Predictive factors for intracranial hemorrhage in patients with traumatic brain injury

https://doi.org/10.53730/ijhs.v8nS1.15438

Authors

  • Mohammed Abdu Mohammed Faqih Saudi Red Crescent Authority
  • Ibrahim Bin Hadi Hassan Khairy Saudi Red Crescent Authority
  • Mohammed Obiad H Alamrani Saudi Red Crescent Authority
  • ‏Khaled Bin Nasser Ahmed Kaabi Saudi Red Crescent Authority
  • ‏Atallah Khader Nassar Alamrani Saudi Red Crescent Authority
  • Nooh Ahmed Mobarki Saudi Red Crescent Authority
  • ‏Homood Sayyah Saleh Al-Azmi Saudi Red Crescent Authority
  • ‏Waleed Hamod Alanazi ‏Saudi Red Crescent Authority
  • Zeyad Mansour Alhaisoni Saudi Red Crescent Authority
  • Yosef Mohammed Yosef Alshareef Saudi Red Crescent Authority
  • ‏Mansour Mohammed Aldawsari Saudi Red Crescent Authority
  • Abdulrahman Rasheed Almubadal Saudi Red Crescent Authority
  • Faiz Thani H Alanazi KSA, National Guard Health Affairs

Keywords:

Intracranial hemorrhage, traumatic brain injury, small-vessel disease, cerebral amyloid angiopathy, predictive factors, hematoma expansion, blood pressure management

Abstract

Background: Intracranial hemorrhage (ICH) is a critical neurological condition that occurs due to the rupture of cerebral blood vessels, leading to blood infiltration into brain parenchyma. It is a leading cause of morbidity and mortality, with a greater impact on disability-adjusted life years (DALYs) compared to ischemic stroke. The primary causes of non-traumatic ICH are small-vessel disease (SVD) and cerebral amyloid angiopathy (CAA), which are affected by aging, hypertension, and other risk factors. Timely diagnosis and management of ICH are crucial due to the potential for hematoma expansion and subsequent neurological impairment. Aim: This study aims to identify predictive factors associated with ICH in patients with traumatic brain injury (TBI) and provide insights into improving patient outcomes through early diagnosis and intervention. Methods: A cohort study design was utilized to assess the predictive factors influencing ICH development in patients diagnosed with TBI. Clinical, radiological, and demographic data were collected, including age, sex, blood pressure, and medical history. Statistical analyses were performed to identify key predictors of ICH, such as the presence of hypertension, anticoagulant use, and delayed imaging. Results: The findings indicated that older age, high blood pressure, and the use of antithrombotic medications were significant predictors of ICH. 

Downloads

Download data is not yet available.

References

van Asch, C. J. et al. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 9, 167–176 (2010). DOI: https://doi.org/10.1016/S1474-4422(09)70340-0

Krishnamurthi, R. V. et al. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet Glob. Health 1, e259–e281 (2013). DOI: https://doi.org/10.1016/S2214-109X(13)70089-5

GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol. 20, 795–820 (2021). DOI: https://doi.org/10.1016/S1474-4422(21)00252-0

Poon, M. T. C., Fonville, A. F. & Al-Shahi Salman, R. Long-term prognosis after intracerebral haemorrhage: systematic review and meta-analysis. J. Neurol. Neurosurg. Psychiatry 85, 660–667 (2014). DOI: https://doi.org/10.1136/jnnp-2013-306476

Moulin, S. et al. Dementia risk after spontaneous intracerebral haemorrhage: a prospective cohort study. Lancet Neurol. 15, 820–829 (2016). DOI: https://doi.org/10.1016/S1474-4422(16)00130-7

Li, L. et al. Risks of recurrent stroke and all serious vascular events after spontaneous intracerebral haemorrhage: pooled analyses of two population-based studies. Lancet Neurol. 20, 437–447 (2021). DOI: https://doi.org/10.1016/S1474-4422(21)00075-2

Krishnamurthi, R. V. et al. Stroke prevalence, mortality and disability-adjusted life years in adults aged 20–64 years in 1990–2013: data from the global burden of disease 2013 study. Neuroepidemiology 45, 190–202 (2015). DOI: https://doi.org/10.1159/000441098

