Welcome to the WSC 2022 Interactive Program

Background and Aims

Hyponatremia is the most common electrolyte disorder in patients with intracerebral hemorrhage (ICH) and a risk factor for in-hospital mortality. Falls are common in the first month after a stroke, causing damage, decreased activity, dependency, and fear of harm. This study aims to determine the relationship between hyponatremia and the risk of falling as assessed by the Morse Fall Scale (MFS) in ICH patients.

Methods

This cross-sectional study enrolled all moderate-grade ICH patients between September and November 2021. Patients' MFS scores and electrolyte parameters, as well as baseline characteristic data, were collected. The Spearman rank was used to assess the variables' relationship to the MFS score. SPSS 22 was used to analyze the data. The local ethics committee approved the study.

Results

The rate of hyponatremia was 68.9% among the 45 patients who met the criteria (mean age of 55.44 [±15.75], male [32; 71.1%], subcortical hemorrhage location [28; 62.2%]. The mean MFS score of the hyponatremia and non-hyponatremia groups was 60.65 (±13.58) and 52.14 (±8.48), respectively. The analysis showed that hyponatremia (r=0,306, p=0,041), and body weight (r=-0,368, p=0,013) were correlated with MFS score. Hyponatremia severity was also correlated with MFS Score (r=0.304, p=0.042).

Conclusions

Our investigation revealed that hyponatremia, alongside its severity, was correlated positively with greater fall risk as assessed by MFS in ICH patients in our population. It is considered that the greater risk of falling is attributed to various mechanisms involving gait disturbance and cognitive impairment in a such population.

Background and Aims

Rationale

Intracerebral haemorrhage (ICH) is a medical emergency and causes more than 1.7 million strokes worldwide per year with a mortality of over 40%. Tranexamic acid (TXA) when given early reduces mortality and haematoma expansion in spontaneous ICH. The haemostatic effect of TXA was demonstrated in prior pilot studies which could change clinical practice globally.

Objectives

We aim to assess the clinical effectiveness of TXA after ICH and determine whether TXA should be used in clinical practice.

Methods

TICH-3 is a pragmatic phase III prospective blinded randomised placebo-controlled trial. 5500 adult patients with ICH will be recruited within 4.5 hours of onset across UK and International sites. Exclusion criteria include known indication for TXA, contraindication for TXA, known to be on anticoagulation, massive ICH (>60ml), severe coma (GCS<5) and end of life care.

Rapid emergency consent will take place and patients will be randomised (1:1) by simple randomisation to receive intravenous TXA 2g; 1g bolus loading dose given as 100ml infused over 10 minutes, followed by another 1g in 250ml infused over 8hrs or matching placebo. Patients, relatives, researchers and outcome assessors will be masked to treatment allocation.

Results

The primary outcome is mortality by day 7. Secondary outcomes include dependency (using the modified Rankin Scale) and Quality of Life (including health economics outcomes) at day 180, serious adverse events (SAE) up to 7 days and fatal SAEs up to day 180.

Conclusions

Funding TICH-3 is funded by the National Institute for Health Research Health and Care, and Patch French Stroke Trials Network.

Background and Aims

The effect of surgical treatment for spontaneous intracerebral hemorrhage (ICH) remains uncertain. We conducted an observational retrospective cohort study on supra-centimeter spontaneous ICH treated with neurosurgical or conservative management. The baseline demographics and risk factors were correlated with in-hospital mortality and 3 and 6-month survival rates stratified by management.

Methods

We included all patients with evidence of spontaneous ICH > 1 cm on CT between August 2020- March 2021 and admitted to the “SMM” Hospital in Perugia.

Results

Onehundredtwentytwo patients were included in the study, and 45% (n.55) were surgically treated. The mean age was 71,9±15.3, and 61% (n.75) were males. Intra-hospital mortality resulted being 31% (n.38), 3 months-survival was 63% (n.77) and 6 months-survival was 60% (n.73).

