After intracerebral hemorrhage, the clinical status changes and hematoma volume (HV) in the brain associated with the prognosis of patients. Our goals were to comment changes of clinical and intracerebral hematoma volume, noncontrast and contrast brain CT-Scanner images in acute supratentorial hemorrhage.
Trang 1CHANGES OF CLINICAL AND INTRACEREBRAL HEMATOMA VOLUME, NONCONTRAST AND CONTRAST BRAIN CT-SCAN IMAGES IN ACUTE SUPRATENTORIAL HEMORRHAGE
Nguyen Van Chuong*; Dinh Vinh Quang**
summary
After intracerebral hemorrhage, the clinical status changes and hematoma volume (HV) in the brain associated with the prognosis of patients Our goals were to comment changes of clinical and intracerebral hematoma volume, noncontrast and contrast brain CT-Scanner images in acute supratentorial hemorrhage
Descriptive, prospective analysis of 188 acute supratentorial hemorrhage patients associated with hypertension at admission, admitted within six hours after onset, from 2010 to 2013
Results: The average age was of 58.2, including 128 males (68%) and 60 females (32%) There were no differences in the Glasgow, mRS score, only differences in the two time points NIHSS at admission and after 72 hours HV average on 2 nd CT was 26.54 cm 3 , 1 st CT was 22.35 cm 3 , rate has increased HV on 2 nd CT after 72 hours was 12.77%
* Key words: S upratentorial hemorrhage; Noncontrast and contrast brain CT-Scanner images.
Introduction
Although stroke is a classic pathology of
the neurology, but still a topical issue in the
world because it is the cause of death ranks
third after cancer and heart disease, the cause
of leading death in neuropathy According to
Orgogozo (1995) and R.Hart (1994), intracerebral
hemorrhage (ICH) accounts for 15% to 20%
of brain stroke patients, and this condition
can cause death or severe disability than
cerebral infarction [2] Every year, more than
20,000 Americans die of ICH ICH frequency
of 10 - 20 people per 100,000 population and
increases with age [7]
After ICH, the clinical status changes and hematoma volume (HV) in the brain associated with the prognosis of patients In our daily work, we have to treat brain stroke patients in general, and particular in ICH, but the results are not as expected, because of some patients thought to be rescued and clinical outcomes will be better but worse go and die Therefore, we studied 188 supratentorial
ICH patients in order to: Comments changes
of clinical and intracerebral hematoma volume, noncontrast and contrast brain CT-Scan images in acute supratentorial hemorrhage
for 72 hours after onset
* 103 Hospital
** 115 Hospital
Address correspondence to Nguyen Van Chuong: 103 Hospttal
E.mail: nvch@yahoo.com
Trang 2Subjects and Methods
1 Study subjects
Patients with acute supratentorial hemorrhage
associated with hypertension, admission before
six hours after onset, treated at the Department
of Cerebral-Vascular Pathology, 115 People
Hospital from 1 - 2011 to 4 - 2013 agreed
with inclusion criteria will be included in the
study
* Inclusion criteria:
ICH is the first acute supratentorial
hemorrhage associated with hypertension
at admission, admitted within six hours after
onset, with brain images computerized
tomography (CT) to confirm the diagnosis of
supratentorial hemorrhage
Hypertension diagnostic criteria (the JNC
VII): The systolic blood pressure (SBP) is higher
than 140 and/or diastolic blood pressure (DBP)
higher than 90 mmHg
* Exclusion criteria:
- Supratentorial hemorrhage (STH) due
to aneurysm rupture, due to arteriovenous
malformations, moyamoya disease, by using
anticoagulants or anti-platelet drugs
-.STH with blood intraventricular
(intraventricular hemorrhage)
- Patients die before the second CT-Scan
shot
- STH transformation of cerebral infarction
- Renal failure, creatinine ≥ 1.7 mg/dl
- History of allergy to contrast drugs
2 Research methodology
Study design: descriptive, prospective
analysis
* Data collection:
- The clinical data:
+ BP, consciousness at admission, paralysis
