Cerebrospinal venous anatomy and hemodynamics changes are associated with many central nervous system disorders. The aim of this study was to detect whether perihematomal edema (PHE) after spontaneous intracerebral hemorrhage (sICH) is associated with cerebral venous outflow volume (CVFV) in the internal jugular veins and vertebral veins.
Spontaneous intracerebral hemorrhage (sICH) is a serious cerebrovascular disease and is associated with a poor prognosis. The mortality and morbidity of sICH have been associated with early hematoma expansion, reduction in cerebral perfusion pressure, and raised intracranial pressure (ICP).
Cerebral venous outflow and perihematomal edema
Newly diagnosed cases of sICH between April 2016 and March 2017 were enrolled and patients were grouped to the mean value of PHE according to previous study. On computed tomography, absolute PHE volume was calculated as the difference between total lesion volume and intracerebral hemorrhage (ICH) volume.
Relative PHE volume was defined as absolute PHE volume divided by ICH volume. CVFV was determined by Doppler ultrasound. Patients were divided according to mean values of absolute PHE at 3 and 12 days, and relative PHE (rPHE) at 3 and 12 days.
Significant differences were observed in smoking, alcohol consumption, glycosylated hemoglobin (GHb), secondary intraventricular hemorrhage (sIVH), and CVFV in PHE at 72 hours.
Only sIVH and CVFV were significantly different at 12 days in PHE. In rPHE, GHb and sIVH were significantly differed at 72 hours. No significant difference was observed at 12 days in rPHE.
The multivariate analyses showed that CVFV was independently associated with late PHE (PHE at 12 ± 3 days) but not with early PHE (PHE at 72 hours) and rPHE. These results suggest that CVFV may be closely related to PHE after sICH.
This study had some limitations. First the number of patients was small. Secondly, the patients had a relatively small amount of hematoma volume. Thirdly, this was a cross-sectional study and no follow-up was conducted to examine the prognosis of the patients.
Finally, doubts have been raised about the use of color Doppler ultrasound to determine CVFV, but no study directly compared this method against more robust blood flow measurement methods in the context of PHE.
Nevertheless, ultrasound is an inexpensive and easily accessible technique, and a number of studies reached valuable conclusions based on this technique. Additional studies are still necessary to examine the factors contributing to PHE in ICH, as well as the prognosis of the patients.