From the multivariate analysis of the surgical patients versus medical patient, we observed the surgical patients were younger (67,5±14,9 vs 75,5 ±14,7 y; OR 0.87; CI 95% 0,85-0,94; p 0,001), with greater ICH volume at the onset (61±39,4 cc vs 51± 64 cc; OR 1,03; CI 95% 1,005-1,07; p 0,05), more midline shift (7,61 ±5,54 mm vs 4,09 ±5,88 mm; OR 1,37; CI 95% 1,045-1,79; p 0,023), and a higher ICH score (3 vs 2 mean ICH score; OR 21,12; CI 95% 2,6-170,6; p 0,004). Intra-hospital mortality was respectively 33% vs 30%, 3 month-survival was 64% vs 63% and 6 month- survival were 60% in both groups.

Conclusions

Our patient cohort shows no overall benefit from surgery over conservative treatment, but surgical patients were younger and had larger ICH volume.

Background and Aims

Rhinocerebral mucormycosis (RCM) is the most common form and is known to invade the skull base and its associated blood vessels—leading to mycotic aneurysms, ischemic infarcts, and intracerebral haemorrhage. We report on a rare case of a patient with rhinocerebral mucormycosis that presented as intracerebral haemorrhage (ICH).

Methods

A 42 years old gentleman presented to ER with sudden onset right-sided hemiparesis, headache and multiple vomitings over the last few hours. The patient had developed COVID 19 illness a month back for which he was treated with a short term course of oral steroids and rivaroxaban. The patient had completely recovered from the COVID -19. On examination, the patient had right hemiparesis with extensor right plantar response.

Results

Urgent NCCT head was done which revealed a massive inhomogenous left frontal hematoma with mass effect and intraventricular extension. The patient underwent decompressive craniotomy with hematoma evacuation.

In view of atypical imaging findings and strong clinical suspicion, the brain hematoma was sent for histopathological examination (HPE). HPE surprisingly revealed the necrotic cerebral tissue with vessel wall invasion by zygomycetic hyphae, confirming the diagnosis of Mucormycosis as the cause of ICH. The patient was treated with intravenous amphotericin B and posaconazole, to which he responded well and was discharged in a relatively stable condition.

Conclusions

Mucormycosis is an aggressive, disseminated disease associated with vascular invasion and thrombosis, particularly in patients with history of COVID -19 illness. Early recognition and treatment are critical in order to improve clinical outcomes and decrease the development of complications.

Background and Aims

Intracerebral hemorrhage (ICH) is the most serious and disabling stroke type, accounting for up to 50% of strokes in low-to-middle-income countries. Cognitive decline and dementia are also high following ICH, due to the common underlying vasculopathy of cerebral small vessel disease (CSVD).

TRIDENT (Triple therapy prevention of Recurrent Intracerebral Disease EveNts Trial) main study aims to determine the effectiveness of the fixed low-dose triple combination of blood pressure-lowering agents (Triple Pill) on recurrent stroke and to evaluate the secondary outcome of cognitive decline and dementia.

The aim of this substudy is to assess the Triple Pill effectiveness on memory decline, cognition, and CSVD progression.

Methods

As part of TRIDENT, an international, multicenter, double-blind, placebo-controlled, parallel-group, randomized controlled trial in ICH approximately 200 participants will be included in Brazil. Participants recruited from TRIDENT local sites will be offered the opportunity to undergo additional cognitive assessments through gold-standard neuropsychological tests at baseline (until up to 6 weeks post-randomization), and 12 months. In parallel, MRI evaluation of these patients will be performed to assess CSVD progression through specific parameters at baseline and 12 months.

Results

The study recruitment is ongoing, and we plan to show preliminary results at the 2022 World Stroke Congress.

Conclusions

The substudy could potentially contribute to evaluating Triple Pill’s effectiveness on cognitive decline, dementia, and CSVC progression in ICH patients.

