Amal Abou-Hamden (Australia)
Royal Adelaide Hospital NeurosurgeryAuthor Of 2 Presentations
ASSESSING COVERT BRAIN INFARCTION IN PATIENTS WITH ACUTE INTRACEREBRAL HEMORRHAGE: AN EVACUATE IMAGING SUB-STUDY
Abstract
Background And Aims
Diffusion-weighted-imaging (DWI) lesions, consistent with cerebral infarction, occur in ~30% of patients with acute intracerebral hemorrhage (ICH), are associated with increased ICH volume, and have been independently associated with negative long-term outcomes. We aim to better understand the relationships between acute ICH and DWI-lesion development. Specifically, we will perform an imaging sub-study of the ongoing EVACUATE trial to explore the natural history of DWI-lesion development in patients who undergo acute hematoma evacuation versus patients who receive standard of care. We hypothesize that the removal of blood in the early stages of ICH onset could reduce the incidence of subsequent brain infarction.
Methods
Patients enrolled into the EVACUATE trial (randomized to either minimally invasive surgery or standard of care within 8 hours of symptom onset) and later-presenting conservatively managed patients otherwise meeting trial eligibility, will undergo an MRI at days 3-7 from symptom onset and will receive clinical follow-up (mRS, NIHSS, MoCA) at 90 days.
Results
Our primary outcome will be the proportion of patients who are DWI-lesion positive at days 3-7. We will recruit 137 patients (1:1.5 ratio [intervention/control]), to identify a clinically meaningful 20% difference in DWI-lesion positivity. Differences in proportions will be adjusted for baseline white matter disease and cerebral microbleeds using Firth logistic regression models.
Conclusions
Funding has been acquired and patient recruitment is due to begin in Q2 2021. The findings of this study may shed further light on ICH pathophysiology and potentially identify new treatment targets for future therapies.
Trial Registration Number
The study described above is an imaging sub-study occuring within the structure of the EVACUATE (NCT04434807) trial.
PREDICTORS OF PROLONGED TIME TO DIAGNOSIS IN SPONTANEOUS INTRACEREBRAL HAEMORRHAGE
Abstract
Background And Aims
Prolonged time to diagnosis of intracerebral haemorrhage (ICH) can result in delays in obtaining appropriate blood pressure control, reversal of coagulopathy or surgical intervention in select cases. We sought to characterise the time to diagnosis in a cohort of patients with ICH and identify factors associated with delayed diagnosis.
Methods
The stroke database of our hospital was retrospectively reviewed to identify patients presenting to our hospitals emergency department with ICH from January 2017 until December 2018. Data collected included demographics (age and sex), comorbidities, anticoagulation status, clinical (NIHSS, GCS, ICH score), imaging (anatomical site, haematoma size). Time of symptom onset imaging diagnosis was recorded. Factors associated with diagnosis >24 hours post ictus were assessed using t-tests and chi squared tests.
Results
235 patients were identified with 125 males (53%) and a median age of 76 (range 40-98). Mean NIHSS score at presentation was 14.3 ± 10.4, and mean ICH score was 1.9 (± 1.4). In 148 (63%) cases hypertension was the aetiology. The site of haemorrhage was lobar in 96 (41%), deep cerebral in 106 (45%), cerebellar in 23 (10%) and brainstem in 10 (4%). 134 (57%) were diagnosed within ≤6 hours of ictus, 77 (33%) at 6-24 hours and 24 (10%) were diagnosed >24 hours post ictus. Factors associated with delayed diagnosis included lower NIHSS (p=0.01), absence of hemiplegia (p=0.01) and a code stroke not being called (p=0.01).
Conclusions
The majority of patients with ICH present within 6 hours of ictus. Cases of delayed diagnosis involved patients with less prominent clinical deficits.