Intracerebral hemorrhage natural history: Difference between revisions
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==Complications== | ==Complications== | ||
The frequency of medical complications after acute stroke is high, although there is substantially more information reported for ischemic stroke than [[Intracerebral hemorrhage|intracerebral hemorrhage (ICH)]]. | |||
The most common complications following [[Intracerebral hemorrhage|intracerebral hemorrhage (ICH)]] include:<ref name="pmid23760151">{{cite journal| author=Elmer J, Hou P, Wilcox SR, Chang Y, Schreiber H, Okechukwu I et al.| title=Acute respiratory distress syndrome after spontaneous intracerebral hemorrhage*. | journal=Crit Care Med | year= 2013 | volume= 41 | issue= 8 | pages= 1992-2001 | pmid=23760151 | doi=10.1097/CCM.0b013e31828a3f4d | pmc=3752686 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23760151 }} </ref><ref name="pmid19461032">{{cite journal| author=Oleinik A, Romero JM, Schwab K, Lev MH, Jhawar N, Delgado Almandoz JE et al.| title=CT angiography for intracerebral hemorrhage does not increase risk of acute nephropathy. | journal=Stroke | year= 2009 | volume= 40 | issue= 7 | pages= 2393-7 | pmid=19461032 | doi=10.1161/STROKEAHA.108.546127 | pmc=2726774 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19461032 }} </ref><ref name="pmid17855672">{{cite journal| author=Malhotra A| title=Low-tidal-volume ventilation in the acute respiratory distress syndrome. | journal=N Engl J Med | year= 2007 | volume= 357 | issue= 11 | pages= 1113-20 | pmid=17855672 | doi=10.1056/NEJMct074213 | pmc=2287190 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17855672 }} </ref> | |||
*Hematoma expansion | |||
*[[Venous thromboembolism|Venous thromboembolism (VTE)]] | |||
**[[Deep vein thrombosis|eep vein thrombosis (DVT)]] | |||
**[[Pulmonary embolism|Pulmonary embolism (PE)]] | |||
*[[Pneumonia]] (5.6%) | |||
*[[Aspiration]] (2.6%) | |||
*[[Respiratory failure|Respiratory failure/distress]] (2%) | |||
*[[Pulmonary embolism]] | |||
*[[Sepsis]] | |||
*Neurogenic [[pulmonary edema]] | |||
*[[Acute respiratory distress syndrome]] | |||
*[[Acute kidney injury]], hyponatremia | |||
*[[Gastrointestinal bleeding]] | |||
*Impaired nutritional status | |||
*[[Urinary tract infections]] | |||
*Post- stroke [[depression]] | |||
Approximately 50% of deaths after stroke are attributed to medical complications, usually after 7 days of hospitalization. Stroke patients who experience medical complications while in the hospital have increased mortality up to 4 years after the initial event. | |||
==Prognosis== | ==Prognosis== | ||
Revision as of 01:38, 24 November 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
Natural history
Complications
The frequency of medical complications after acute stroke is high, although there is substantially more information reported for ischemic stroke than intracerebral hemorrhage (ICH).
The most common complications following intracerebral hemorrhage (ICH) include:[1][2][3]
- Hematoma expansion
- Venous thromboembolism (VTE)
- Pneumonia (5.6%)
- Aspiration (2.6%)
- Respiratory failure/distress (2%)
- Pulmonary embolism
- Sepsis
- Neurogenic pulmonary edema
- Acute respiratory distress syndrome
- Acute kidney injury, hyponatremia
- Gastrointestinal bleeding
- Impaired nutritional status
- Urinary tract infections
- Post- stroke depression
Approximately 50% of deaths after stroke are attributed to medical complications, usually after 7 days of hospitalization. Stroke patients who experience medical complications while in the hospital have increased mortality up to 4 years after the initial event.
Prognosis
Prognostic factors
- Despite aggressive and newer management strategies, the prognosis of patients with intracerebral hemorrhage is very poor. However, some studies suggested that excellent medical care has a direct impact on intracerebral hemorrhage (ICH) morbidity and mortality.[4]
- Case-fatality at 1 month is over 40 % and has not improved in last few decades.[5]
Prognsostic factors in Intracerebral hemorrhage include:[6]
| Poor prognostic factors | Associations |
|---|---|
| Fever[7] |
|
| Higher initial blood pressure[8] |
|
| Higher creatinine[9] |
|
| Higher serum glucose[8] |
|
| Warfarin-related hemorrhages[10][11] |
|
| Warfarin therapy with an INR >3[12] |
|
| Intraventricular hemorrhage[13][14] |
|
References
- ↑ Elmer J, Hou P, Wilcox SR, Chang Y, Schreiber H, Okechukwu I; et al. (2013). "Acute respiratory distress syndrome after spontaneous intracerebral hemorrhage*". Crit Care Med. 41 (8): 1992–2001. doi:10.1097/CCM.0b013e31828a3f4d. PMC 3752686. PMID 23760151.
