title: Increased brain volume among good grade patients with intracerebral hemorrhage. Results from the Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) study.
abstract: BACKGROUND
  We ascertained the occurrence of global cerebral edema manifesting as increased brain volume in subjects with intracerebral hemorrhage (ICH) and explored the relationship between subject characteristics and three month outcomes.
  
  
  METHODS
  A post-hoc analysis of a multicenter prospective study that recruited patients with ICH, elevated SBP ≥170 mm Hg, and Glasgow Coma Scale (GCS) score ≥8, who presented within 6 h of symptom onset was performed. Computed tomographic (CT) scans at baseline and 24 h, submitted to a core image laboratory, were analyzed to measure total brain, hematoma, and perihematoma edema volumes from baseline and 24-h CT scans using image analysis software. The increased brain volume was determined by subtracting the hematoma and perihematomal edema volumes from the total brain volume.
  
  
  RESULTS
  A total of 18 (44 %) of 41 subjects had increased brain volume that developed between initial CT scan and 24-h CT scan. The median increase in brain volume among the 18 subjects was 35 cc ranging from 0.12 to 296 cc. The median baseline GCS score was 15 in both groups of subjects who experienced increased brain volume and those who did not, and the median hematoma volume was 10.18 and 6.73, respectively. Three of the 18 subjects with increased brain volume underwent concurrent neurological deterioration and one subject died during hospitalization.
  
  
  CONCLUSIONS
  We found preliminary evidence of increased cerebral brain volume in subjects with good grade and small ICHs, which may be suggestive of global cerebral edema.
authors.affiliation: Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, MN, USA, aiqureshi@hotmail.com.
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
authors.forename: Shahram
authors.initials: S
authors.lastname: Majidi
authors.forename: Waqas I
authors.initials: WI
authors.lastname: Gilani
authors.forename: Yuko Y
authors.initials: YY
authors.lastname: Palesch
authors.forename: Renee
authors.initials: R
authors.lastname: Martin
authors.forename: Jill
authors.initials: J
authors.lastname: Novitzke
authors.forename: Salvador
authors.initials: S
authors.lastname: Cruz-Flores
authors.forename: Asad
authors.initials: A
authors.lastname: Ehtisham
authors.forename: Joshua N
authors.initials: JN
authors.lastname: Goldstein
authors.forename: Jawad F
authors.initials: JF
authors.lastname: Kirmani
authors.forename: Haitham M
authors.initials: HM
authors.lastname: Hussein
authors.forename: M Fareed K
authors.initials: MF
authors.lastname: Suri
authors.forename: Nauman
authors.initials: N
authors.lastname: Tariq
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000188:drug therapy; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
chemical_list: D000959:Antihypertensive Agents