Background and Aims

The incidence and prognosis of acute intracerebral haemorrhage (ICH) are linked to blood pressure (BP) levels, and good BP control has been shown to prevent recurrent ICH. However, adherence to BP lowering remains a global issue, with uncertainty over the most appropriate strategy to maintain BP control. TRIDENT aims to determine the effectiveness of a novel, fixed, low-dose combination of agents in a single “Triple Pill” (telmisartan 20mg, amlodipine 2.5mg and indapamide 1.25mg) versus matching placebo on top of standard care on time to first occurrence of recurrent stroke.

Methods

An international, multi-centre, double blind, placebo controlled, randomised trial involving 1500 patients from 70+ sites globally. After a single-blind, active run-in period, participants are randomised to active or placebo treatment, with 6-monthly follow-up for an average of 3 years.

Results

Recruitment commenced in September 2017, with 890 participants from 55 hospitals across 10 countries to date: Australia, Brazil, Georgia, Malaysia, Netherlands, Nigeria, Singapore, Sri Lanka, Taiwan, and UK. Recruitment continues despite the impact of global issues: drug re-supply, data security policies and privacy laws, and COVID-19.

Conclusions

A broad network including emerging research markets and a flexible, pragmatic approach are necessary to manage and minimise risks in conducting such an independent double-blind global trial.

Background and Aims

The case fatality rate of acute spontaneous intracerebral hemorrhage (ICH) is high 54% at 1 year, and only 12% to 39% of survivors achieve long term functional independence. The INTEnsive care bundle with blood pressure Reduction in Acute Cerebral haemorrhage Trial (INTERACT3) was an international, multicentre, cluster-randomized clinical trial to assess a multifaceted goal-directed care bundle of physiological management in patients with acute ICH. We aimed to study the challenges encountered in recruitment during the pandemics in India.

Methods

Between August 2020 and October 2022, all adult patients presenting with spontaneous ICH within 6 hours from symptom onset were enrolled under the standard of usual care management until they are informed of crossing over to intervention and to be contacted at 6 months follow-up.

Results

Six out of ten screened centres participated. The pandemic posed many challenges to the recruitment of patients in the trial:

The ethics committee meetings were interrupted, preventing us enrolling more sites. Fewer patients presented to hospital due to fear of covid, economic crisis, transportation barriers, delayed presentation beyond 6 hours due to poor triaging, delay in RTPCR testing, slow referrals, unwillingness to followup in outpatient clinic.

Solutions: frequent virtual meetings with ethics committees were held by site PIs, RTPCR switched to rapid testing, ER physicians trained to rapidly identify ICH cases and trial strategy was modified at each centre to boost recruitment.

Conclusions

Alternative approaches for rapid triaging and modified strategies to recruitment are needed to overcome challenges of implementing a stroke trial during a pandemic.

Background and Aims

Intracerebral hemorrhage (ICH) is the most devastating type of stroke, with high mortality and poor prognosis. The dynamic progression and outcome of ICH are primarily influenced by hematoma (primary brain injury) and perihematomal brain injury (secondary brain injury). In damaged ICH tissue, a biphasic role of activated microglia may achieve a spectrum of functional phenotypes, M1 polarization (detrimentally augment secondary injury) and M2 polarization (promote phagocytosis and anti-inflammatory). We recently discovered that ICH-induced proteasome over-activation causes proteostasis disturbance and neuroinflammation. ICH-induced rapid proteasome over-activation exaggerates the ER stress/proteostasis disturbance, and neuroinflammation might be a critical event in acute ICH pathology. Proteasomes, including constitutive and immunoproteasome LMP2 (low-molecular-weight protein 2; PSMB9 β1i) and LMP7 (low-molecular-weight protein 7; PSMB8 β5i), have been reported to activate NFκB through degradation of the inhibitor subunit (IкB), which in turn induced inflammation. However, the effect of immunoproteasome inhibition on hemorrhagic stroke remains unclear.

Methods

Intra-striatal infusion of collagenase VII-S induced ICH, and the immunoproteasome inhibitor ONX-0914 (LMP-7 specific inhibitor) was microinjected 1-hours post-ICH. Neuroinflammation and phagocytosis were examined by RT-qPCR and immunoblotting, respectively. The neurological deficits were evaluated by modified Neurological Severity Scores.

