ARTICLE Peak perihemorrhagic edema correlates with functional outcome in intracerebral hemorrhage Bastian Volbers, MD, Antje Giede-Jeppe, MD, Stefan T. Gerner, MD, Jochen A. Sembill, MD, Joji B. Kuramatsu, MD, Stefan Lang, MD, Hannes L¨ ucking, MD, Dimitre Staykov, MD, and Hagen B. Huttner, MD, PhD Neurology® 2018;90:e1005-e1012. doi:10.1212/WNL.0000000000005167 Correspondence Dr. Volbers bastian.volbers@gmx.net Abstract Objective To evaluate the association of perihemorrhagic edema (PHE) evolution and peak edema extent with day 90 functional outcome in patients with intracerebral hemorrhage (ICH) and identify pathophysiologic factors influencing edema evolution. Methods This retrospective cohort study included patients with spontaneous supratentorial ICH be- tween January 2006 and January 2014. ICH and PHE volumes were studied using a validated semiautomatic volumetric algorithm. Multivariable logistic regression and propensity score matching (PSM) accounting for age, ICH volume, and location were used for assessing measures associated with functional outcome and PHE evolution. Clinical outcome on day 90 was assessed using the modified Rankin Scale (0–3 = favorable, 4–6 = poor). Results A total of 292 patients were included. Median age was 70 years (interquartile range [IQR] 62–78), median ICH volume on admission 17.7 mL (IQR 7.9–40.2). Besides established factors for functional outcome, i.e., ICH volume and location, age, intraventricular hemorrhage, and NIH Stroke Scale score on admission, multivariable logistic regression revealed peak PHE volume (odds ratio [OR] 0.984 [95% confidence interval (CI) 0.973–0.994]) as an in- dependent predictor of day 90 outcome. Peak PHE volume was independently associated with initial PHE increase up to day 3 (OR 1.060 [95% CI 1.018–1.103]) and neutrophil to lymphocyte ratio on day 6 (OR 1.236 [95% CI 1.034–1.477; PSM cohort, n = 124]). Initial PHE increase (PSM cohort, n = 224) was independently related to hematoma expansion (OR 3.647 [95% CI 1.533–8.679]) and fever burden on days 2–3 (OR 1.456 [95% CI 1.103–1.920]). Conclusion Our findings suggest that peak PHE volume represents an independent predictor of functional outcome after ICH. Inflammatory processes and hematoma expansion seem to be involved in PHE evolution and may represent important treatment targets. From the Neurological Department (B.V., A.G.-J., S.T.G., J.A.S., J.B.K., D.S., H.B.H.) and Neuroradiological Department (S.L., H.L.), University of Erlangen-Nuremberg, Germany; Department of Neurology (D.S.), Hospital of the Brothers of St. John, Eisenstadt, Austria; and Department of Neurology (B.V.), Inselspital, University Hospital of Bern, Switzerland. Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article. Copyright © 2018 American Academy of Neurology e1005 Copyright ª 2018 American Academy of Neurology. Unauthorized reproduction of this article is prohibited. source: https://doi.org/10.7892/boris.111844 | downloaded: 18.6.2020