• Humans
• Male
• Female
• Retrospective Studies
• Reflex, Pupillary/physiology
• Middle Aged
• Intensive Care Units
• Tomography, X-Ray Computed
• Aged
• Adult
• Neuroscience Nursing

• Outcome
• Pyrexia
• Stroke
• Traumatic brain injury

• Humans
• Fever/etiology
• Brain Injuries/complications
• Brain Injuries/mortality
• Intensive Care Units/organization & administration
• Intensive Care Units/statistics & numerical data

• Antiplatelet therapy
• Intracerebral hemorrhage
• Meta-analysis
• Prognosis

• Humans
• Cerebral Hemorrhage/mortality
• Cerebral Hemorrhage/drug therapy
• Platelet Aggregation Inhibitors/adverse effects
• Platelet Aggregation Inhibitors/therapeutic use
• Platelet Aggregation Inhibitors/administration & dosage
• Prognosis
• Risk Factors

• Acute ischemic stroke
• Dickkopf-3
• Early neurological deterioration
• Predictive value
• Risk of death

• Humans
• Male
• Female
• Middle Aged
• Aged
• Ischemic Stroke/blood
• Ischemic Stroke/mortality
• Predictive Value of Tests
• Biomarkers/blood
• Intercellular Signaling Peptides and Proteins/blood
• Hospital Mortality
• Adaptor Proteins, Signal Transducing/blood
• Risk Factors
• Prognosis
• Enzyme-Linked Immunosorbent Assay
• Chemokines/blood
• Aged, 80 and over
• Time Factors
• Reference Values

• AHA Scientific Statements
• cerebral amyloid angiopathy
• cerebral hemorrhage
• intracranial hemorrhage
• prevention
• recovery
• treatment

Spontaneous intracerebral hemorrhage (ICH) has an increasing incidence and a worse outcome in elderly patients. The ability to predict the functional outcome in these patients can be helpful in supporting treatment decisions and establishing prognostic expectations. We evaluated the performance of a machine learning (ML) model to predict the 6-month functional status in elderly patients with ICH leveraging the predictive value of the clinical characteristics at hospital admission. Data were extracted by a retrospective multicentric database of patients ≥ 70 years of age consecutively admitted for the management of spontaneous ICH between January 1, 2014 and December 31, 2019. Relevant demographic, clinical, and radiological variables were selected by a feature selection algorithm (Boruta) and used to build a ML model. Outcome was determined according to the Glasgow Outcome Scale (GOS) at 6 months from ICH: dead (GOS 1), poor outcome (GOS 2–3: vegetative status/severe disability), and good outcome (GOS 4–5: moderate disability/good recovery). Ten features were selected by Boruta with the following relative importance order in the ML model: Glasgow Coma Scale, Charlson Comorbidity Index, ICH score, ICH volume, pupillary status, brainstem location, age, anticoagulant/antiplatelet agents, intraventricular hemorrhage, and cerebellar location. Random forest prediction model, evaluated on the hold-out test set, achieved an AUC of 0.96 (0.94–0.98), 0.89 (0.86–0.93), and 0.93 (0.90–0.95) for dead, poor, and good outcome classes, respectively, demonstrating high discriminative ability. A random forest classifier was successfully trained and internally validated to stratify elderly patients with spontaneous ICH into prognostic subclasses. The predictive value is enhanced by the ability of ML model to identify synergy among variables.

• Conventional statistics
• Hemorrhagic stroke
• Intracerebral hemorrhage
• Intracranial hemorrhage
• Machine learning
• Outcome

• Intensive care unit
• Mortality
• Outcome
•     Ischaemic stroke

• Brain
• Brain Ischemia/complications
• Brain Ischemia/drug therapy
• Humans
• Ischemic Stroke
• Reperfusion
• Stroke/etiology
• Stroke/prevention & control

