title: Natural History of Perihematomal Edema and Impact on Outcome After Intracerebral Hemorrhage.
abstract: Edema may worsen outcome after intracerebral hemorrhage (ICH). We assessed its natural history, factors influencing growth, and association with outcome.
  
  
  
  We estimated edema volumes in ICH patients from the Helsinki ICH study using semiautomated planimetry. We assessed the correlation between edema extension distance (EED) and time from ICH onset, creating an edema growth trajectory model up to 3 weeks. We interpolated expected EED at 72 hours and identified clinical and imaging characteristics associated with faster edema growth. Association of EED and mortality was assessed using logistic regression adjusting for predictors of ICH outcome.
  
  
  
  From 1013 consecutive patients, 861 were included. There was a strong inverse correlation between EED growth rate (cm/d) and time from onset (days): EED growth=0.162*days exp(-0.927),R2=0.82. Baseline factors associated with larger than expected EED were older age (71 versus 68;P=0.002), higher National Institutes of Health Stroke Scale score (14 versus 8;P<0.001), and lower Glasgow Coma scale score (13 versus 15;P<0.001), larger ICH volume (19.7 versus 12.7 mL;P<0.001), larger initial EED (0.42 versus 0.30;P<0.001), irregularly shaped hematoma (55% versus 42%;P<0.001), and higher glucose (7.6 versus 6.9 mmol/L;P=0.001). Patients with faster edema growth had more midline shift (50% versus 31%;P<0.001), herniation (12% versus 4%;P<0.001), and higher 6-month (46% versus 26%;P<0.001) mortality. In the logistic regression model, higher-than-expected EED was associated with 6-month mortality (odds ratio, 1.60; 95% confidence interval, 1.04-2.46;P=0.032).
  
  
  
  Edema growth can be readily monitored and is an independent determinant of mortality after ICH, providing an important treatment target for strategies to improve patient outcome.
authors.affiliation: From the Department of Medicine and Neurology (T.Y.W., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Department of Neurology, Helsinki University Hospital, Finland (D.S., J.P., T.T., A.M.); Department of Clinical Neurosciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
authors.forename: Teddy Y
authors.initials: TY
authors.lastname: Wu
authors.affiliation: From the Department of Medicine and Neurology (T.Y.W., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Department of Neurology, Helsinki University Hospital, Finland (D.S., J.P., T.T., A.M.); Department of Clinical Neurosciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
authors.forename: Gagan
authors.initials: G
authors.lastname: Sharma
authors.affiliation: From the Department of Medicine and Neurology (T.Y.W., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Department of Neurology, Helsinki University Hospital, Finland (D.S., J.P., T.T., A.M.); Department of Clinical Neurosciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Strbian
authors.affiliation: From the Department of Medicine and Neurology (T.Y.W., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Department of Neurology, Helsinki University Hospital, Finland (D.S., J.P., T.T., A.M.); Department of Clinical Neurosciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
authors.forename: Jukka
authors.initials: J
authors.lastname: Putaala
authors.affiliation: From the Department of Medicine and Neurology (T.Y.W., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Department of Neurology, Helsinki University Hospital, Finland (D.S., J.P., T.T., A.M.); Department of Clinical Neurosciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Desmond
authors.affiliation: From the Department of Medicine and Neurology (T.Y.W., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Department of Neurology, Helsinki University Hospital, Finland (D.S., J.P., T.T., A.M.); Department of Clinical Neurosciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
authors.forename: Turgut
authors.initials: T
authors.lastname: Tatlisumak
authors.affiliation: From the Department of Medicine and Neurology (T.Y.W., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Department of Neurology, Helsinki University Hospital, Finland (D.S., J.P., T.T., A.M.); Department of Clinical Neurosciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Davis
authors.affiliation: From the Department of Medicine and Neurology (T.Y.W., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), The Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Department of Neurology, Helsinki University Hospital, Finland (D.S., J.P., T.T., A.M.); Department of Clinical Neurosciences, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.). atte.meretoja@unimelb.edu.au.
authors.forename: Atte
authors.initials: A
authors.lastname: Meretoja
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001929:Brain Edema / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000401:mortality; D005260:Female; D005387:Finland / Q000453:epidemiology; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed
keywords: cerebral hemorrhage; edema; mortality; natural history; stroke