Results

Immunoproteasomal inhibition significantly modulated phagocytosis at day three post-ICH, accompanied by hematoma volume reduction and neurological deficit improvement.

Conclusions

Immunoproteasomal inhibition exerts a neuroprotective effect via hematoma clearance and anti-inflammation.

Background and Aims

A few Incidences of intracranial haemorrhages (ICH) have been reported in SARS-Cov 2 infection. Similarly different kinds of haemorrhages (such as intraparenchymal bleed, subarachnoid haemorrhage, petechial bleeds) have been well documented as a complication of extracorporeal membrane oxygenation (ECMO). However, the independent incidence of bilateral gangliothalamic bleed in covid 19 cases or in patients on ECMO is exceedingly rare.

Methods

A 42 year old male with a past history of well controlled hypertension and hypothyroidism presented to the hospital with fever, cough, shortness of breath and chest discomfort for 5 days. He was diagnosed with acute hypoxic respiratory failure due to Covid 19 infection, which was confirmed with a positive RT PCR (reverse transcriptase polymerase chain reaction) test.

Results

In view of worsening ARDS and Pao2/Fio2 ratio, after written informed consent from the family, veno-venous ECMO was initiated. Next day, the patient’s sensorium deteriorated. Urgent NCCT head revealed bilateral gangliothalamic hemorrhage

Conclusions

The deeper structures like basal ganglia and thalami are highly metabolic brain regions and are predisposed to metabolic derangements , neurodegeneration and hypoxic ischemic injuries. These areas are also prone for hypertensive bleeds although majority are unilateral. The common pathology behind covid 19 associated coagulopathy is related to elevated CRP and D Dimer levels causing vascular damage and probable activation of intrinsic /extrinsic fibrinolytic pathways

Background and Aims

Intracerebral hemorrhage (ICH) has high mortality and disability rate in stroke cases and needs months of recovery. It may be interrupted by a recurrent vascular event, about 5.7% is an acute ischemic stroke (AIS). Uncontrolled comorbidities, such as Diabetes Mellitus type 2, hypertension, and dyslipidemia, could increase the risk of it. This study aimed to investigate the risk factor of AIS after ICH.

Methods

We performed a retrospective cohort study by using secondary data of ICH patients from January 2020 to December 2020 and AIS after ICH from January 2021 to December 2021 in National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono. We evaluate the association of characteristic variables with vascular risk factors by using the Chi-square test and Independent t-test.

Results

Among 102 patients of ICH patients that we followed up in a year, about 18 patients had AIS (17.65%). They had HbA1c levels >6.2% (50%; p <0.001). Also, they were undertreated with a single oral anti-hypertensive (50%; p <0.001).

Conclusions

We found that in post-ICH patients with characteristics of Hba1c level >6.2%, inadequate control of hypertension with a single anti-hypertensive drug could be a predictor of AIS after ICH.

Background and Aims

Background: Intracerebral hemorrhage (ICH) ranges from 10.0% to 38.5% in patients with young stroke. Our aim was to study the clinical features, severity, risk factors and etiologic distribution of ICH in young patients.

Aim: To evaluate the risk factors, etiologic distribution, clinical features, severity and hematoma characteristics of ICH in young patients.

Methods

Methods: This cross sectional study was conducted with 100 patients of 18-49 years of CT or MRI proven ICH in Department of Neurology, Bangabandhu Sheikh Mujib Medical University and Stroke unit, National Institute of Neurosciences & Hospital, Dhaka from January 2020 to February 2022. The etiology of ICH was determined based on SMASH-U classification.