Ariesen, M. J., Claus, S. P., Rinkel, G. J. E. & Algra, A. Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke 34, 2060–2065 (2003). DOI: https://doi.org/10.1161/01.STR.0000080678.09344.8D

Tatlisumak, T., Cucchiara, B., Kuroda, S., Kasner, S. E. & Putaala, J. Nontraumatic intracerebral haemorrhage in young adults. Nat. Rev. Neurol. 14, 237–250 (2018). DOI: https://doi.org/10.1038/nrneurol.2018.17

An, S. J., Kim, T. J. & Yoon, B.-W. Epidemiology, risk factors, and clinical features of intracerebral hemorrhage: an update. J. Stroke 19, 3–10 (2017). DOI: https://doi.org/10.5853/jos.2016.00864

Kittner, S. J. et al. Ethnic and racial variation in intracerebral hemorrhage risk factors and risk factor burden. JAMA Netw. Open 4, e2121921 (2021). DOI: https://doi.org/10.1001/jamanetworkopen.2021.21921

Roquer, J. et al. Sex-related differences in primary intracerebral hemorrhage. Neurology 87, 257–262 (2016). DOI: https://doi.org/10.1212/WNL.0000000000002792

Gokhale, S., Caplan, L. R. & James, M. L. Sex differences in incidence, pathophysiology, and outcome of primary intracerebral hemorrhage. Stroke 46, 886–892 (2015). DOI: https://doi.org/10.1161/STROKEAHA.114.007682

van Beijnum, J. et al. Outcome after spontaneous and arteriovenous malformation-related intracerebral haemorrhage: population-based studies. Brain 132, 537–543 (2009). DOI: https://doi.org/10.1093/brain/awn318

Rannikmäe, K. et al. Reliability of intracerebral hemorrhage classification systems: a systematic review. Int. J. Stroke 11, 626–636 (2016). DOI: https://doi.org/10.1177/1747493016641962

Meretoja, A. et al. SMASH-U: a proposal for etiologic classification of intracerebral hemorrhage. Stroke 43, 2592–2597 (2012). DOI: https://doi.org/10.1161/STROKEAHA.112.661603

Charidimou, A. et al. The cerebral haemorrhage anatomical rating instrument (CHARTS): development and assessment of reliability. J. Neurol. Sci. 372, 178–183 (2017). DOI: https://doi.org/10.1016/j.jns.2016.11.021

Martí-Fàbregas, J. et al. The H-ATOMIC criteria for the etiologic classification of patients with intracerebral hemorrhage. PLoS ONE 11, e0156992 (2016). DOI: https://doi.org/10.1371/journal.pone.0156992

Raposo, N. et al. A causal classification system for intracerebral hemorrhage subtypes (CLAS-ICH). Ann. Neurol. 93, 16–28 (2023). DOI: https://doi.org/10.1002/ana.26519

van Asch, C. J. J. et al. Diagnostic yield and accuracy of CT angiography, MR angiography, and digital subtraction angiography for detection of macrovascular causes of intracerebral haemorrhage: prospective, multicentre cohort study. BMJ 351, h5762 (2015). DOI: https://doi.org/10.1136/bmj.h5762

Pantoni, L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 9, 689–701 (2010). DOI: https://doi.org/10.1016/S1474-4422(10)70104-6

Rodrigues, M. A. et al. The Edinburgh CT and genetic diagnostic criteria for lobar intracerebral haemorrhage associated with cerebral amyloid angiopathy: model development and diagnostic test accuracy study. Lancet Neurol. 17, 232–240 (2018). DOI: https://doi.org/10.1016/S1474-4422(18)30006-1

Sembill, J. A. et al. Simplified Edinburgh CT criteria for identification of lobar intracerebral hemorrhage associated with cerebral amyloid angiopathy. Neurology 98, e1997–e2004 (2022). DOI: https://doi.org/10.1212/WNL.0000000000200261

Flaherty, M. L. et al. Racial variations in location and risk of intracerebral hemorrhage. Stroke 36, 934–937 (2005). DOI: https://doi.org/10.1161/01.STR.0000160756.72109.95

Charidimou, A. et al. Emerging concepts in sporadic cerebral amyloid angiopathy. Brain 140, 1829–1850 (2017). DOI: https://doi.org/10.1093/brain/awx047