Neuroimaging is crucial for assessing mass effect in brain-injured patients. Transport to an imaging suite, however, is challenging for critically ill patients. We evaluated the use of a low magnetic field, portable MRI (pMRI) for assessing midline shift (MLS). In this observational study, 0.064 T pMRI exams were performed on stroke patients admitted to the neuroscience intensive care unit at Yale New Haven Hospital. Dichotomous (present or absent) and continuous MLS measurements were obtained on pMRI exams and locally available and accessible standard-of-care imaging exams (CT or MRI). We evaluated the agreement between pMRI and standard-of-care measurements. Additionally, we assessed the relationship between pMRI-based MLS and functional outcome (modified Rankin Scale). A total of 102 patients were included in the final study (48 ischemic stroke; 54 intracranial hemorrhage). There was significant concordance between pMRI and standard-of-care measurements (dichotomous, κ = 0.87; continuous, ICC = 0.94). Low-field pMRI identified MLS with a sensitivity of 0.93 and specificity of 0.96. Moreover, pMRI MLS assessments predicted poor clinical outcome at discharge (dichotomous: adjusted OR 7.98, 95% CI 2.07–40.04, p = 0.005; continuous: adjusted OR 1.59, 95% CI 1.11–2.49, p = 0.021). Low-field pMRI may serve as a valuable bedside tool for detecting mass effect.

Objectives: The original intracerebral hemorrhage (oICH) score is the severity score most commonly used in clinical intracerebral hemorrhage (ICH) research but may be influenced by hematoma expansion or intraventricular hemorrhage (IVH) growth in acute ICH. Here, we aimed to develop new clinical scores to improve the prediction of functional outcomes in patients with ICH.

Methods: Patients admitted to the First Affiliated Hospital of Chongqing Medical University with primary ICH were prospectively enrolled in this study. Hematoma volume was measured using a semiautomated, computer-assisted technique. The dynamic ICH (dICH) score was developed by incorporating hematoma expansion and IVH growth into the oICH score. The ultra-early ICH (uICH) score was developed by adding the independent non-contrast CT markers to the oICH score. Receiver operating characteristic curve analysis was used to compare performance among the oICH score, dICH score, and uICH score.

Results: There were 310 patients in this study which included 72 patients (23.2%) with hematoma expansion and 58 patients (18.7%) with IVH growth. Of 31 patients with two or more non-contrast computed tomography markers, 61.3% died, and 96.8% had poor outcomes at 90 days. After adjustment for potential confounding variables, we found that age, baseline Glasgow Coma Scale score, presence of IVH on initial CT, baseline ICH volume, infratentorial hemorrhage, hematoma expansion, IVH growth, blend sign, black hole sign, and island sign could independently predict poor outcomes in multivariate analysis. In comparison with the oICH score, the dICH score and uICH score exhibited better performance in the prediction of poor functional outcomes.

Conclusions: The dICH score and uICH score were useful clinical assessment tools that could be used for risk stratification concerning functional outcomes and provide guidance in clinical decision-making in acute ICH.

• ICH score
• NCCT marker
• computed tomography
• hematoma expansion
• intracerebral hemorrhage
• outcome

Antiplatelet therapy increases the risk of hematoma expansion in intracerebral hemorrhage (ICH) while the effect on functional outcome is uncertain.

This is an exploratory analysis of the TICH‐2 (Tranexamic Acid in Intracerebral Hemorrhage‐2) double‐blind, randomized, placebo‐controlled trial, which studied the efficacy of tranexamic acid in patients with spontaneous ICH within 8 hours of onset. Multivariable logistic regression and ordinal regression were performed to explore the relationship between pre‐ICH antiplatelet therapy, and 24‐hour hematoma expansion and day 90 modified Rankin Scale score, as well as the effect of tranexamic acid. Of 2325 patients, 611 (26.3%) had pre‐ICH antiplatelet therapy. They were older (mean age, 75.7 versus 66.5 years), more likely to have ischemic heart disease (25.4% versus 2.7%), ischemic stroke (36.2% versus 6.3%), intraventricular hemorrhage (40.2% versus 27.5%), and larger baseline hematoma volume (mean, 28.1 versus 22.6 mL) than the no‐antiplatelet group. Pre‐ICH antiplatelet therapy was associated with a significantly increased risk of hematoma expansion (adjusted odds ratio [OR], 1.28; 95% CI, 1.01–1.63), a shift toward unfavorable outcome in modified Rankin Scale (adjusted common OR, 1.58; 95% CI, 1.32–1.91) and a higher risk of death at day 90 (adjusted OR, 1.63; 95% CI, 1.25–2.11). Tranexamic acid reduced the risk of hematoma expansion in the overall patients with ICH (adjusted OR, 0.76; 95% CI, 0.62–0.93) and antiplatelet subgroup (adjusted OR, 0.61; 95% CI, 0.41–0.91) with no significant interaction between pre‐ICH antiplatelet therapy and tranexamic acid (P interaction=0.248).