- ↑ Oleinik A, Romero JM, Schwab K, Lev MH, Jhawar N, Delgado Almandoz JE; et al. (2009). "CT angiography for intracerebral hemorrhage does not increase risk of acute nephropathy". Stroke. 40 (7): 2393–7. doi:10.1161/STROKEAHA.108.546127. PMC 2726774. PMID 19461032.
- ↑ Malhotra A (2007). "Low-tidal-volume ventilation in the acute respiratory distress syndrome". N Engl J Med. 357 (11): 1113–20. doi:10.1056/NEJMct074213. PMC 2287190. PMID 17855672.
- ↑ Hemphill JC, Newman J, Zhao S, Johnston SC (2004). "Hospital usage of early do-not-resuscitate orders and outcome after intracerebral hemorrhage". Stroke. 35 (5): 1130–4. doi:10.1161/01.STR.0000125858.71051.ca. PMID 15044768.
- ↑ Apanasenko BG, Kunitsyn AI, Isaev GA, Khodyrev LP (1976). "[Determination of the weight of disemulsified lipid circulating in the blood as a method of diagnosis of fat embolism]". Lab Delo (1): 41–3. PMID 0056489.
- ↑ Tuhrim S, Horowitz DR, Sacher M, Godbold JH. Volume of ventricular blood is an important determinant of outcome in supratentorial intracere- bral hemorrhage. Crit Care Med. 1999;27:617–621.
- ↑ Leira R, Dávalos A, Silva Y, Gil-Peralta A, Tejada J, Garcia M; et al. (2004). "Early neurologic deterioration in intracerebral hemorrhage: predictors and associated factors". Neurology. 63 (3): 461–7. PMID 15304576.
- ↑ 8.0 8.1 Sawyer GJ, Fabre JW (1997). "Indirect T-cell allorecognition and the mechanisms of immunosuppression by allogeneic blood transfusions". Transpl Int. 10 (4): 276–83. PMID 9249937.
- ↑ Miller CM, Vespa PM, McArthur DL, Hirt D, Etchepare M (2007). "Frameless stereotactic aspiration and thrombolysis of deep intracerebral hemorrhage is associated with reduced levels of extracellular cerebral glutamate and unchanged lactate pyruvate ratios". Neurocrit Care. 6 (1): 22–9. doi:10.1385/NCC:6:1:22. PMID 17356187.
- ↑ Cucchiara B, Messe S, Sansing L, Kasner S, Lyden P, CHANT Investigators (2008). "Hematoma growth in oral anticoagulant related intracerebral hemorrhage". Stroke. 39 (11): 2993–6. doi:10.1161/STROKEAHA.108.520668. PMID 18703803.
- ↑ Broderick JP, Diringer MN, Hill MD, Brun NC, Mayer SA, Steiner T; et al. (2007). "Determinants of intracerebral hemorrhage growth: an exploratory analysis". Stroke. 38 (3): 1072–5. doi:10.1161/01.STR.0000258078.35316.30. PMID 17290026.
- ↑ Flaherty ML, Tao H, Haverbusch M, Sekar P, Kleindorfer D, Kissela B; et al. (2008). "Warfarin use leads to larger intracerebral hematomas". Neurology. 71 (14): 1084–9. doi:10.1212/01.wnl.0000326895.58992.27. PMC 2668872. PMID 18824672.
- ↑ Bhattathiri PS, Gregson B, Prasad KS, Mendelow AD; STICH Investigators. Intraventricular hemorrhage and hydrocephalus after spon- taneous intracerebral hemorrhage: results from the STICH trial. Acta Neurochir Suppl. 2006;96:65–68.
- ↑ Hallevi H, Albright KC, Aronowski J, Barreto AD, Martin-Schild S, Khaja AM, Gonzales NR, Illoh K, Noser EA, Grotta JC. Intraventricular hemorrhage: anatomic relationships and clinical implications. Neurology. 2008;70:848–852. doi: 10.1212/01.wnl.0000304930.47751.75.