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BMC Neurology
Published in: BMC Neurology 1/2017

Open Access 01-12-2017 | Research article

Post-operative re-bleeding in patients with hypertensive ICH is closely associated with the CT blend sign

Authors: Guofeng Wu, Zhengkui Shen, Likun Wang, Shujie Sun, Jinbiao Luo, Yuanhong Mao

Published in: BMC Neurology | Issue 1/2017

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Abstract

Backgrounds

Intracranial post-operative re-haemorrhage is an important complication in patients with hypertensive intracerebral haemorrhage (ICH). The purpose of the present study was to determine the value of the computed tomography (CT) blend sign in predicting post-operative re-haemorrhage in patients with ICH.

Methods

A total of 126 patients with ICH were included in the present study. All the patients underwent standard stereotactic minimally invasive surgery(MIS) to remove the ICH within 24 h following admission. There were 41 patients with a blend sign on initial CT and 85 patients without a blend sign on the initial CT. Multivariable logistic regression analyses were performed to assess the relationship between the presence of the blend sign on the non-enhanced admission CT scan and post-operative re-haemorrhage.

Results

Post-operative re-haemorrhage occurred in 24 of the 41 patients with the blend sign, and in 9 of the 85 patients without the blend sign. The incidence of re-haemorrhage was significantly different between the groups. The multivariate logistic regression analysis demonstrated that the initial Glasgow coma scale score (p = 0.002) and blend sign (P < 0.00) on the initial CT scan are independent predictors of post-operative re-haemorrhage. The sensitivity, specificity, and positive and negative predictive values of the blend sign for predicting post-operative re-haemorrhage were 72.7, 81.7, 58.5 and 89.4%, respectively.

