 2007 Jun;45 Suppl A:A131-40
pubmed: 17544034
Crit Care Med. 2008 Jan;36(1):172-5
pubmed: 18007267