nach oben

Neurocritical Care

Erschienen in:

22.05.2018 | Original Article

Prediction of Shunt Dependency After Intracerebral Hemorrhage and Intraventricular Hemorrhage

verfasst von: Lu-Ting Kuo, Hsueh-Yi Lu, Jui-Chang Tsai, Yong-Kwang Tu

Erschienen in: Neurocritical Care | Ausgabe 2/2018

Einloggen, um Zugang zu erhalten

Abstract

Background

Spontaneous intracerebral hemorrhage is a disease with high morbidity and mortality. Extension of the hemorrhage into the ventricles is associated with the development of acute hydrocephalus and a poor outcome. Although it can be managed by external ventricular drainage (EVD), a subset of these patients require placement of permanent ventricular shunts. This study aimed to examine the factors on admission that can predict shunt dependency after EVD management.

Methods

Seventy-two patients who underwent EVD were included in this study. Seventeen of these patients underwent placement of a ventriculoperitoneal shunt. Variables analyzed included age, intraventricular hemorrhage (IVH) score, bicaudate index, acute hydrocephalus, initial Glasgow Coma Scale scores, and blood volume in each ventricle.

Results

In univariate analysis, IVH score (p = 0.020), bicaudate index (p < 0.001), blood volume in lateral ventricles (p = 0.025), blood volume in the fourth ventricle (p = 0.038), and the ratio of blood volume in lateral ventricles to that in third and fourth ventricles (p = 0.003) were significantly associated with persistent hydrocephalus. The best multiple logistic regression model included blood volume parameters and bicaudate index as predictors with the area under a receiver operating characteristic curve of 0.849. The variance inflation factor (VIF) showed that collinearity was not found among predictors. Patients diagnosed with acute hydrocephalus had less blood volume in the lateral ventricles (OR = 0.910) and had more blood volume in the third ventricle (OR = 3.174) and fourth ventricle (OR = 2.126).

Conclusions

These findings may promote more aggressive monitoring and earlier interventions for persistent hydrocephalus after intraventricular hemorrhage in patients at risk.

Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Executive summary: heart disease and stroke statistics–2013 update: a report from the American Heart Association. Circulation. 2013;127(1):143–52.CrossRefPubMed

Leira R, Davalos A, Silva Y, Gil-Peralta A, Tejada J, Garcia M, Castillo J. Early neurologic deterioration in intracerebral hemorrhage: predictors and associated factors. Neurology. 2004;63(3):461–7.CrossRefPubMed

Tuhrim S, Horowitz DR, Sacher M, Godbold JH. Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage. Crit Care Med. 1999;27(3):617–21.CrossRefPubMed

Bhattathiri PS, Gregson B, Prasad KS, Mendelow AD. Intraventricular hemorrhage and hydrocephalus after spontaneous intracerebral hemorrhage: results from the STICH trial. Acta Neurochir Suppl. 2006;96:65–8.CrossRefPubMed

Hallevi H, Albright KC, Aronowski J, Barreto AD, Martin-Schild S, Khaja AM, Gonzales NR, Illoh K, Noser EA, Grotta JC. Intraventricular hemorrhage: anatomic relationships and clinical implications. Neurology. 2008;70(11):848–52.CrossRefPubMed

Diringer MN, Edwards DF, Zazulia AR. Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage. Stroke J Cereb Circ. 1998;29(7):1352–7.CrossRef

Juvela S. Risk factors for impaired outcome after spontaneous intracerebral hemorrhage. Arch Neurol. 1995;52(12):1193–200.CrossRefPubMed

Adams RE, Diringer MN. Response to external ventricular drainage in spontaneous intracerebral hemorrhage with hydrocephalus. Neurology. 1998;50(2):519–23.CrossRefPubMed

Engelhard HH, Andrews CO, Slavin KV, Charbel FT. Current management of intraventricular hemorrhage. Surg Neurol. 2003;60(1):15–21.CrossRefPubMed

10.

Findlay JM, Jacka MJ. Cohort study of intraventricular thrombolysis with recombinant tissue plasminogen activator for aneurysmal intraventricular hemorrhage. Neurosurgery. 2004;55(3):532–7.CrossRefPubMed

11.