Antiplatelet therapy is independently associated with hematoma expansion and unfavorable functional outcome. Tranexamic acid reduced hematoma expansion regardless of prior antiplatelet therapy use.

URL: https://www.isrctn.com; Unique identifier: ISRCTN93732214.

• antiplatelet
• cerebral hemorrhage
• hematoma expansion
• randomized controlled trial
• tranexamic acid

• Emergency Department Prognosis.
• Emergency department
• Intensive Care Unit
• Intensive care unit
• Modified Early Warning Score
• Modified early warning score
• Prognosis

• Cerebral hemorrhage
• Stroke
• Tertiary care centers
• Triage

• Acute stroke
• Brain hemorrhage
• Cerebral brain hemorrhage
• Cerebral stroke
• Cerebrovascular stroke
• Stroke

• Intracerebral hemorrhage
• Mortality
• Prognosis
• Therapy

• Blood pressure
• Coagulopathy reversal
• Hematoma
• Intracerebral hemorrhage
• Intraventricular hemorrhage
• Minimally invasive surgery

• Cincinnati Prehospital Stroke Scale (CPSS)
• emergency medical services (EMS)
• intracranial hemorrhage
• stroke

• Blood pressure variability
• hyperosmolar therapy
• postmechanical ventilation sedation
• spontaneous intracranial hemorrhage

Management of minor intracranial hemorrhage typically involves ICU admission. ICU capacity is increasingly strained, resulting in increased emergency department boarding of critically ill patients. Our objectives were to implement a novel protocol using our emergency department–based resuscitative care unit for management of management of minor intracranial hemorrhage patients in the emergency department setting, to provide timely and appropriate critical care, and to decrease inpatient ICU utilization.

• emergency department
• intracranial hemorrhage
• resuscitative care unit

• Emergency medicine
• Intracerebral hemorrhage
• Spot sign

• Non-traumatic intracerebral hemorrhage
• current managment
• diagnosis
• stroke
• treatment
• update

• PAR1 pathway
• choroid plexuses
• hydrocephalus
• thrombin
• vascular endothelial-cadherin

• Brain hematoma
• Brain herniation
• Clinical management
• Clot lysis
• Intracerebral hemorrhage
• Minimally invasive surgery

• BCVI = blunt cerebrovascular injury
• CTA = CT angiography
• GCS = Glasgow Coma Scale
• GOS = Glasgow Outcome Scale
• HTS = hypertonic saline
• ICU = intensive care unit
• LOC = loss of consciousness
• LOS = length of stay
• MOI = mechanism of injury
• TBI = traumatic brain injury
• isolated traumatic subarachnoid hemorrhage
• neuroworsening
• pediatric
• tSAH = traumatic subarachnoid hemorrhage
• trauma
• traumatic brain injury

• Adolescent
• Brain/diagnostic imaging
• Child
• Child, Preschool
• Disease Progression
• Female
• Humans
• Infant
• Infant, Newborn
• Male
• Neuroimaging
• Retrospective Studies
• Risk Assessment
• Subarachnoid Hemorrhage, Traumatic/diagnostic imaging
• Tomography, X-Ray Computed

• Aged
• Aged, 80 and over
• Ambulances
• Brain Ischemia/physiopathology
• Brain Ischemia/therapy
• Double-Blind Method
• Female
• Follow-Up Studies
• Glasgow Coma Scale
• Humans
• Intracranial Hemorrhages/physiopathology
• Intracranial Hemorrhages/therapy
• Male
• Middle Aged
• Outcome Assessment, Health Care
• Patient Admission
• Severity of Illness Index
• Stroke/physiopathology
• Stroke/therapy
• Time Factors