Results

The mean age of patients was 39.54 years with 63% in 40-49 years group and 46 (46%) were female. Altered level of consciousness (61%)was the most frequent clinical presentation. Hypertension was the most common risk factor (64%). On admission, 45% patients had moderate NIHSS (5-15) and 24% patient had severe NIHSS (>20) with median NIHSS 15 and 18 %, 36%, 30%, 14%, 2% patients had ICH score 0, 1, 2, 3, 4 respectively. The etiological distribution according to SMASH-U classification showed most of the patients had hypertensive etiology (53%). Structural etiology accounts for 28% of the patients. 12% patient was of undetermined etiology.

Conclusions

With the rising trend of hypertension in young age the etiological distribution of ICH in young is also changing, hypertension being the most frequent one. Most of the patient presents with moderate severity according to NIHSS.

Background and Aims

Subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) are rare complications of infectious endocarditis (IE). They are usually due to an infected (mycotic) aneurysm.

To present a rare case of a patient with SAH and ICH in infectious endocarditis caused by Staphylococcus aureus.

Methods

A 64-year-old patient was admitted to the hospital as a matter of urgency due to complaints of a rash on the body and limbs, bruising of the lower extremities, vomiting, general fatigue, low blood pressure, and fever up to 39.2 degrees. A neurologist consulted the patient on the second day after hospitalization due to a new weakness in the left limbs. The examination revealed left-sided central hemiparesis with the participation of VII CN on the left and left-sided hemihypesthesia.

Results

After an MRI of the head with contrast, intraaxial hematomas were found in the right parietooccital, left parietal, and right frontal, subarachnoid hemorrhage bilaterally frontoparietal and right occipital. Growth of Staphylococcus aureus - MSSA was established from blood culture. The transesophageal echocardiography showed vegetation of rear valve mitral canvas (RVMC) - very small soft echogenic on the ventricular surface of RVMC. The patient was treated conservatively. Cardiac surgery was postponed due to the development of neurological complications. Despite the therapy, the patient developed secondary thrombocytopenia, a paraclinical constellation for consumptive coagulopathy. The outcome was lethal.

Conclusions

Even with timely diagnosis and adequate therapy, infectious endocarditis caused by Staphylococcus aureus MSSA is a condition that is difficult to control and according to the literature leads to mortality in 20-27% of cases.

Background and Aims

Minimally invasive surgical techniques for ICH offer the potential for alleviating the injury to the normal brain tissue. This study aimed to investigate the effectiveness of stereotactic computed tomographic (CT) guided recombinant tissue plasminogen activator (r-TPA) for treating patients with supratentorial ICH.

Methods

Eighty patients with supratentorial ICH >/= 30 ml, and an initial Glasgow Coma Scale (GCS) score of >/=5 were treated. A catheter was directed stereotactically into the ICH through a burr hole under CT guidance. Hematoma aspiration was followed by plus alteplase (1mg) repeating every 8 hours at the bedside, until the ICH volume was reduced to </= 20ml, or after a maximum of 7 r-TPA doses.

Results

Mean age was 55.6 years (SD 11.4). The mean initial GCS was 9.75 (SD 2.1). 73.7% had hematoma located within the basal ganglia, while 26.3% had lobar. The mean final ICH volume was 26.5ml (SD 27.5), with ICH volume reduction by an average of 60.8%. Six months after the procedure, 41 patients (51.2%) had favourable outcomes (modified Rankin Scale [mRS]) score 0-3), and the remaining had poor outcomes (mRS 4-6). The mortality rate was 23.75% (n=19 patients). In comparison with the poor outcomes group, those with favourable outcomes had significantly higher GCS scores (mean, 9.7 [SD= 1.6] vs 8.2 [SD=1.3], p<0.0001). In contrast, those who had poor outcomes were more likely to be older (mean, 59.6 [SD=11.4] vs 51.6 [SD=10.0]; p=0.001).

Conclusions

CT-guided thrombolysis and aspiration can be safe and effective in reducing ICH volume and selecting a group of young patients.