Viswanathan, A. & Greenberg, S. M. Cerebral amyloid angiopathy in the elderly. Ann. Neurol. 70, 871–880 (2011). DOI: https://doi.org/10.1002/ana.22516

Charidimou, A., Gang, Q. & Werring, D. J. Sporadic cerebral amyloid angiopathy revisited: recent insights into pathophysiology and clinical spectrum. J. Neurol. Neurosurg. Psychiatry 83, 124–137 (2012). DOI: https://doi.org/10.1136/jnnp-2011-301308

Rossrussel, R. W. Observations on intracerebral aneurysms. Brain 86, 425–442 (1963). DOI: https://doi.org/10.1093/brain/86.3.425

Fischer, U. et al. Acute post-stroke blood pressure relative to premorbid levels in intracerebral haemorrhage versus major ischaemic stroke: a population-based study. Lancet Neurol. 13, 374–384 (2014). DOI: https://doi.org/10.1016/S1474-4422(14)70031-6

Al-Shahi Salman, R. et al. Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data. Lancet Neurol. 17, 885–894 (2018).

Dowlatshahi, D. et al. Defining hematoma expansion in intracerebral hemorrhage: relationship with patient outcomes. Neurology 76, 1238–1244 (2011). DOI: https://doi.org/10.1212/WNL.0b013e3182143317

Greenberg, C. H., Frosch, M. P., Goldstein, J. N., Rosand, J. & Greenberg, S. M. Modeling intracerebral hemorrhage growth and response to anticoagulation. PLoS ONE 7, e48458 (2012). DOI: https://doi.org/10.1371/journal.pone.0048458

Schlunk, F. & Greenberg, S. M. The pathophysiology of intracerebral hemorrhage formation and expansion. Transl Stroke Res. 6, 257–263 (2015). DOI: https://doi.org/10.1007/s12975-015-0410-1

Ironside, N., Chen, C.-J., Ding, D., Mayer, S. A. & Connolly, E. S. J. Perihematomal edema after spontaneous intracerebral hemorrhage. Stroke 50, 1626–1633 (2019). DOI: https://doi.org/10.1161/STROKEAHA.119.024965

Zheng, H., Chen, C., Zhang, J. & Hu, Z. Mechanism and therapy of brain edema after intracerebral hemorrhage. Cerebrovasc. Dis. 42, 155–169 (2016). DOI: https://doi.org/10.1159/000445170

Keep, R. F., Hua, Y. & Xi, G. Intracerebral haemorrhage: mechanisms of injury and therapeutic targets. Lancet Neurol. 11, 720–731 (2012). DOI: https://doi.org/10.1016/S1474-4422(12)70104-7

Aronowski, J. & Zhao, X. Molecular pathophysiology of cerebral hemorrhage: secondary brain injury. Stroke 42, 1781–1786 (2011). DOI: https://doi.org/10.1161/STROKEAHA.110.596718

Loan, J. J. et al. Secondary injury and inflammation after intracerebral haemorrhage: a systematic review and meta-analysis of molecular markers in patient brain tissue. J. Neurol. Neurosurg. Psychiatry 93, 126–132 (2022). DOI: https://doi.org/10.1136/jnnp-2021-327098

Maślińska, D. & Gajewski, M. Some aspects of the inflammatory process. Folia Neuropathol. 36, 199–204 (1998).

Gong, C., Hoff, J. T. & Keep, R. F. Acute inflammatory reaction following experimental intracerebral hemorrhage in rat. Brain Res. 871, 57–65 (2000). DOI: https://doi.org/10.1016/S0006-8993(00)02427-6

Puy, L. et al. Neutrophil extracellular traps (NETs) infiltrate haematoma and surrounding brain tissue after intracerebral haemorrhage: a post-mortem study. Neuropathol. Appl. Neurobiol. 47, 867–877 (2021). DOI: https://doi.org/10.1111/nan.12733

Papayannopoulos, V. Neutrophil extracellular traps in immunity and disease. Nat. Rev. Immunol. 18, 134–147 (2018). DOI: https://doi.org/10.1038/nri.2017.105

