Determinants of Early Versus Delayed Neurological Deterioration in Intracerebral Hemorrhage

Abstract Background Intracerebral hemorrhage (ICH) is caused by bleeding, primarily into parenchymal brain tissue, and accounts for 9 to 27% of all strokes worldwide. Higher neutrophils, lower lymphocytes, and higher neutrophil-to-lymphocytes ratio (NLR) values predict worse outcomes after spontaneous intracranial hemorrhage (sICH) and could aid in the risk stratification of patients. Methods Eighty patients with sICH within the first 24 h of stroke onset and admitted into the neurology intensive care unit of an Egyptian university hospital and were assessed by GCS for consciousness level and NIHSS for stroke severity assessment, complete blood count, and special attention to NLR. Patients were reevaluated by GCS and NIHSS on the 7th day of the stroke. Early neurological deterioration (END) was defined as four points or a greater increase in the NIHSS score or two points or a greater decrease in GCS or death. Results END was recorded in 21.25% of patients while non-END was recorded in 78.75%. END was highly significantly associated with a low grade of GCS, high grade of NIHSS, elevated absolute lymphocyte count (ALC), and elevated NLR. Lower GCS score, higher NIHSS score, larger hematoma volume, and higher NLR values were independent predictors for END. The best cutoff of NLR in END prediction was > 9.1. Conclusion NLR is a trustworthy early predictor of sICH outcome.

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Late Neurological Deterioration after Acute Intracerebral Hemorrhage: A post hoc Analysis of the ATACH-2 Trial

Cerebrovascular Diseases ◽

10.1159/000506117 ◽

2020 ◽

Vol 49 (1) ◽

pp. 26-31 ◽

Cited By ~ 1

Author(s):

Shuhei Okazaki ◽

Haruko Yamamoto ◽

Lydia D. Foster ◽

Mayumi Fukuda-Doi ◽

Masatoshi Koga ◽

...

Keyword(s):

Blood Pressure ◽

Intracerebral Hemorrhage ◽

Significant Risk ◽

Blood Pressure Level ◽

Neurological Deterioration ◽

Major Influence ◽

Case Report Form ◽

Hematoma Volume ◽

Systolic Blood Pressure Level ◽

Significant Difference

Background: Neurological deterioration (ND) has a major influence on the prognosis of intracerebral hemorrhage (ICH); however, factors associated with ND occurring after 24 h of ICH onset are unknown. Methods: We performed exploratory analyses of data from the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 trial, which compared intensive and standard blood pressure lowering treatment in ICH. NDs were captured on the adverse event case report form. Logistic regression analysis was performed to examine the independent predictors of late ND. Results: Among 1,000 participants with acute ICH, 82 patients (8.2%) developed early ND (≤24 h), and 64 (6.4%) had late ND. Baseline hematoma volume (adjusted OR [aOR] per 1-cm3 increase 1.04, 95% CI 1.02–1.06, p < 0.0001), hematoma volume increase in 24 h (aOR 2.24, 95% CI 1.23–4.07, p = 0.008), and the presence of intraventricular hemorrhage (IVH; aOR 2.38, 95% CI 1.32–4.29, p = 0.004) were independent predictors of late ND (vs. no late ND). Late ND was a significant risk factor for poor 90-day outcome (OR 3.46, 95% CI 1.82–6.56). No statistically significant difference in the incidence of late ND was noted between the 2 treatment groups. Conclusions: Initial hematoma volume, early hematoma volume expansion, and IVH are independent predictors of late ND after ICH. Intensive reduction in the systolic blood pressure level does not prevent the development of late ND.

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Prevention of postoperative posterior tethering of spinal cord after resection of ependymoma

Journal of Neurosurgery Spine ◽

10.3171/spi.2003.99.2.0181 ◽

2003 ◽

Vol 99 (2) ◽

pp. 181-187 ◽

Cited By ~ 7

Author(s):

Takeo Goto ◽

Kenji Ohata ◽

Toshihiro Takami ◽

Misao Nishikawa ◽

Akimasa Nishio ◽

...