Gaberel T, Magheru C, Parienti JJ, Huttner HB, Vivien D, Emery E. Intraventricular fibrinolysis versus external ventricular drainage alone in intraventricular hemorrhage: a meta-analysis. Stroke J Cereb Circ. 2011;42(10):2776–81.CrossRef

12.

Varelas PN, Rickert KL, Cusick J, Hacein-Bey L, Sinson G, Torbey M, Spanaki M, Gennarelli TA. Intraventricular hemorrhage after aneurysmal subarachnoid hemorrhage: pilot study of treatment with intraventricular tissue plasminogen activator. Neurosurgery. 2005;56(2):205–13.CrossRefPubMed

13.

Hallevi H, Dar NS, Barreto AD, Morales MM, Martin-Schild S, Abraham AT, Walker KC, Gonzales NR, Illoh K, Grotta JC, Savitz SI. The IVH score: a novel tool for estimating intraventricular hemorrhage volume: clinical and research implications. Crit Care Med. 2009;37(3):969–974, e961.CrossRefPubMedPubMedCentral

14.

van Gijn J, Hijdra A, Wijdicks EF, Vermeulen M, van Crevel H. Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurosurg. 1985;63(3):355–62.CrossRefPubMed

15.

Sezgin M, Sankur B. Survey over image thresholding techniques and quantitative performance evaluation. J Electron Imaging. 2004;13:146–68.CrossRef

16.

Liu CC, Tsai CY, Liu J, Yu CY, Yu SS. A pectoral muscle segmentation algorithm for digital mammograms using Otsu thresholding and multiple regression analysis. Comput Math Appl. 2012;64:1100–7.CrossRef

17.

Otsu N. A threshold selection method from gray-level histograms. IEEE Trans Syst Man Cybern. 1979;9:62–8.CrossRef

18.

Koch GG. Intraclass correlation coefficient. In: Kotz S, Johnson NL, editors. Encyclopedia of statistical sciences. 4th ed. New York: Wiley; 1982. p. 213–7.

19.

Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull. 1979;86(2):420–8.CrossRefPubMed

20.

Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3(1):32–5.CrossRefPubMed

21.

Hajian-Tilaki K. Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation. Caspian J Intern Med. 2013;4(2):627–35.PubMedPubMedCentral

22.

Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29–36. https://doi.org/10.1148/radiology.143.1.7063747.CrossRefPubMed

23.

Obuchowski NA. Receiver operating characteristic curves and their use in radiology. Radiology. 2003;229(1):3–8. https://doi.org/10.1148/radiol.2291010898.CrossRefPubMed

24.

Herrick DB, Ullman N, Nekoovaght-Tak S, Hanley DF, Awad I, LeDroux S, Thompson CB, Ziai WC. Determinants of external ventricular drain placement and associated outcomes in patients with spontaneous intraventricular hemorrhage. Neurocrit Care. 2014;21(3):426–34. https://doi.org/10.1007/s12028-014-9959-x.CrossRefPubMed

25.

Cheung RT, Zou LY. Use of the original, modified, or new intracerebral hemorrhage score to predict mortality and morbidity after intracerebral hemorrhage. Stroke J Cereb Circ. 2003;34(7):1717–22.CrossRef

26.

Zacharia BE, Vaughan KA, Hickman ZL, Bruce SS, Carpenter AM, Petersen NH, Deiner S, Badjatia N, Connolly ES Jr. Predictors of long-term shunt-dependent hydrocephalus in patients with intracerebral hemorrhage requiring emergency cerebrospinal fluid diversion. Neurosurg Focus. 2012;32(4):E5. https://doi.org/10.3171/2012.2.FOCUS11372.CrossRefPubMed

27.

Miller C, Tsivgoulis G, Nakaji P. Predictors of ventriculoperitoneal shunting after spontaneous intraparenchymal hemorrhage. Neurocrit Care. 2008;8(2):235–40. https://doi.org/10.1007/s12028-007-9018-y.CrossRefPubMed

28.

Rincon F, Gordon E, Starke RM, Buitrago MM, Fernandez A, Schmidt JM, Claassen J, Wartenberg KE, Frontera J, Seder DB, Palestrant D, Connolly ES, Lee K, Mayer SA, Badjatia N. Predictors of long-term shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage. Clinical article. J Neurosurg. 2010;113(4):774–80.CrossRefPubMed

29.

Staykov D, Kuramatsu JB, Bardutzky J, Volbers B, Gerner ST, Kloska SP, Doerfler A, Schwab S, Huttner HB. Efficacy and safety of combined intraventricular fibrinolysis with lumbar drainage for prevention of permanent shunt dependency after intracerebral hemorrhage with severe ventricular involvement: a randomized trial and individual patient data meta-analysis. Ann Neurol. 2017;81(1):93–103.CrossRefPubMed

30.

Kukuljan M, Kolic Z, Bonifacic D, Vukas D, Miletic D. Normal bicaudate index by aging. J Med Image Rev. 2009;5:72–4.CrossRef

31.

Hwang BY, Bruce SS, Appelboom G, Piazza MA, Carpenter AM, Gigante PR, Kellner CP, Ducruet AF, Kellner MA, Deb-Sen R, Vaughan KA, Meyers PM, Connolly ES Jr. Evaluation of intraventricular hemorrhage assessment methods for predicting outcome following intracerebral hemorrhage. J Neurosurg. 2012;116(1):185–92. https://doi.org/10.3171/2011.9.JNS10850.CrossRefPubMed

32.

Chen CC, Liu CL, Tung YN, Lee HC, Chuang HC, Lin SZ, Cho DY. Endoscopic surgery for intraventricular hemorrhage (IVH) caused by thalamic hemorrhage: comparisons of endoscopic surgery and external ventricular drainage (EVD) surgery. World Neurosurg. 2011;75(2):264–8.CrossRefPubMed

33.

Lodhia KR, Shakui P, Keep RF. Hydrocephalus in a rat model of intraventricular hemorrhage. Acta Neurochir Suppl. 2006;96:207–11.CrossRefPubMed

Titel: Prediction of Shunt Dependency After Intracerebral Hemorrhage and Intraventricular Hemorrhage
verfasst von: Lu-Ting Kuo
Hsueh-Yi Lu
Jui-Chang Tsai
Yong-Kwang Tu
Publikationsdatum: 22.05.2018
Verlag: Springer US
Erschienen in: Neurocritical Care / Ausgabe 2/2018
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-018-0532-x

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Neurologie

Akuter Schwindel: Wann lohnt sich eine MRT?

28.04.2024 Schwindel Nachrichten

Akuter Schwindel stellt oft eine diagnostische Herausforderung dar. Wie nützlich dabei eine MRT ist, hat eine Studie aus Finnland untersucht. Immerhin einer von sechs Patienten wurde mit akutem ischämischem Schlaganfall diagnostiziert.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Frühe Alzheimertherapie lohnt sich

25.04.2024 AAN-Jahrestagung 2024 Nachrichten

Ist die Tau-Last noch gering, scheint der Vorteil von Lecanemab besonders groß zu sein. Und beginnen Erkrankte verzögert mit der Behandlung, erreichen sie nicht mehr die kognitive Leistung wie bei einem früheren Start. Darauf deuten neue Analysen der Phase-3-Studie Clarity AD.

Viel Bewegung in der Parkinsonforschung

25.04.2024 Parkinson-Krankheit Nachrichten

Neue arznei- und zellbasierte Ansätze, Frühdiagnose mit Bewegungssensoren, Rückenmarkstimulation gegen Gehblockaden – in der Parkinsonforschung tut sich einiges. Auf dem Deutschen Parkinsonkongress ging es auch viel um technische Innovationen.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Background

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2018

The Use of Continuous EEG Monitoring in Intensive Care Units in The Netherlands: A National Survey

A Promising New Noninvasive Measure of Cerebrovascular Reactivity: Not Yet Cerebral Autoregulation

Spontaneous Elevation of Blood Pressure After SAH: An Epiphenomenon of Disease Severity and Demand, But Not a Surrogate for Outcome?

Influence of Bleeding Pattern on Ischemic Lesions After Spontaneous Hypertensive Intracerebral Hemorrhage with Intraventricular Hemorrhage

Clinical Characteristics and Prognosis of Severe Anti-N-methyl-d-aspartate Receptor Encephalitis Patients