The Persisting Burden of Intracerebral Haemorrhage: Can Effective Treatments Be Found?

Colin Josephson, Rustam Al-Shahi Salman, and colleagues discuss the effectiveness of treatments for intracerebral haemorrhage

Copeptin is associated with mortality and outcome in patients with acute intracerebral hemorrhage

Spontaneous intracerebral hemorrhage (ICH) accounts for a high mortality and morbidity. Early prediction of outcome is crucial for optimized care and treatment decision. Copeptin, the C-terminal part of provasopressin, has emerged as a new prognostic marker in a variety of diseases, but its prognostic value in ICH is unknown

Poor Correlation Between Perihematomal MRI Hyperintensity and Brain Swelling After Intracerebral Hemorrhage

BACKGROUND AND PURPOSE: The perihematomal hyperintensity is commonly interpreted to represent cerebral edema following ICH, but the accuracy of this interpretation is unknown. We therefore investigated the relationship between changes in PHH and changes in hemispheric brain volume as a measure of edema during the first week after ICH. METHODS: Fifteen individuals aged 66±13 with baseline hematoma size of 13.1 mL (range 3–43) were prospectively studied with sequential MRI 1.0±0.5, 2.6±0.9, and 6.5±1.0 days after spontaneous supratentorial ICH. Changes in hemispheric brain volume were assessed on MPRAGE using the Brain-Boundary Shift Integral. Hematoma and PHH volumes were measured on T2-weighted images. RESULTS: Brain volume increased a small but statistically significant amount (6.3±8.0 mL, 0.6±0.7%) between the first and second scans relative to 10 normal controls (−0.9±4.1 mL, p=0.02) and returned toward baseline at the third scan (1.5±9.5 mL vs. controls 0.9±4.0 mL, p=0.85). There were no significant differences in the volume changes between the two hemispheres at scan 2 or scan 3. At both scan 2 (p=0.04) and scan 3 (p=0.004), the change in PHH was significantly greater than and poorly correlated with the change in ipsilateral hemispheric volume. There were no significant correlations between change in NIHSS and change in PHH, ipsilateral, or total brain volume at scan 2 or scan 3 (all p> 0.05). CONCLUSIONS: In patients with small-to-moderate-sized hematomas, change in PHH was a poor measure of brain edema in the first week following ICH. A small degree of bihemispheric brain swelling occurred but was of little clinical significance