Lai, T. W., Zhang, S. & Wang, Y. T. Excitotoxicity and stroke: identifying novel targets for neuroprotection. Prog. Neurobiol. 115, 157–188 (2014). DOI: https://doi.org/10.1016/j.pneurobio.2013.11.006

Zhang, Y. et al. Modes of brain cell death following intracerebral hemorrhage. Front. Cell Neurosci. 16, 799753 (2022). DOI: https://doi.org/10.3389/fncel.2022.799753

Inaji, M. et al. Chronological changes of perihematomal edema of human intracerebral hematoma. Acta Neurochir. Suppl. 86, 445–448 (2003). DOI: https://doi.org/10.1007/978-3-7091-0651-8_91

Venkatasubramanian, C. et al. Natural history of perihematomal edema after intracerebral hemorrhage measured by serial magnetic resonance imaging. Stroke 42, 73–80 (2011). DOI: https://doi.org/10.1161/STROKEAHA.110.590646

Puy, L. et al. Brain peri-hematomal area, a strategic interface for blood clearance: a human neuropathological and transcriptomic study. Stroke 53, 2026–2035 (2022). DOI: https://doi.org/10.1161/STROKEAHA.121.037751

Schwartz, M. & Shechter, R. Systemic inflammatory cells fight off neurodegenerative disease. Nat. Rev. Neurol. 6, 405–410 (2010). DOI: https://doi.org/10.1038/nrneurol.2010.71

Schaer, D. J., Buehler, P. W., Alayash, A. I., Belcher, J. D. & Vercellotti, G. M. Hemolysis and free hemoglobin revisited: exploring hemoglobin and hemin scavengers as a novel class of therapeutic proteins. Blood 121, 1276–1284 (2013). DOI: https://doi.org/10.1182/blood-2012-11-451229

Wang, G., Wang, L., Sun, X.-G. & Tang, J. Haematoma scavenging in intracerebral haemorrhage: from mechanisms to the clinic. J. Cell Mol. Med. 22, 768–777 (2018). DOI: https://doi.org/10.1111/jcmm.13441

Hu, R. et al. Long-term outcomes and risk factors related to hydrocephalus after intracerebral hemorrhage. Transl Stroke Res. 12, 31–38 (2021). DOI: https://doi.org/10.1007/s12975-020-00823-y

Bu, Y. et al. Mechanisms of hydrocephalus after intraventricular haemorrhage in adults. Stroke Vasc. Neurol. 1, 23–27 (2016). DOI: https://doi.org/10.1136/svn-2015-000003

Uchida, K. et al. Clinical prediction rules to classify types of stroke at prehospital stage. Stroke 49, 1820–1827 (2018). DOI: https://doi.org/10.1161/STROKEAHA.118.021794

Fiebach, J. B. et al. Stroke magnetic resonance imaging is accurate in hyperacute intracerebral hemorrhage: a multicenter study on the validity of stroke imaging. Stroke 35, 502–506 (2004). DOI: https://doi.org/10.1161/01.STR.0000114203.75678.88

Kidwell, C. S. et al. Comparison of MRI and CT for detection of acute intracerebral hemorrhage. JAMA 292, 1823–1830 (2004). DOI: https://doi.org/10.1001/jama.292.15.1823

Leira, R. et al. Early neurologic deterioration in intracerebral hemorrhage: predictors and associated factors. Neurology 63, 461–467 (2004). DOI: https://doi.org/10.1212/01.WNL.0000133204.81153.AC

Frija, G. et al. How to improve access to medical imaging in low- and middle-income countries? EClinicalMedicine 38, 101034 (2021). DOI: https://doi.org/10.1016/j.eclinm.2021.101034

Kothari, R. U. et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27, 1304–1305 (1996). DOI: https://doi.org/10.1161/01.STR.27.8.1304

Schlunk, F. et al. Volumetric accuracy of different imaging modalities in acute intracerebral hemorrhage. BMC Med. Imaging 22, 9 (2022). DOI: https://doi.org/10.1186/s12880-022-00735-3

Morotti, A. et al. Intracerebral haemorrhage expansion: definitions, predictors, and prevention. Lancet Neurol. 22, 159–171 (2023). DOI: https://doi.org/10.1016/S1474-4422(22)00338-6

