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Extents of White Matter Lesions and Increased Intraventricular Extension of Intracerebral Hemorrhage

Kim, Beom Joon MD, PhD1,2; Lee, Seung-Hoon MD, PhD2; Ryu, Wi-Sun MD, MSc2; Kim, Chi Kyung MD2; Chung, Jong-Won MD2; Kim, Dohoung MD2; Park, Hong-Kyun MD2; Yoon, Byung-Woo MD, PhD2

doi: 10.1097/CCM.0b013e31827c05e9
Neurologic Critical Care

Objectives: To determine whether the extent of white matter lesions on a CT scan of acute intracerebral hemorrhage patients is associated with the prevalence and severity of intraventricular extension of hemorrhage.

Design and Setting: A post hoc analysis of Acute Brain Bleeding Analysis–IntraCerebral Hemorrhage cohort, a nationwide prospective cohort of acute intracerebral hemorrhage patients (total number of cohort subjects, 1,604).

Patients: Spontaneous intracerebral hemorrhage patients (n = 1,262).

Interventions: None.

Measurements: The authors analyzed CT scan images taken within 48 hours after stroke onset. Extent of white matter lesions, volume of intracerebral hemorrhage, presence of intraventricular extension of hemorrhage, and intraventricular extension of hemorrhage score (approximation of intraventricular extension of hemorrhage volume) were measured using CT scans, and demographic, laboratory, clinical, and mortality data were also gathered through review of medical records and retrieval from the governmental statistical archive.

Main Results: The frequency of intraventricular extension of hemorrhage in our population was 27.2% (343 subjects). The proportion of extensive white matter lesions in intraventricular extension of hemorrhage subjects (33.8%) was higher than that of non–intraventricular extension of hemorrhage cases (16.3%; p < 0.01). Multivariable analysis showed that mild (odds ratio, 1.48; 95% confidence interval 1.05– 0.09; p < 0.01) and extensive (odds ratio, 2.73; 95% confidence interval 1.88–3.98; p < 0.01) white matter lesions were significantly associated with the presence of intraventricular extension of hemorrhage in spontaneous intracerebral hemorrhage patients. The estimated mean of the intraventricular extension of hemorrhage score from the extensive white matter lesions group (9.09 ± 0.76) was significantly higher than that of the no white matter lesions group (6.72 ± 0.78; p < 0.01 from analyses of covariances) after adjustment for relevant covariates.

Conclusions: We documented that the severity of white matter lesions is related to the occurrence and amount of intraventricular extension of hemorrhage in spontaneous intracerebral hemorrhage cases.

1Department of Neurology and Stroke Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea.

2Department of Neurology and Clinical Research Center for Stroke, Seoul National University Hospital, Seoul, Republic of Korea.

Supported, in part, by grants from the Korean Food and Drug Administration (KFDA) and the Korea Healthcare Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A102065 and A110490). The analyses and interpretations of the data and the final content of the article were produced independent of the financial sponsors. The original Acute Brain Bleeding Analysis study was supported by the KFDA, but the KFDA has no role in the analysis of the Acute Brain Bleeding Analysis–IntraCerebral Hemorrhage cohort.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: bwyoon@snu.ac.kr

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins