Introduction: Perihematomal edema (PHE) is a well-established sequelae of intracerebral hemorrhage (ICH), but its pathophysiology and natural history are poorly understood. We sought to determine whether PHE volume varies according to ICH location.

Methods: Consecutive patients with spontaneous ICH who presented to a single institution between 2011 and 2012 were included in this retrospective analysis. Available CT scans were categorized according to time since ICH onset (admission, 24 hours, 72 hours, 4-7 days, and 8-14 days). Absolute PHE volume was measured on each CT image using BrainLAB semi-automated volumetric analysis software. Patients were stratified into three groups according to ICH location (cortical, deep [basal ganglia/thalamus], or cerebellar). Brainstem hemorrhages were excluded, as the sample size was too small to draw generalizable conclusions about PHE in this location. One-way analysis of variance was performed at each time point to compare absolute PHE volume by location.

Results: One-hundred ten consecutive patients with 222 CT scans were identified. Four patients with brainstem ICH were excluded. Of the remaining patients, hemorrhage location was cortical in 25 (23.6%), deep in 72 (67.9%) and cerebellar in 9 (8.5%). At admission, absolute PHE volume was greater in patients with cortical bleeds than in those with deep or cerebellar bleeds, and this difference trended towards but did not reach statistical significance (p=0.112). At all other time points, PHE volume did not differ significantly according to hemorrhage location (p=0.477, 0.733, 0.823, and 0.893 at 24h, 72h, 4-7d, and 8-14d, respectively).

Conclusions: Although limited by small sample size and inconsistent availability of post-ICH CT scans, this data suggests that absolute PHE volume does not vary significantly according to hemorrhage location. The comparatively greater PHE volume observed at admission in patients with cortical ICH is likely due to delayed presentation relative to patients with deep or cerebellar hemorrhages.

Patient Care: The ability to more reliably predict PHE volume would allow for improved prognostication and more informed management decisions in patients with ICH.

Learning Objectives: By the conclusion of this session, participants should be able to describe how PHE volume varies according to hemorrhage location in patients with ICH.

References: Venkatasubramanian, Chitra, Michael Mlynash, Anna Finley-Caulfield, Irina Eyngorn, Rajalakshmi Kalimuthu, R W Snider, and Christine Anne Wijman. 2011. “Natural history of perihematomal edema after intracerebral hemorrhage measured by serial magnetic resonance imaging..” Stroke; a journal of cerebral circulation 42(1): 73–80. Zazulia, A R, M N Diringer, C P Derdeyn, and W J Powers. 1999. “Progression of mass effect after intracerebral hemorrhage..” Stroke; a journal of cerebral circulation 30(6): 1167–1173.