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Research paper
Rate of perihaematomal oedema expansion is associated with poor clinical outcomes in intracerebral haemorrhage
  1. Santosh B Murthy1,2,
  2. Sebastian Urday3,
  3. Lauren A Beslow3,
  4. Jesse Dawson4,
  5. Kennedy Lees4,
  6. W Taylor Kimberly5,
  7. Costantino Iadecola1,2,
  8. Hooman Kamel1,2,
  9. Daniel F Hanley6,
  10. Kevin N Sheth3,
  11. Wendy C Ziai7
  12. for the VISTA ICH Collaborators
    1. 1Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medicine, New York, New York, USA
    2. 2Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
    3. 3Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
    4. 4Department of Cerebrovascular Medicine, University of Glasgow, Glasgow, UK
    5. 5Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Center for Human Genetic Research Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
    6. 6Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
    7. 7Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
    1. Correspondence to Dr Santosh B Murthy, Department of Neurology, Weill Cornell Medicine/New York Presbyterian Hospital, 525 E 68th Street, Suite 2-312 New York, NY 10065, USA; sam9200{at}


    Background Perihaematomal edema (PHE) expansion rate may be a predictor of outcome after intracerebral haemorrhage (ICH). We determined whether PHE expansion rate in the first 72 hours after ICH predicts outcome, and how it compares against other PHE measures.

    Methods We included patients from the Virtual International Stroke Trials Archive. We calculated PHE expansion rate using the equation: (PHE at 72 hours PHE at baseline)/(time to 72-hour CT scan time to baseline CT scan). Outcomes of interest were mortality and poor 90-day outcome (modified Rankin Scale score of ≥3). Logistic regression was used to assess relationships with outcome.

    Results A total of 596 patients with ICH were included. At baseline, median haematoma volume was 15.0 mL (IQR 7.9–29.2) with median PHE volume of 8.7 mL (IQR 4.5–15.5). Median PHE expansion rate was 0.31 mL/hour (IQR 0.12–0.55). The odds of mortality were greater with increasing PHE expansion rate (OR 2.63, CI 1.10 to 6.25), while the odds of poor outcome also increased with greater PHE growth (OR 1.67, CI 1.28 to 2.39). Female sex had an inverse relationship with PHE growth, but baseline haematoma volume had a direct correlation. Among other PHE measures, only interval increase in PHE correlated with poor outcome. There was no significant difference between the 2 measures of PHE volume expansion.

    Conclusions Rate of PHE growth over 72 hours was an independent predictor of mortality and poor functional outcomes following ICH. Baseline haematoma volume and gender appear to influence PHE growth.

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    • KNS and WCZ both contributed equally.

    • Collaborators VISTA-ICH Steering Committee: DFH (Chair), K Butcher, S Davis, B Gregson, KL, P Lyden, S Mayer, K Muir and T Steiner.

    • Funding SBM is supported by the American Brain Foundation and American Academy of Neurology. S. Urday received the 2014 American Heart Association's Student Scholarship in Cerebrovascular Disease and Stroke. LAB was supported by NIH-K12-NS049453. WTK is supported by NINDS K23NS076597. CI is supported by NIH grants R37NS089323-02, R01 NS034179-21, R01 NS037853-19 and R01 NS073666-04. HK is supported by NINDS grant K23NS082367 and the Michael Goldberg Stroke Research Fund. DFH was awarded significant research support through grant numbers 5U01NS062851 for Clot Lysis Evaluation of Accelerated Resolution of Intraventricular Haemorrhage III and for Minimally Invasive Surgery Plus r-tPA for Intracerebral Haemorrhage Evacuation (MISTIE) III 1U01NS08082.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.