• neurology
• prehospital care
• stroke

• 6-minute walk test
• Stroke
• feasibility
• safety

• Aged
• Aged, 80 and over
• Cross-Sectional Studies
• Dependent Ambulation
• Exercise Tolerance
• Feasibility Studies
• Female
• Health Status
• Heart Rate
• Humans
• Japan
• Male
• Middle Aged
• Mobility Limitation
• Patient Admission
• Patient Safety
• Predictive Value of Tests
• Prognosis
• Risk Assessment
• Risk Factors
• Stroke/diagnosis
• Stroke/physiopathology
• Time Factors
• Walk Test/adverse effects

• Intracerebral hemorrhage
• Outcome
• Poor prognosis
• Predictors

• clinical outcomes
• pediatric
• prognosis
• spontaneous intracerebral hemorrhage

• Do-not-resuscitate order
• Emergency department
• Spontaneous intracerebral hemorrhage

• Aged
• Cerebral Hemorrhage/mortality
• Cerebral Hemorrhage/physiopathology
• Cerebral Hemorrhage/therapy
• Emergency Service, Hospital
• Female
• Hospital Mortality
• Humans
• Male
• Outcome Assessment, Health Care
• Predictive Value of Tests
• Prognosis
• Resuscitation Orders
• Retrospective Studies
• Taiwan/epidemiology

Intracerebral haemorrhage (ICH) is the most devastating and disabling type of stroke. Uncontrolled hypertension (HTN) is the most common cause of spontaneous ICH. Recent advances in neuroimaging, organised stroke care, dedicated Neuro-ICUs, medical and surgical management have improved the management of ICH. Early airway protection, control of malignant HTN, urgent reversal of coagulopathy and surgical intervention may increase the chance of survival for patients with severe ICH. Intensive lowering of systolic blood pressure to <140 mm Hg is proven safe by two recent randomised trials. Transfusion of platelets in patients on antiplatelet therapy is not indicated unless the patient is scheduled for surgical evacuation of haematoma. In patients with small haematoma without significant mass effect, there is no indication for routine use of mannitol or hypertonic saline (HTS). However, for patients with large ICH (volume > 30 cbic centmetre) or symptomatic perihaematoma oedema, it may be beneficial to keep serum sodium level at 140–150 mEq/L for 7–10 days to minimise oedema expansion and mass effect. Mannitol and HTS can be used emergently for worsening cerebral oedema, elevated intracranial pressure (ICP) or pending herniation. HTS should be administered via central line as continuous infusion (3%) or bolus (23.4%). Ventriculostomy is indicated for patients with severe intraventricular haemorrhage, hydrocephalus or elevated ICP. Patients with large cerebellar or temporal ICH may benefit from emergent haematoma evacuation. It is important to start intermittent pneumatic compression devices at the time of admission and subcutaneous unfractionated heparin in stable patients within 48 hours of admission for prophylaxis of venous thromboembolism. There is no benefit for seizure prophylaxis or aggressive management of fever or hyperglycaemia. Early aggressive comprehensive care may improve survival and functional recovery.

• CT
• Hemorrhage
• Hydrocephalus
• Intracranial Pressure
• MRI

• Cerebral hemorrhage
• Cerebrovascular disorders
• Intracranial hemorrhages
• Stroke
• Therapeutics

• coagulopathy
• hypertension
• imaging
• intracerebral hemorrhage
• management
• surgery

• intracranial haemorrhage
• neurocritical care
• stroke

Hypertensive intracerebral hemorrhage (HICH) has been on the decline. However, mortality at long-term follow up is on the increase. The aim of the present study was to investigate early warning signals of death in patients with acute HICH. The medical records of 128 patients with acute HICH within 6 h of onset were retrospectively analyzed. For these patients, systolic blood pressure (BP) was recorded at different time points (emergency, admission, every 6 h within 24 h and twice daily after 24 h) within 1 week. Computed tomography scanning was performed at emergency and the following 24±3 h to assess the hematoma volume. Neurological impairment was evaluated using the Glasgow Coma Scale and National Institutes of Health Stroke Scale. Outcomes were death, defined as a modified Rankin scale score 6, at 90 days. The results showed that at 90 days, 15 HICH patients succumbed (mortality of 11.7%). Of the 15 patients, 1 patient (6.7%) sucumbed within 24 h and 6 patients (40%) within 1 week. HICH mortality was closely associated with age (P<0.001) but not with gender. A significant association was detected between mortality and high BP taken at 30 min, 45 min and 6 h after admission (P=0.003), albeit not at emergency and admission (P>0.05). Death was also correlated with hematoma volume at 24 h but not with the site. Results from the multivariate binary logistic regression analysis showed that age and hematoma volume were independent risk factors of death of HICH. In conclusion, age and hematoma volume may be important early predictors of death in HICH. Proactive control and management of hematoma may reduce the mortality of HICH.

• blood pressure control
• early mortality
• intracerebral hemorrhage
• predictors of mortality

Spontaneous intracerebral hemorrhage is a type of stroke associated with poor outcomes. Mortality is elevated, especially in the acute phase. From a pathophysiological point of view the bleeding must traverse different stages dominated by the possibility of re-bleeding, edema, intracranial hypertension, inflammation and neurotoxicity due to blood degradation products, mainly hemoglobin and thrombin. Neurological deterioration and death are common in early hours, so it is a true neurological-neurosurgical emergency. Time is brain so that action should be taken fast and accurately. The most significant prognostic factors are level of consciousness, location, volume and ventricular extension of the bleeding. Nihilism and early withdrawal of active therapy undoubtedly influence the final result. Although there are no proven therapeutic measures, treatment should be individualized and guided preferably by pathophysiology. The multidisciplinary teamwork is essential. Results of recently completed studies have birth to promising new strategies. For correct management it’s important to establish an orderly and systematic strategy based on clinical stabilization, evaluation and establishment of prognosis, avoiding secondary insults and adoption of specific individualized therapies, including hemostatic therapy and intensive control of elevated blood pressure. Uncertainty continues regarding the role of surgery.

• Intracerebral hemorrhage
• Prognosis
• Hematoma expansion
• Inflammation
• Hemostatic therapy
• Oral anticoagulants

• AHA Scientific Statements
• blood pressure
• coagulopathy
• diagnosis
• intracerebral hemorrhage
• intraventricular hemorrhage
• surgery
• treatment

• American Heart Association
• Cerebral Hemorrhage/diagnosis
• Cerebral Hemorrhage/epidemiology
• Cerebral Hemorrhage/therapy
• Disease Management
• Health Personnel/standards
• Humans
• Stroke/diagnosis
• Stroke/epidemiology
• Stroke/therapy
• United States/epidemiology

Extended time in the emergency department (ED) has been related to adverse outcomes among stroke patients. We examined the associations of ED nursing shift change (SC) and length of stay in the ED with outcomes in patients with intracerebral hemorrhage (ICH).

Data were collected on all spontaneous ICH patients admitted to our stroke center from 7/1/08–6/30/12. Outcomes (frequency of pneumonia, modified Rankin Scale (mRS) score at discharge, NIHSS score at discharge, and mortality rate) were compared based on shift change experience and length of stay (LOS) dichotomized at 5 hours after arrival.

Of the 162 patients included, 60 (37.0%) were present in the ED during a SC. The frequency of pneumonia was similar in the two groups. Exposure to an ED SC was not a significant independent predictor of any outcome. LOS in the ED ≥5 hours was a significant independent predictor of discharge mRS 4–6 (OR 3.638, 95% CI 1.531–8.645, and P = 0.0034) and discharge NIHSS (OR 3.049, 95% CI 1.491–6.236, and P = 0.0023) but not death.

Our study found no association between nursing SC and adverse outcome in patients with ICH but confirms the prior finding of worsened outcome after prolonged length of stay in the ED.