Welcome to the WSC 2021 Interactive Program

Background and Aims

The risk of haematoma expansion in intracerebral haemorrhage (ICH) increases with larger baseline volume until haemostasis or a tamponade is effected by the rigid cranium. We explored the association of ICH volume to intracranial volume ratio (ICH/ICV) with mass effect and whether it could predict haematoma expansion at 24-hour.

Methods

CT scans of 133 patients with ICH in the RIGHT-2 trial were analysed. ICH/ICV ratio (%) was estimated using semi-automated segmentation methods. Significant mass effect was defined as midline shift of ≥5mm or ambient cistern score of ≥1 (effacement of at least one ambient cistern). Multivariable logistic regression with adjustment for baseline variables was performed to explore the predictors of haematoma expansion (>6mL or >33%) and significant mass effect.

Results

The mean baseline ICH volume was 37.8 (38.6) mL and mean ICH/ICV ratio 2.68 (2.72)%. ICH/ICV ratio of ≥6% was significantly associated with ambient cistern effacement (adjusted odd ratio [aOR] 21.6, 95%CI 5.5-84.8) and midline shift ≥5mm (aOR 220) on baseline CT but not at lower cut-offs. Increasing ICH/ICV ratio predicted haematoma expansion but the effect plateaued at 3-4% when further increase did not significantly increase the aOR (Figure 1). The accuracy of ICH/ICV ratio in predicting haematoma expansion was similar compared to ICH volume (area under the receiver operator characteristics curve 0.69 for both, Figure 2).

Conclusions

ICH/ICV ratio predicted haematoma expansion and may be used to prognosticate or stratify patients in stroke trials testing potential treatments. The potential mechanisms and effect on functional outcomes need further exploration.

Background and Aims

Cerebral amyloid angiopathy (CAA) is a major cause of intracerebral hemorrhage (ICH) in elderly, with high recurrent risk. Convexity subarachnoid hemorrhage (cSAH) on MRI may predict ICH recurrence, and CT-visible cSAH may indicate increased recurrence risk in CAA-related ICH survivors after discharge. We aimed to investigate the association of CT-visible cSAH and early recurrence in patients with CAA-related ICH.

Methods

Patients diagnosed as possible or probable CAA according to Boston criteria from 2 prospective cohorts from 21 hospitals in China during Jan. 2015 to Feb. 2020 were included. The demographic, clinical and imaging data, ICH recurrence at discharge and 90-day follow-up were collected. Presence of cSAH was assessed on CT. The association of cSAH and early recurrence was explored using multivariable analysis.

Results

A total 197 cases (73.3±8.9 years) were included. cSAH was observed on CT in 91 patients (46.2%). 5.1% (10/197) and 9.5% (17/179) patients had ICH recurrence within 2 weeks and 90 days respectively. The presence of cSAH was related to 2-week recurrence (p= 0.041), after adjusted for hypertension, anticoagulant use and history of previous ICH. The presence of cSAH was related to 90-day recurrence (P= 0.013), after adjusted for hypertension, history of previous ICH and intraventricular hemorrhage. Prespecified multivariable analysis also showed cSAH was related to 2-week recurrence (p= 0.029) and 90-day recurrence (p=0.007), after adjusted for age, antiplatelet use, warfarin use and history of previous ICH.

Conclusions

CT-visible cSAH was detected in 46.3% of patients with CAA related ICH and indicates an increased risk of recurrent ICH.

Background and Aims

Intracerebral haemorrhage (ICH) in young stroke patients can have crippling effects on the patient, their family and society with high morbidity and mortality. This investigation seeks to clarify the SMASH-U aetiology and prevalence of risk factors in this cohort.

Methods

Retrospective analysis of medical records of patients under the age of 55 with ICH admitted to two acute stroke units in North West London over 5 years. These patients were identified by ICD-10 coding. Haemorrhagic transformation was excluded.

Results

63 patients were identified. The median age was 44 (ranging between 27-55). 46 (73%) patients were male and 37 (59%) patients were from ethnic minorities.

Analysing the patients using the SMASH-U aetiological classification: 39 (62%) had hypertension induced ICH, 1 (1.5%) medications, 1 (1.5%) amyloid angiopathy, 10 (16%) structural, 9 (14%) systemic and 6 (10%) were of unknown aetiology.

39 (62%) patients had uncontrolled hypertension on admission, 33 (52%) patients had previously diagnosed hypertension and 7 (11%) patients had newly diagnosed hypertension on admission.

6 (10%) patients had known diabetes and 4 (6%) had newly diagnosed diabetes on admission.

13 (21%) patients were smokers, 7 (11%) take recreational drugs and 9 (14%) have excessive alcohol consumption.

8 (13%) patients had diagnosed hypercholesterolaemia on treatment and LDL levels were >1.8mmol/L in 31 (49%) patients.

Conclusions

ICH in our cohort of young stroke patients is predominantly secondary to hypertension. A large proportion of these had known uncontrolled hypertension. This study suggests a significant proportion of young strokes are preventable with modifiable risk factors.