of cranial nerve VII, strength of the arms and legs paralyzed
+ The Glasgow, NIHSS, Rankin at admission and 72 hours after onset
+ BP at 6 hour, then BP measurement every 4 hours to 72 hours after stroke
- Tests data:
+ Noncontrast brain CT on admission + Brain CT-angiography (CTA) in the first
24 hours after onset
+Second noncontrast brain CT when clinical status worsening (Glasgow score decreased from 2 points or more) or at the time of 72 hours after onset
* Assessment criterial:
- Clinical status after 72 hours was assessed by Glasgow scale, NIHSS, mRS Change clinically was evaluated by comparing the Glasgow, NIHSS, mRS at admission and after 72 hours
-STH status of patients after 72 hours were evaluated in two groups: blood volume without increased and increased (enlargement)
HV in the brain increases granted under Kazui [8] as V2 - V1 ≥ 12.5 cm3
or V2/V1
≥ 1.4, where V1, V2 respectively HV on brain CT-Scan 1st and 2nd time
- HV calculated by Kothari,s formulas (or Broderich): V = (AxBxC)/2 [10] Where A, B, C are the three largest diameter perpendicular
to each other in three dimensions of the hematoma
Results and discussion
After collecting data and statistical analysis
in the study group of 188 patients from 2010
to 2013, we had the following results:
Trang 31 General characteristics of the study
group
- Age: The average age was 58.29,
similar to the common age for stroke in
general, but age in our study was slightly
smaller than the age of the other ICH studies
[1, 2, 6, 7] According to the literature, the
rate of brain stroke increased with age In
developed countries with aging populations,
the average age of stroke in brain research in
these countries was higher than in our study,
as well as studies conducted in developing
countries
- Gender: 188 patients, including 128
males (68.08%) and 60 females (31.91%),
male:females was 2:1
- The time between admission and stroke:
average 4.03 hours, of which 10 patients (5.3%)
had stroke during the first hospitalization,
76 patients (40.4%) at 3 hours
2 Clinical features
* Symptoms at onset:
Figure 1: The symptoms of patients at onset
When STH, all patients in the plot study
were paralyzed to varying degrees, headache
was common symptoms of 2nd following
paralysis
* Blood pressure:
Table 1: Blood pressure of patients at
admission
* Consciousness at admission:
At the hospital: 72% had in Glasgow from
13 - 15, the number of patients in the group with consciousness disorders decreased with the severity of consciousness
* Paralysis of cranial nerve VII: 93% of
patients had paralyzed nerves VII, only 13 patients (6.9%) were not paralyzed nerve VII
* Hemiplegia: right (48.4%) and left
(51.6%) hemiplegia were almost the same
* Strength of the paralyzed arms and legs:
At admission, all patients (100%) in paralyzed arms to varying degrees, only 1 patient (0.53%) was not paralyzed in the legs
* Neurological deficiencies at admission: Table 2: Neurological deficiencies of patients
at admission according to neurological scales
(* Median [inter-quartile range] 12 (7, 16)
* Neurological deficiencies at admission was assessed by three neurological scales:
Trang 4Figure 2: Neurological deficiencies at
admission were assessed by three
neurological scales
Almost of patients with severe neurological
deficiencies level (mRS ≥ 4)
3 Brain computerized tomography at
admission (1 st time)
* Time of 1 st brain CT:
In 188 patients, brain CT-Scanner time
was as early as 30 minutes after onset,
median (inter-quartile range) of 200 (120 -
310) minutes Only 5.85% of patients had
done CT-Scanner before the first 1 hour
after onset The majority (30.32%) had a
CT-Scanner first time over a period of 5 - 6
hours after onset
* Hematoma volume on 1 st brain CT:
Figure 3: Hematoma volume on 1st brain CT
In the 188 patients studied, nearly half of
patients with HV < 15 ml (cm3)
* Location of hematoma on brain CT:
There were significant differences in the rate of hematoma location between groups according to location as follows: 82.98% basal ganglia, 2.66% capsule, 9.04% thalamus, 5.32% brain lobes Over 85% of patients with putamen hemorrhage