Keyword(s):

Spinal Cord ◽

Neurological Deterioration ◽

Fisher Exact Test ◽

Content Type ◽

Exact Test ◽

Spinal Ependymoma ◽

Group A ◽

Delayed Neurological Deterioration ◽

Group B ◽

Fine Print

Object. The authors evaluated an alternative method to avoid postoperative posterior tethering of the spinal cord following resection of spinal ependymomas. Methods. Twenty-five patients with spinal ependymoma underwent surgery between 1978 and 2002. There were 16 male and nine female patients whose ages at the time of surgery ranged from 14 to 64 years (mean 41.8 years). The follow-up period ranged from 6 to 279 months (mean 112.4 months). In the initial 17 patients (Group A), the procedure to prevent arachnoidal adhesion consisted of the layer-to-layer closure of three meninges and laminoplasty. In the subsequently treated eight patients (Group B), the authors performed an alternative technique that included pial suturing, dural closure with Gore-Tex membrane—assisted patch grafting, and expansive laminoplasty. In Group A, postoperative adhesion was radiologically detected in eight cases (47%), and delayed neurological deterioration secondary to posterior tethering of the cord was found in five cases. In Group B, there was no evidence of adhesive posterior tethering or delayed neurological deterioration. A significant intergroup statistical difference was demonstrated for radiologically documented posterior tethering (p < 0.05, Fisher exact test). Moreover, patients with radiologically demonstrated posterior tethering suffered a significant delayed neurological functional deterioration (p < 0.01, Fisher exact test). Conclusions. This new technique for closure of the surgical wound is effective in preventing of postoperative posterior spinal cord tethering after excision of spinal ependymoma.

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Delayed Neurological Deterioration in ICH Due to Cerebral Infarction

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100010325 ◽

2010 ◽

Vol 37 (3) ◽

pp. 397-399

Author(s):

Richard Farb ◽

David Pelz ◽

B. K. Menon ◽

J. Singh ◽

M. D. Hill

Keyword(s):

Cerebral Infarction ◽

Neurological Deterioration ◽

Delayed Neurological Deterioration

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Predictors and Outcomes of Neurological Deterioration in Intracerebral Hemorrhage: Results from the TICH-2 Randomized Controlled Trial

Translational Stroke Research ◽

10.1007/s12975-020-00845-6 ◽

2020 ◽

Author(s):

Zhe Kang Law ◽

◽

Rob Dineen ◽

Timothy J England ◽

Lesley Cala ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Intracerebral Hemorrhage ◽

Tranexamic Acid ◽

Controlled Trial ◽

Neurological Deterioration ◽

Unique Identifier ◽

Risk Of Death ◽

Randomized Controlled ◽

Early Neurological Deterioration ◽

The Uk

Abstract Neurological deterioration is common after intracerebral hemorrhage (ICH). We aimed to identify the predictors and effects of neurological deterioration and whether tranexamic acid reduced the risk of neurological deterioration. Data from the Tranexamic acid in IntraCerebral Hemorrhage-2 (TICH-2) randomized controlled trial were analyzed. Neurological deterioration was defined as an increase in National Institutes of Health Stroke Scale (NIHSS) of ≥ 4 or a decline in Glasgow Coma Scale of ≥ 2. Neurological deterioration was considered to be early if it started ≤ 48 h and late if commenced between 48 h and 7 days after onset. Logistic regression was used to identify predictors and effects of neurological deterioration and the effect of tranexamic acid on neurological deterioration. Of 2325 patients, 735 (31.7%) had neurological deterioration: 590 (80.3%) occurred early and 145 (19.7%) late. Predictors of early neurological deterioration included recruitment from the UK, previous ICH, higher admission systolic blood pressure, higher NIHSS, shorter onset-to-CT time, larger baseline hematoma, intraventricular hemorrhage, subarachnoid extension and antiplatelet therapy. Older age, male sex, higher NIHSS, previous ICH and larger baseline hematoma predicted late neurological deterioration. Neurological deterioration was independently associated with a modified Rankin Scale of > 3 (aOR 4.98, 3.70–6.70; p < 0.001). Tranexamic acid reduced the risk of early (aOR 0.79, 0.63–0.99; p = 0.041) but not late neurological deterioration (aOR 0.76, 0.52–1.11; p = 0.15). Larger hematoma size, intraventricular and subarachnoid extension increased the risk of neurological deterioration. Neurological deterioration increased the risk of death and dependency at day 90. Tranexamic acid reduced the risk of early neurological deterioration and warrants further investigation in ICH. URL:https://www.isrctn.com Unique identifier: ISRCTN93732214

