Review Article

Molecular, Pathological, Clinical, and Therapeutic Aspects of Perihematomal Edema in Different Stages of Intracerebral Hemorrhage

Table 5

Clinical studies on the relationship between PHE and neurologic functions after ICH.

Quantitative methodsStudyDesignNo. of patientsFunctional outcome measuresImaging modalityMedian ICH volume on admission (mL)Time phase for PHE quantitationFindings

Absolute PHE volumeVolbers et al. [100]Retrospective29290-day mRSCT17.7Peak PHE volumeThe high peak volume of PHE was an independent predictor of the worse outcome on day 90.
Volbers et al. [20]Retrospective220mRS at dischargeCT22.8Within 12 hThe high peak PHE volume predicted a poor discharge outcome.
Ozdinc et al. [175]Retrospective10630-day mortalityCT2.14 vs. 18.73 for survivors and nonsurvivors within 30 d after ICH onsetOn days 1-12The absolute area of the perihematomal edema but not the absolute volume of the perihematomal edema was an independent indicator of mortality at 30 days.
Nawabi et al. [99]Retrospective81190-day mRSCT47Within 12 hAn increase in early PHE volume did not increase the probability of a poor outcome in OAC-ICH but was independently associated with poor outcomes in NON-OAC-ICH.
Shirazian et al. [176]Prospective1,08930-day mortality, 90-day mRSCT22.5Within 48 hThe absolute increase in PHE within 48 hours after ICH was associated with increased mortality and worse functional outcomes.
Appelboom et al. [177]Prospective133Discharge outcome (mRS)CTLess than 30Within 24 hThe effect of absolute PHE volume on functional outcome after ICH depended on the size of the hematoma, with only patients with smaller hemorrhages showing poorer results with worse PHE.
Loan et al. [178]Prospective342Death or dependence (mRS) one year after ICHCT48Within 3 daysThe high volume of perihematomal edema did not predict a poor outcome.

PHE growthLv et al. [179]Prospective2333-month mRSCT13.4From baseline to 24 hoursEarly expansion of PHE was associated with poor outcomes.
Ye et al. [116]Prospective19790-day mRSCT12.7From baseline to day 3An increase in PHE  mL from baseline to day 3 may lead to a poor outcome on day 90 after ICH.
Grunwald et al. [180]Retrospective11590-day mortality or poor functional outcome ()CT11.3 vs. 36.9 for patients with deep and lobar ICHFrom baseline to 24 h and 72 hPHE 72 hours was associated with poor functional outcomes after deep ICH, while PHE 24 hours was associated with mortality for deep and lobar ICH.
Urday et al. [109]Retrospective13990-day mRSCT19PHE expansion rate between admission and 24-hour post-ICHA faster PHE expansion rate 24 hours after ICH predicted a worse outcome.
Murthy et al. [181]Prospective59690-day mRSCT15Within a period of 6 to 72 hours after the onset of ICHThe absolute increase in PHE during the first 72 hours after ICH was associated with worse functional outcomes, particularly with basal ganglia ICH and  mL.
Hurford et al. [136]Prospective1,02890-day mRSCT13.7From onset to 72 hoursAn increase in EED in the first 72 hours was independently associated with decreased functional outcomes at 90 days.
Wu et al. [115]Prospective8616-month mortalityCT14The first 72 hoursA higher EED than expected was associated with mortality at 6 months.
Venkatasubramanian et al. [21]Prospective27Barthel index, mRS, and extended GCS scores at 3 monthsMRI33.6From admission to 48 hThe growth of edema volume was correlated with a decrease in neurologic status at 48 hours, but not with a functional outcome.

rPHE volumeSykora et al. [139]Prospective38Early neurologic deteriorationCT20.6348-72 h after ictusrPHE independently predicted early neurologic deterioration.
Arima et al. [138]Prospective270Death or dependency at 90 daysCTNAOn day 3Both absolute PHE and rPHE predicted death or dependency at 90 days.
Gebel et al. [182]Prospective14212-week mRS or 30-day mortalityCT12.2Within 3 hours after the onset of ICH and then 1 and 20 hours laterrPHE independently predicted a poor 3-month functional outcome.
Absolute edema volume predicted neither mortality nor functional outcome.
Staykov et al. [110]Retrospective219In-hospital mortalityCT35.7Increase in absolute PHE between days 1 and 3, initial rPHEAn increase in absolute PHE but not rPHE between days 1 and 3 was significantly predictive of in-hospital mortality.

Abbreviations: PHE: perihematomal edema; ICH: intracerebral hemorrhage; OAC: oral anticoagulant; NON-OAC-ICH: nonoral anticoagulation-related intracerebral hemorrhage; rPHE: relative perihematomal edema; EED: extension distance; mRS: modified Rankin scale; GCS: Glasgow Coma Scale; CT: computed tomography; MRI: magnetic resonance imaging.