Abstract Details

Title Surveillance Neuroimaging and Neurologic Examinations Influence Management after Intracerebral Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S12 - (-)

Poster/Presentation
Number 005

Objective

Background The value of routinely performing serial neuroimaging and neurologic examinations to monitor patients after ICH is unknown. US and European guidelines only address imaging for purposes of diagnosis and determining etiology. We tested the hypothesis that a structured surveillance protocol of serial neuroimaging and neurological examinations identified clinical changes requiring emergent surgical interventions.

Design/Methods Patients with primary ICH were enrolled into a prospective registry between December 2006 and July 2012. Patients were managed in a dedicated neuroscience intensive care unit with a protocol that included routine serial neuroimaging at 6, 24 and 48 hours, and hourly serial neurologic examinations using the Glasgow Coma Scale and National Institutes of Health Stroke Scale. We evaluated all cases of craniotomy and ventriculostomy to determine whether the procedure was part of the initial management plan or was unplanned in the initial management. For those that were unplanned, we determined worsening on neurologic examination or worsened neuroimaging findings initiated the process leading to intervention.

Results 239 patients were studied. There were 88 surgical interventions in 84 patients (35%), including ventriculostomy in 52 (59%), craniotomy in 21 (24%) and both in 11 (13%). Of the 88 interventions, 24 (27%) occurred subsequently and distinctly from initial management, a median of 15.9 hr [8.9-27.0 hr] after symptom onset. Thirteen (54%) were instigated by findings on neurologic examination and 11 (46%) by neuroimaging. Demographics, severity of hemorrhage and location of hemorrhage were not associated with delayed intervention.

Conclusions Over 25% of surgical interventions performed after ICH were distinct from the initial management plan, and prompted by delayed imaging or clinical findings. Serial neurologic examinations and serial neuroimaging are both important and effective surveillance techniques for monitoring patients with ICH.

Authors/Disclosures
Matthew Maas, MD, FAAN (Northwestern University) PRESENTER	The institution of Dr. Maas has received research support from National Institutes of Health.
Neil Rosenberg, MD (Rosenberg Medical, PLLC)	Dr. Rosenberg has nothing to disclose.
	No disclosure on file
Florian P. Thomas, MD, PhD, MA, FAAN (Hackensack Meridian Health)	Dr. Thomas has received personal compensation for serving as an employee of Hackensack Meridian Health. Dr. Thomas has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Pharnext. Dr. Thomas has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Journal of Spinal Cord Medicine. Dr. Thomas has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Gravel & Shae. The institution of Dr. Thomas has received research support from University of Pennsylavania. Dr. Thomas has a non-compensated relationship as a Board Member, Metro New Jersey with National MS Society that is relevant to AAN interests or activities. Dr. Thomas has a non-compensated relationship as a Board Member with American Paraplegia Society that is relevant to AAN interests or activities.
	No disclosure on file
James Guth, MD	No disclosure on file
Eric Liotta, MD (Northwestern University)	Dr. Liotta has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Penumbra. The institution of Dr. Liotta has received research support from NIH-NINDS.
Shyam Prabhakaran, MD (University of Chicago)	Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. The institution of Dr. Prabhakaran has received research support from NIH . The institution of Dr. Prabhakaran has received research support from AHRQ. Dr. Prabhakaran has received publishing royalties from a publication relating to health care.
Andrew M. Naidech, MD, FAAN (Department of Neurology)	The institution of Dr. Naidech has received research support from NIH. Dr. Naidech has received publishing royalties from a publication relating to health care.

��ɫ��

��ɫ��