Date of Award

January 2019

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Kevin N. Sheth

Abstract

Perihematomal edema (PHE) expansion rate may predict functional outcome following spontaneous intracerebral hemorrhage (ICH), but it has not been well characterized for the different anatomic subtypes of ICH. We hypothesized that the effect of PHE expansion rate on outcome is greater for deep versus lobar ICH. Subjects (n = 115) were retrospectively identified from a prospective ICH cohort enrolled from 2000 to 2013. Inclusion criteria were age > 18 years, spontaneous supratentorial ICH, and known onset time. Exclusion criteria were primary intraventricular hemorrhage (IVH), trauma, subsequent surgery, or warfarin-related ICH. ICH and PHE volumes were measured from CT scans and used to calculate expansion rates. Logistic regression assessed the association between PHE expansion rates and 90-day mortality or poor functional outcome (modified Rankin Scale > 2). Odds ratios are per 0.04 mL/h. PHE expansion rate from baseline to 24 hours (PHE24) was associated with mortality for deep (p = 0.03, OR 1.13[1.02-1.26]) and lobar ICH (p = 0.02, OR 1.03[1.00-1.06]) in unadjusted regression models and in models adjusted for age (deep: p = 0.02, OR 1.15[1.02-1.28]; lobar: p = 0.03, OR 1.03[1.00-1.06]), Glasgow Coma Scale (deep: p = 0.03, OR 1.13[1.01-1.27]; lobar: p = 0.02, OR 1.03[1.01-1.06]), time to baseline CT (deep: p = 0.046, OR 1.12[1.00-1.25]; lobar: p = 0.047, OR 1.03[1.00-1.06]), or ICH Score (deep: p = 0.03, OR 1.17[1.02-1.34]; lobar: p = 0.06, OR 1.03[1.0-1.06]). PHE expansion rate from baseline to 72 hours (PHE72) was associated with mRS > 2 for deep ICH in models that were unadjusted (p = 0.02, OR 4.04[1.25-13.04]) or adjusted for ICH volume (p = 0.02, OR 4.3[1.25-14.98]), age (p = 0.03, OR 5.4[1.21-24.11]), GCS (p = 0.02, OR 4.19[1.2-14.55]), time to first CT (p = 0.03, OR 4.02[1.19-13.56]), ICH expansion (p = 0.02, OR 4.96[1.24-19.83]), or ICH Score (p = 0.04, OR 3.39[1.07-10.75]). In conclusion, PHE72 was associated with poor functional outcomes after deep ICH, whereas PHE24 was associated with mortality for deep and lobar ICH.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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