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Neurocritical Care
Published in: Neurocritical Care 1/2012

01-02-2012 | Original Article

Autonomic Effects of Intraventricular Extension in Intracerebral Hemorrhage

Authors: Marek Sykora, Thorsten Steiner, Sven Poli, Andrea Rocco, Peter Turcani, Jennifer Diedler

Published in: Neurocritical Care | Issue 1/2012

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Abstract

Background

Autonomic dysfunction after stroke is common and relates to unfavorable outcome. The pathophysiology of autonomic impairment after intracerebral hemorrhage (ICH) is unknown. This study examined the relationship between intraventricular hemorrhage extension (IVH) and autonomic dysregulation after ICH.

Methods

We examined the autonomic modulation using the cross-correlational time-sequence baroreflex sensitivity (BRS) in 68 ICH patients with and without IVH. Localization and extent of IVH based on the LeRoux score, hydrocephalus, hematoma volume, initial stroke severity and baseline demographic, clinical, and biochemical parameters were included in the analysis.

Results

IVH was present in 36 (52.9%) of patients. BRS was significantly lower in patients with IVH compared to those without IVH (BRS 2.35 vs. 3.5 ms/mmHg, P = 0.03). Patients with IVH including third and fourth ventricle had significantly lower BRS than patients with IVH in lateral ventricles (2.1 vs. 5.9 ms/mmg, P = 0.008) or patients without IVH (2.1 vs. 3.5 ms/mmHg, P = 0.003). There was no significant difference in BRS between patients with IVH in the lateral ventricles and patients without IVH (median BRS 5.9 vs. 3.5 ms/mmHg, P = 0.36). The amount of IVH in the third and fourth ventricle inversely correlated with decreased BRS (r = −0.43, P < 0.001). BRS did not correlate with initial hydrocephalus, hemorrhage volume, NIHSS score at admission, etiology of the ICH or parenchymal localization of the ICH.