* Shape of hematoma on the 1 st brain CT:
20 patients (10.64%) had irregular hematoma shape, 168 patients (89.36%) had regular hematoma shape on the 1st brain CT
* Spot sign: Image of contrast drug
extravasation (spot sign) on brain CTA: After ICH, the contrast brain CT scan and/or CT-angiography (CTA) in the early hours could be seen image of contrast drug extravasation and left in hematoma, the predicted blood sign still continues to flow, and can identify patients at increased risk
HV [3, 5, 9]
In this study, 20 patients (10.64%) had spot sign on CTA
Trang 5Figure 4: Spot sign on CTA (arrow)
(Source: Nonconstrast and contrast brain
CT of 1 patient from this study)
* Time CTA:
Figure 5: The time from stroke onset
to take CTA
Only 39 patients (20.97%) took CTA in
the first 6 hours after the onset of STH,
mostly concentrated in the period from
6 - 12 hours (32.26%) and 18 - 24 hours
(34, 41%) after stroke onset
* Time noncontrast 2 nd brain CT:
Table 3: Time taken 2nd brain CT-Scanner (at clinical worsening or 72 hours after stroke onset)
2 nd brain
* Evaluating patient ’ s clinical and CT, compared 2 nd with the 1 st times:
Table 4: Clinical assessment of patients,
compared 2nd with the 1st times
Glasgow 1st 13.3 5 15 2.27
0.07
0.0005*
0.37
(* Wilcoxon sign rank test)
* Change of Glasgow, NIHSS, Rankin score after 72 hours: When comparing the
second Glasgow, NIHSS, Rankin to the first
at admission, we found no differences in Glasgow at two time points (13.32 and 12.97) with p = 0.07, there was not difference in the mRS score at two time points (3.84 and 3.79) with p = 0.37, about the NIHSS scale, their differences in NIHSS score at two time points with median (quartile range) was 12 (7.16) and 11 (6.16) with p = 0.0005 Thus, over a period of 72 hours after stroke onset, NIHSS scale is one of three most sensitive scales to assess the neurological deficiencies after stroke
* HV on 2 nd brain CT as compared with 1 st :
There were 24 patients (12.77%) with increased HV when compared HV on 1st brain CT with the 2nd times Enlargement
Trang 6HV rate was 20.83% in patients with small
hematoma volume (< 15 cm3), 29.17% in
those with moderate HV (15 - 29 cm3),
16.67% in those who had big hematoma (30
- 45 cm3), and 33.33% in those with a large
hematoma (> 45 cm3) Enlargement HV rate
increased significantly with an increase in
blood volume in the first CT Result was
similar in a study by Fujii [4]
Conclusion
Through prospectively study of 188 patients
STH with hypertension at admission, we draw
some conclusions:
- The average age was 58 years old, the
rate of men was an twice much as women
- When STH, all of the patients (100%) in
the plots study were paralyzed to varying
degrees, the percentage of patients with
right and left paralyzed almost the same;
headache was common symptoms ranking 3rd
following paralysis and paralyzed VII nerve
- At the hospital: 72% of patients had in
Glasgow from 13 - 15, the number of patients
in the group with consciousness disorders
decreased with the severity of consciousness
- SBP average was 165 mm Hg, DBP was
97 and MAP was 100 mmHg at admission
- SBP 72 h average was 138, DBP was
81mmHg
- Average of Glasgow, NIHSS, Rankin
score when assessing 2nd were 12.97, 12.86
and 3.79, respectively There was no difference
in the Glasgow, mRS score, only differences
in the two time points NIHSS at admission
and after 72 hours with p = 0.0005 During
the 72 hours after stroke, NIHSS scale was
the most sensitive of three scales when
assessing neurological deficiencies after stroke
- HV average on 2nd CT was 26.54cm3,
1st CT was 22.35 cm3
- 89.36% of patients had regular hematoma shape, 10.64% had irregular hematoma shape, over 85% of STH located in the basal ganglia and capsule
-10.64% of patients had spot sign on the CTA
- The rate of increased HV on 2nd CT after
72 hours was 12.77%
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