Dowlatshahi, D. et al. Predicting intracerebral hemorrhage growth with the spot sign: the effect of onset-to-scan time. Stroke 47, 695–700 (2016). DOI: https://doi.org/10.1161/STROKEAHA.115.012012

Boulouis, G., Morotti, A., Charidimou, A., Dowlatshahi, D. & Goldstein, J. N. Noncontrast computed tomography markers of intracerebral hemorrhage expansion. Stroke 48, 1120–1125 (2017). DOI: https://doi.org/10.1161/STROKEAHA.116.015062

Greenberg, S. M. et al. 2022 Guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke 53, e282–e361 (2022). DOI: https://doi.org/10.1161/STR.0000000000000407

Greenberg, S. M. et al. Cerebral microbleeds: a guide to detection and interpretation. Lancet Neurol. 8, 165–174 (2009). DOI: https://doi.org/10.1016/S1474-4422(09)70013-4

Shams, S. et al. SWI or T2*: which MRI sequence to use in the detection of cerebral microbleeds? The Karolinska imaging dementia study. AJNR Am. J. Neuroradiol. 36, 1089–1095 (2015). DOI: https://doi.org/10.3174/ajnr.A4248

Schmieder, R. E. End organ damage in hypertension. Dtsch. Arztebl Int. 107, 866–873 (2010). DOI: https://doi.org/10.3238/arztebl.2010.0866

Charidimou, A. et al. The Boston criteria version 2.0 for cerebral amyloid angiopathy: a multicentre, retrospective, MRI-neuropathology diagnostic accuracy study. Lancet Neurol. 21, 714–725 (2022).

Guidoux, C. et al. Amyloid angiopathy in brain hemorrhage: a postmortem neuropathological-magnetic resonance imaging study. Cerebrovasc. Dis. 45, 124–131 (2018). DOI: https://doi.org/10.1159/000486554

Carpenter, A. M., Singh, I. P., Gandhi, C. D. & Prestigiacomo, C. J. Genetic risk factors for spontaneous intracerebral haemorrhage. Nat. Rev. Neurol. 12, 40–49 (2016). DOI: https://doi.org/10.1038/nrneurol.2015.226

Falcone, G. J. & Woo, D. Genetics of spontaneous intracerebral hemorrhage. Stroke 48, 3420–3424 (2017). DOI: https://doi.org/10.1161/STROKEAHA.117.017072

Rost, N. S., Greenberg, S. M. & Rosand, J. The genetic architecture of intracerebral hemorrhage. Stroke 39, 2166–2173 (2008). DOI: https://doi.org/10.1161/STROKEAHA.107.501650

Published

01-03-2024

How to Cite

Faqih, M. A. M., Khairy, I. B. H. H., Alamrani, M. O. H., Kaabi, ‏Khaled B. N. A., Alamrani, ‏Atallah K. N., Mobarki, N. A., Al-Azmi, ‏Homood S. S., Alanazi, ‏Waleed H., Alhaisoni, Z. M., Alshareef, Y. M. Y., Aldawsari, ‏Mansour M., Almubadal, A. R., & Alanazi, F. T. H. (2024). Predictive factors for intracranial hemorrhage in patients with traumatic brain injury. International Journal of Health Sciences, 8(S1), 1908–1922. https://doi.org/10.53730/ijhs.v8nS1.15438

Issue

Vol. 8 No. S1 (2024)

Section

Peer Review Articles
Copyright & Licensing

Copyright (c) 2024 International journal of health sciences

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Articles published in the International Journal of Health Sciences (IJHS) are available under Creative Commons Attribution Non-Commercial No Derivatives Licence (CC BY-NC-ND 4.0). Authors retain copyright in their work and grant IJHS right of first publication under CC BY-NC-ND 4.0. Users have the right to read, download, copy, distribute, print, search, or link to the full texts of articles in this journal, and to use them for any other lawful purpose.

Articles published in IJHS can be copied, communicated and shared in their published form for non-commercial purposes provided full attribution is given to the author and the journal. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.

This copyright notice applies to articles published in IJHS volumes 4 onwards. Please read about the copyright notices for previous volumes under Journal History.

Crossref
Scopus
Google Scholar
Europe PMC

Most read articles by the same author(s)