Conclusions

Hematoma extension to the third and fourth ventricle seems to cause profound autonomic dysregulation, possibly contributing to poor outcome. Patients with IVH in this location should be monitored vigorously to prevent and treat complications of autonomic failure.
Literature
1.
Sykora M, Diedler J, Rupp A, Turcani P, Rocco A, Steiner T. Impaired baroreflex sensitivity predicts outcome of acute intracerebral hemorrhage. Crit Care Med. 2008;36:3074–9.PubMedCrossRef
2.
Robinson TG, Dawson SL, Eames PJ, Panerai RB, Potter JF. Cardiac baroreceptor sensitivity predicts long-term outcome after acute ischemic stroke. Stroke. 2003;34:705–12.PubMedCrossRef
3.
Bassi A, Colivicchi F, Santini M, Caltagirone C. Cardiac autonomic dysfunction and functional outcome after ischaemic stroke. Eur J Neurol. 2007;14:917–22.PubMedCrossRef
4.
Tokgozoglu SL, Batur MK, Top uoglu MA, Saribas O, Kes S, Oto A. Effects of stroke localization on cardiac autonomic balance and sudden death. Stroke. 1999;30:1307–11.PubMedCrossRef
5.
Korpelainen JT, Sotaniemi KA, Myllyla VV. Autonomic nervous system disorders in stroke. Clin Auton Res. 1999;9:325–33.PubMedCrossRef
6.
Sykora M, Diedler J, Turcani P, Hacke W, Steiner T. Baroreflex: a new therapeutic target in human stroke? Stroke. 2009;40:e678–82.PubMedCrossRef
7.
Sykora M, Diedler J, Rupp A, Turcani P, Steiner T. Impaired baroreceptor reflex sensitivity in acute stroke is associated with insular involvement, but not with carotid atherosclerosis. Stroke. 2009;40(3):737–42.PubMedCrossRef
8.
Ay H, Koroshetz WJ, Benner T, et al. Neuroanatomic correlates of stroke-related myocardial injury. Neurology. 2006;66:1325–9.PubMedCrossRef
9.
Hilz MJ, Moeller S, Akhundova A, et al. High NIHSS values predict impairment of cardiovascular autonomic control. Stroke. 2011;42(6):1528–33.PubMedCrossRef
10.
Sykora M, Diedler J, Poli S, et al. Autonomic shift and increased susceptibility to infections after acute intracerebral hemorrhage. Stroke. 2011;42:1218–23.PubMedCrossRef
11.
Grassi G, Parati G, Pomidossi G, et al. Neural control of circulation before and after intravenous urapidil in essential hypertension. Drugs. 1988;35(Suppl 6):104–10.PubMedCrossRef
12.
Kothari RU, Brott T, Broderick JP, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996;27:1304–5.PubMedCrossRef
13.
Huttner HB, Steiner T, Hartmann M, et al. Comparison of ABC/2 estimation technique to computer-assisted planimetric analysis in warfarin-related intracerebral parenchymal hemorrhage. Stroke. 2006;37:404–8.PubMedCrossRef
14.
Gebel JM, Sila CA, Sloan MA, et al. Comparison of the ABC/2 estimation technique to computer-assisted volumetric analysis of intraparenchymal and subdural hematomas complicating the GUSTO-1 trial. Stroke. 1998;29:1799–801.PubMedCrossRef
15.
Winn HR, Grady MS, Newell DW, Haglund MM, LeRoux PD. Intraventricular hemorrhage in blunt head trauma: an analysis of 43 cases. Neurosurgery. 1992;31:678–84. discussion 84–5.PubMedCrossRef
16.
van Gijn J, Hijdra A, Wijdicks EF, Vermeulen M, van Crevel H. Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurosurg. 1985;63:355–62.PubMedCrossRef
17.
La Rovere MT, Bigger JT Jr, Marcus FI, Mortara A, Schwartz PJ. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators. Lancet. 1998;351:478–84.PubMedCrossRef
18.
La Rovere MT, Pinna GD, Hohnloser SH, et al. Baroreflex sensitivity and heart rate variability in the identification of patients at risk for life-threatening arrhythmias: implications for clinical trials. Circulation. 2001;103:2072–7.PubMed
19.
Westerhof BE, Gisolf J, Stok WJ, Wesseling KH, Karemaker JM. Time-domain cross-correlation baroreflex sensitivity: performance on the EUROBAVAR data set. J Hypertens. 2004;22:1371–80.PubMedCrossRef
20.
Benarroch EE. The central autonomic network: functional organization, dysfunction, and perspective. Mayo Clin Proc. 1993;68:988–1001.PubMed
21.
Wang YC, Lin CW, Shen CC, Lai SC, Kuo JS. Tissue plasminogen activator for the treatment of intraventricular hematoma: the dose-effect relationship. J Neurol Sci. 2002;202:35–41.PubMedCrossRef
22.
Mayfrank L, Kissler J, Raoofi R, et al. Ventricular dilatation in experimental intraventricular hemorrhage in pigs. Characterization of cerebrospinal fluid dynamics and the effects of fibrinolytic treatment. Stroke. 1997;28:141–8.
23.
Ozdemir O, Calisaneller T, Hasturk A, Aydemir F, Caner H, Altinors N. Prognostic significance of third ventricle dilation in spontaneous intracerebral hemorrhage: a preliminary clinical study. Neurol Res. 2008;30:406–10.PubMedCrossRef
24.
Shapiro SA, Campbell RL, Scully T. Hemorrhagic dilation of the fourth ventricle: an ominous predictor. J Neurosurg. 1994;80:805–9.PubMedCrossRef
25.
Hanley DF. Intraventricular hemorrhage: severity factor and treatment target in spontaneous intracerebral hemorrhage. Stroke. 2009;40:1533–8.PubMedCrossRef
26.
Staykov D, Volbers B, Wagner I, et al. Prognostic significance of third ventricle blood volume in intracerebral haemorrhage with severe ventricular involvement. J Neurol Neurosurg Psychiatry. 2011. doi:10.​1136/​jnnp.​2010.​234542.
27.
Sykora M, Diedler J, Poli S, Rupp A, Turcani P, Steiner T. Blood pressure course in acute stroke relates to baroreflex dysfunction. Cerebrovasc Dis. 2010;30:172–9.PubMedCrossRef
28.
Orlandi G, Fanucchi S, Strata G, et al. Transient autonomic nervous system dysfunction during hyperacute stroke. Acta Neurol Scand. 2000;102:317–21.PubMedCrossRef
29.
Bruder N, Rabinstein A. Cardiovascular and Pulmonary Complications of Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care. 2011;15(2):257–69.PubMedCrossRef
30.
31.
Ay H, Arsava EM, Koroshetz WJ, Sorensen AG. Middle cerebral artery infarcts encompassing the insula are more prone to growth. Stroke. 2008;39:373–8.PubMedCrossRef
32.
Chiu TF, Huang CC, Chen JH, Chen WL. Depressed sympathovagal balance predicts mortality in patients with subarachnoid hemorrhage. Am J Emerg Med. 2011. [Epub ahead of print].
33.
Hamann GF, Strittmatter M, Hoffmann KH, et al. Pattern of elevation of urine catecholamines in intracerebral haemorrhage. Acta Neurochir (Wien). 1995;132:42–7.CrossRef
34.
Appelboom G, Piazza MA, Hwang BY, et al. Severity of intraventricular extension correlates with level of admission glucose after intracerebral hemorrhage. Stroke. 2011;42:1883–8.PubMedCrossRef
35.
Lee SH, Kim BJ, Bae HJ, et al. Effects of glucose level on early and long-term mortality after intracerebral haemorrhage: the acute brain bleeding analysis study. Diabetologia. 2010;53:429–34.PubMedCrossRef
36.
Leira R, Davalos A, Silva Y, et al. Early neurologic deterioration in intracerebral hemorrhage: predictors and associated factors. Neurology. 2004;63:461–7.PubMed
37.
Fogelholm R, Avikainen S, Murros K. Prognostic value and determinants of first-day mean arterial pressure in spontaneous supratentorial intracerebral hemorrhage. Stroke. 1997;28:1396–400.PubMedCrossRef
38.
Bestue-Cardiel M, Martin-Martinez J, Iturriaga-Heras C, Ara-Callizo JR, Oliveros-Juste A. Leukocytes and primary intracerebral hemorrhage. Rev Neurol. 1999;29:968–71.PubMed
39.
Barreto AD, Dar NS, Hallevi H, et al. The IVH score: a novel tool for estimating intraventricular hemorrhage volume: clinical and research implications. Crit Care Med. 2009;37:969–74. e1.PubMedCrossRef
Metadata
Title
Autonomic Effects of Intraventricular Extension in Intracerebral Hemorrhage
Authors
Marek Sykora
Thorsten Steiner
Sven Poli
Andrea Rocco
Peter Turcani
Jennifer Diedler
Publication date
01-02-2012
Publisher
Humana Press Inc
Published in
Neurocritical Care / Issue 1/2012
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-011-9637-1

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