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Correlation of leukocytosis with early neurological deterioration following supratentorial intracerebral hemorrhage

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2011.11.020 ◽

2012 ◽

Vol 19 (8) ◽

pp. 1096-1100 ◽

Cited By ~ 25

Author(s):

Wei Sun ◽

Amanda Peacock ◽

Jane Becker ◽

Barbara Phillips-Bute ◽

Daniel T. Laskowitz ◽

...

Keyword(s):

Intracerebral Hemorrhage ◽

Neurological Deterioration ◽

Early Neurological Deterioration

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Platelet-to-neutrophil Ratio after Intravenous Thrombolysis Predicts Unfavorable Outcomes in Acute Ischemic Stroke

Current Neurovascular Research ◽

10.2174/1567202617666200517111802 ◽

2020 ◽

Vol 17 (4) ◽

pp. 411-419

Author(s):

Mei-Qi Wang ◽

Ying-Ying Sun ◽

Yan Wang ◽

Xiu-Li Yan ◽

Hang Jin ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Intravenous Thrombolysis ◽

Final Analysis ◽

Hemorrhagic Transformation ◽

Neurological Deterioration ◽

Receiver Operating Curve ◽

Outcome Indicators ◽

Early Neurological Deterioration ◽

Delayed Neurological Deterioration

Background and Purpose: Platelet-to-neutrophil ratio (PNR) was suggested to be an independent protective predictor for 90-days outcomes in acute ischemic stroke (AIS) patients in previous studies. This study aims to investigate the association between PNR and outcomes of AIS in intravenous thrombolysis (IVT) group. Methods: Data on acute ischemic stroke patients who received intravenous thrombolysis from April 2015 to March 2019 were collected. We defined the PNR value at admission as pre-IVT PNR and after IVT within 24 h was defined as post-IVT PNR. Clinical outcome indicators included early neurological deterioration (END), hemorrhagic transformation (HT), delayed neurological deterioration (DND), and poor 3-month outcome (3m-mRS >2). Results: A total of 581 patients were enrolled in the final analysis. The age was 61(53-69) years, and 423(72.8%) were males. Post-IVT PNR was independently associated with hemorrhagic transformation (OR = 0.974; 95%CI = 0.956-0.992; P=0.006), early neurological deterioration (OR = 0.939; 95%CI = 0.913-0.966; P = 0.01), delayed neurological deterioration (OR = 0.949; 95%CI = 0.912- 0.988; P = 0.011), and poor outcome (OR = 0.962; 95%CI = 0.948-0.976; P<0.001). PNR level was identified as high (at the cut-off value or above) or low (below the cut-off value) according to receiver operating curve (ROC) analyses on each endpoint. Comparison of early neurological deterioration, hemorrhagic transformation, delayed neurological deterioration, and poor 3-month outcome (3m-mRS >2) between patients at high and low levels for platelet-to-neutrophil ratio (PNR) showed statistical differences (p<0.001). Conclusions: Post-IVT PNR was independently associated with early neurological deterioration, hemorrhagic transformation, delayed neurological deterioration, and poor 3-month outcome. Lower PNR can predict a worse outcome.

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