Background and Aims

Dutch-type hereditary cerebral amyloid angiopathy (D-CAA, also known as HCHWA-D), is an autosomal dominant form of cerebral amyloid angiopathy (CAA) caused by a mutation in the amyloid-beta (Aβ) precursor protein gene. Because of pathological and biochemical similarities, D-CAA is considered to be a monogenic model for sporadic CAA (sCAA). Though the disease course varies widely, disease onset is approximately 20 years earlier in D-CAA than in sCAA patients. This wide variation in phenotype suggests that additional systemic factors may interact with amyloid in triggering ICH. The aim of this prospective follow-up study is to investigate the (pre)symptomatic disease course and to assess clinical risk factors and biomarkers of disease progression.

Methods

In all patients, 3T-MRI and 7T-MRI at baseline and follow-up (alternating years) will be performed over a period of 6 years. The standardized annual study protocol consists of an interview (general health and vascular risk factors), neurological examination, cognitive screening and blood withdrawal. Participants will be asked for a lumbar puncture each study visit. Blood and cerebrospinal fluid will be stored for future biomarker analysis. Electroencephalography and home blood pressure monitoring will be performed once during follow-up.

Results

Main study parameters: CAA markers on 3T-MRI and 7T-MRI, changes in CSF and plasma, ICH recurrence rate and clinical outcome. We will investigate disease progression in 150 (pre)symptomatic mutation carriers and compare D-CAA patients with the sCAA population (FOCAS study, analogous protocol).

Conclusions

Current status: AURORA started in May 2018, until now 99 patients have been included.

Background and Aims

Hypocalcemia have been significantly associated with extent of bleeding in patients with intracerebral hemorrhage (ICH). It may be related to calcium's involvement in platelet function and the coagulation cascade.We aimed to investigate whether hypocalcemia is associated with an increase in hospital mortality in critically ill patients with ICH.

Methods

The data were extracted from the eICU Collaborative Research Database (2014–2015). The primary outcome was hospital mortality with ICU mortality as a secondary outcome. Hypocalcemia was defined as an albumin-adjusted total calcium value of 8.4 or less. A multivariable regression model was built to evaluate the association of hypocalcemia with hospital and ICU mortality. Subgroup analyses were performed according to age group (above and below 65 years), sex, region, cause of ICH (trauma or not), SOFA score, history of hypertension and diabetes, BMI. Cumulative survival rate analysis was performed using Kaplan–Meier curves with log-rank statistics.

Results

We enrolled 1954 patients with ICH who had been hospitalized in ICU for more than 24 hours and were older than 16 years. We noted that a total of 373 (19%) hospital mortality occurred including 235 (12%) ICU mortality. Hypocalcemia was associated with a 67% increased risk of hospital mortality (odds ratio [OR], 1.67; 95% confidence interval [CI)], 1.09–2.56; P=0.019) and a 72% increased risk of ICU mortality (OR, 1.72; 95%CI,1.06-2.77; P=0.027). This association was consistent across subgroup analyses.

Conclusions

Hypocalcemia was associated with high risk of hospital and ICU mortality among critically ill patients with ICH. Future prospective, randomized, controlled studies are needed to confirm our results.

Background and Aims

With over 2 million new cases annually, stroke is associated with highest disability in China. Cerebral hemorrhage is less well reported. We aim to describe genetic diversity and associations between genetic variations and clinical manifestations on cerebral hemorrhage.

Methods

The hemorrhagic stroke data of 368 patients is from study on the Etiology and Diagnosis of Cerebral Amyloid Angiopathy. The participants were enrolled from 16 hospitals with cerebral hemorrhage between January 2015 and December 2018. Age, gender, hypertension history, oral anticoagulants therapy, antiplatelet treatment, hemorrhage locations and volume, ApoE genotypes, in-hospital hemorrhage recurrence and clinical outcomes (death during hospitalization or discharge alive) were collected. ApoE genotypes are defined as ε2ε2, ε2ε3, ε2ε4, ε3ε3, ε3ε4 and ε4ε4. Means, standard deviations, counts, and proportions were described. We use Fisher’s exact test to compare the difference of clinical manifestation between different genotype groups.