Conclusions

The presence of the blend sign on the initial CT scan is closely associated with post-operative re-haemorrhage in patients with ICH who undergo stereotactic MIS.
Literature
1.
2.
Miller CM, Vespa P, Saver JL, Kidwell CS, Carmichael ST, Alger J, Frazee J, Starkman S, Liebeskind D, Nenov V, et al. Image-guided endoscopic evacuation of spontaneous intracerebral hemorrhage. Surg Neurol. 2008;69(5):441–6. discussion 446CrossRefPubMedPubMedCentral
3.
Chang YH, Hwang SK. Frameless stereotactic aspiration for spontaneous intracerebral hemorrhage and subsequent fibrinolysis using urokinase. J Cerebrovasc Endovasc neurosurg. 2014;16(1):5–10.CrossRefPubMedPubMedCentral
4.
Chen X, Chen W, Ma A, Wu X, Zheng J, Yu X, Wang YX, Wang D. Frameless stereotactic aspiration and subsequent fibrinolytic therapy for the treatment of spontaneous intracerebral haemorrhage. Br J Neurosurg. 2011;25(3):369–75.CrossRefPubMed
5.
Kuo LT, Chen CM, Li CH, Tsai JC, Chiu HC, Liu LC, Tu YK, Huang AP. Early endoscope-assisted hematoma evacuation in patients with supratentorial intracerebral hemorrhage: case selection, surgical technique, and long-term results. Neurosurg Focus. 2011;30(4):E9.CrossRefPubMed
6.
Umebayashi D, Mandai A, Osaka Y, Nakahara Y, Tenjin H. Effects and complications of stereotactic aspiration for spontaneous intracerebral hemorrhage. Neurol Med Chir. 2010;50(7):538–44.CrossRef
7.
Morgenstern LB, Demchuk AM, Kim DH, Frankowski RF, Grotta JC. Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage. Neurology. 2001;56(10):1294–9.CrossRefPubMed
8.
Dowlatshahi D, Brouwers HB, Demchuk AM, Hill MD, Aviv RI, Ufholz LA, Reaume M, Wintermark M, Hemphill JC 3rd, Murai Y, et al. Predicting Intracerebral hemorrhage growth with the spot sign: the effect of onset-to-scan time. Stroke. 2016;47(3):695–700.PubMedPubMedCentral
9.
Li Q, Zhang G, Huang YJ, Dong MX, Lv FJ, Wei X, Chen JJ, Zhang LJ, Qin XY, Xie P. Blend sign on computed tomography: novel and reliable predictor for early hematoma growth in patients with Intracerebral hemorrhage. Stroke. 2015;46(8):2119–23.CrossRefPubMed
10.
Li Q, Zhang G, Xiong X, Wang XC, Yang WS, Li KW, Wei X, Xie P. Black hole sign: novel imaging marker that predicts hematoma growth in patients with Intracerebral hemorrhage. Stroke. 2016;47(7):1777–81.CrossRefPubMed
11.
Xu F, Tang Z, Luo X, Kang H, Hu Q, Wang W, Zhu S. No evidence of preoperative hematoma growth representing an increased postoperative rebleeding risk for minimally invasive aspiration and thrombolysis of ICH. Br J Neurosurg. 2010;24(3):268–74.CrossRefPubMed
12.
Brouwers HB, Chang Y, Falcone GJ, Cai X, Ayres AM, Battey TW, Vashkevich A, McNamara KA, Valant V, Schwab K, et al. Predicting hematoma expansion after primary intracerebral hemorrhage. JAMA Neurol. 2014;71(2):158–64.CrossRefPubMedPubMedCentral
13.
Wu G, Wang L, Hong Z, Mao Y, Hu X. Effects of minimally invasive techniques for evacuation of hematoma in basal ganglia on cortical spinal tract from patients with spontaneous hemorrhage: observed by diffusion tensor imaging. Neurol Res. 2010;32(10):1103–9.CrossRefPubMed
14.
Wu G, Wang L, Liu J, Mao Y, Qin G. Minimally invasive procedures reduced the damages to motor function in patients with thalamic hematoma: observed by motor evoked potential and diffusion tensor imaging. J Stroke Cerebrovasc Dis. 2013;22(3):232–40.CrossRefPubMed
15.
Zhou H, Zhang Y, Liu L, Han X, Tao Y, Tang Y, Hua W, Xue J, Dong Q. A prospective controlled study: minimally invasive stereotactic puncture therapy versus conventional craniotomy in the treatment of acute intracerebral hemorrhage. BMC Neurol. 2011;11:76.CrossRefPubMedPubMedCentral
16.
Zhou H, Zhang Y, Liu L, Huang Y, Tang Y, Su J, Hua W, Han X, Xue J, Dong Q. Minimally invasive stereotactic puncture and thrombolysis therapy improves long-term outcome after acute intracerebral hemorrhage. J Neurol. 2011;258(4):661–9.CrossRefPubMedPubMedCentral
17.
Boulouis G, Morotti A, Brouwers HB, Charidimou A, Jessel MJ, Auriel E, Pontes-Neto O, Ayres A, Vashkevich A, Schwab KM, et al. Association between Hypodensities detected by computed tomography and hematoma expansion in patients with Intracerebral hemorrhage. JAMA Neurol. 2016;73(8):961–8.CrossRefPubMed
18.
Boulouis G, Dumas A, Betensky RA, Brouwers HB, Fotiadis P, Vashkevich A, Ayres A, Schwab K, Romero JM, Smith EE, et al. Anatomic pattern of intracerebral hemorrhage expansion: relation to CT angiography spot sign and hematoma center. Stroke. 2014;45(4):1154–6.CrossRefPubMedPubMedCentral
19.
Brouwers HB, Raffeld MR, van Nieuwenhuizen KM, Falcone GJ, Ayres AM, McNamara KA, Schwab K, Romero JM, Velthuis BK, Viswanathan A, et al. CT angiography spot sign in intracerebral hemorrhage predicts active bleeding during surgery. Neurology. 2014;83(10):883–9.CrossRefPubMedPubMedCentral
Metadata
Title
Post-operative re-bleeding in patients with hypertensive ICH is closely associated with the CT blend sign
Authors
Guofeng Wu
Zhengkui Shen
Likun Wang
Shujie Sun
Jinbiao Luo
Yuanhong Mao
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2017
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-017-0910-6

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