Results

There is statistical significance between ApoE alleles and hemorrhage location. There is no statistical significance between ApoE alleles and hemorrhage volume. The in-hospital rebleeding (4/80, 5%) and mortality (7/78, 8.97%) of lobar hemorrhage group are more than non-lobar group(3/265, 1.13%, 6/272, 2.21%) with statistical significance, χ2=4.625, P=0.032, χ2=7.765 , P=0.005. There is no statistical significance of in-hospital rebleeding and mortality for deep hemorrhage group: 4/234, 1.71%, 6/239, 2.51%, χ2=0.421, P=0.517, χ2=2.066, P=0.151.

Conclusions

ε2 and ε4 is more frequently in lobar cerebral hemorrhage. There is statistical significance association between the ApoE ε2ε2 genotype and the in-hospital recurrence of cerebral hemorrhage. There is a trend that ε2 and ε4 is related with in-hospital mortality.

Background and Aims

The aim - to develop an algorithm for clinical and neuroimaging verification of the prognosis of the course and outcome of the acute period of spontaneous supratentorial intracerebral hemorrhage (SSICH) on the background of conservative therapy as part of the basis for choosing the optimal treatment strategy.

Methods

A prospective study of 308 patients with acute SSICH on the background of conservative therapy was done. Neurological deficit was assessed using the Full Outline of UnResponsiveness score (FOUR) and the National Institute of Health Stroke Scale (NIHSS). Visualization of the cerebral structures was performed using computed tomography. Endpoints were early neurological deterioration (END), lethal outcome (LO) and unfavorable functional outcome (UFFO) of the acute period of SSICH.

Results

Three highly sensitive multi-predictor logistic regression models were elaborated. They integrate the prognostic value of clinical (FOUR score, NIHSS score) and neuroimaging parameters (intracerebral hemorrhage volume, midline shift, secondary intraventricular hemorrhage volume, localization of the lesion) and allow to determine the individual risks of END, LO and UFFO of the SSICH acute period (AUC>0.85, p<0.05) as part of the basis for choosing the optimal treatment strategy: Step 1 - verification of the vital prognosis, Step 2 - verification of the functional prognosis (if vital prognosis is favourable), Step 3 - verification of END individual risk.

Conclusions

An algorithm for clinical and neuroimaging verification of short-term prognosis in patients with SSICH has been developed. This algorithm allows to determine the individual risks of END, LO, UFFO (on the background of conservative therapy) and to optimize treatment startegy.

Background and Aims

ACE is one of the main candidate genes of ICH. To explore whether ACE SNPs are related to ICH, and whether the association between ACE and ICH is different among different sexes.

Methods

This is a multicenter case-control study. 557 patients (120 lobar and 437 deep ICH) and 534 controls were included. 8 SNPs were included: rs4298, rs4309, rs4316, rs4331, rs4343, rs4362, rs117134739 and rs147912715. Chi square test, univariable and multivariate logistic regression models were used. Haplotypes were constructed by sliding window method. The multiplicative interaction model was used to analyze whether the associations between genotypes or haplotypes and ICH were different among different sexes.

Results

Allele frequencies of rs4309 C, rs4316 C, rs4331a and rs4343 in ICH patients were higher than those in the control group (P = 0.0005, 0.0007, 0.0019, 0.0019). They were mainly associated with deep ICH (P = 0.0004, 0.0012, 0.0029, 0.0031), but not with lobar ICH. The ACT haplotype (rs117134739-rs4298-rs4309) was most closely associated with the reduction of total and deep ICH risk (P = 0.0008, 0.0005), while the CCA haplotype (rs4309-rs4316-rs4331) was most closely associated with the increase of total and deep ICH risk (P = 0.0003, 0.0003). There was a significant interaction between gender and haplotypes, including rs4316-rs4331-rs4343, and rs4331-rs4343-rs4362 (P = 0.0020, 0.00004). They were only related to the risk of total and deep ICH in men, but not to the risk of ICH in women.

Conclusions

ACE SNPs were associated with overall and deep ICH in Chinese population, and there is an interaction between ACE gene and gender