Automatic Detection and Classification of Cerebral Microbleeds Using 3D CNN.

Cerebral Microbleeds (CMBs) are referred to tiny foci of hemorrhage in brain parenchyma which are smaller than 5 (to 10) mm in size. The presence of CMBs is implicated in pathophysiology of cognitive impairment, dementia, radiation-induced vascular injury, traumatic brain injury, hypertensive microangiopathy, and aging. On brain Magnetic Resonance Imaging (MRI) scans, CMBs appear as hypointense foci, most notable on T2*-weighted or Susceptibility-Weighted Imaging (SWI).

Association Between Cerebral Amyloid Angiopathy and Nontraumatic Subdural Hemorrhage.

Background And Objectives: Cerebral amyloid angiopathy (CAA) is a common cause of intracerebral hemorrhage (ICH) in older patients. Whether CAA is associated with isolated subdural hemorrhage (SDH), without an accompanying ICH, remains unclear. We, therefore, tested this relationship in a large, heterogeneous sample of patients across the United States.

Prevalence of Cerebral Amyloid Angiopathy and Associated Risk of Subsequent Ischemic and Hemorrhagic Stroke and Mortality in a Nationwide Cohort.

Objective: There are limited population-based data regarding the prevalence of cerebral amyloid angiopathy (CAA) and associated risks of mortality and incident cerebrovascular events.

Methods: We performed a retrospective cohort study using inpatient and outpatient claims from 2008 to 2022 from a 5% national sample of Medicare beneficiaries. CAA and ischemic and hemorrhagic stroke were identified using validated International Classification of Diseases 10th Revision (ICD-10) codes.

Outcomes Following Minimally Invasive Surgery for Intracerebral Hemorrhage in the AHA Get With The Guidelines-Stroke Registry.

Background: The efficacy of minimally invasive surgery (MIS) in improving outcomes after nontraumatic intracerebral hemorrhage (ICH) remains uncertain, with inconsistent findings from randomized clinical trials. Our objective was to evaluate the real-world impact of MIS on ICH outcomes using a nationally representative cohort.

Methods: We performed a retrospective cohort study of patients with a nontraumatic ICH enrolled in the American Heart Association Get With The Guidelines-Stroke Registry between January 1, 2011, and December 31, 2021.

Optimizing Automated Hematoma Expansion Classification from Baseline and Follow-Up Head Computed Tomography.

Hematoma expansion (HE) is an independent predictor of poor outcomes and a modifiable treatment target in intracerebral hemorrhage (ICH). Evaluating HE in large datasets requires segmentation of hematomas on admission and follow-up CT scans, a process that is time-consuming and labor-intensive in large-scale studies. Automated segmentation of hematomas can expedite this process; however, cumulative errors from segmentation on admission and follow-up scans can hamper accurate HE classification.

Optimal Magnitude of Blood Pressure Reduction and Hematoma Growth and Functional Outcomes in Intracerebral Hemorrhage.

Background And Objectives: Early intensive systolic blood pressure (SBP) reduction is a promising strategy for intracerebral hemorrhage (ICH), but the optimal magnitude of reduction in the first 2 hours remains uncertain. This study aimed to determine the optimal SBP reduction magnitude to maximize benefit in patients enrolled in the Antihypertensive Treatment of Acute Cerebral Hemorrhage 2 (ATACH-2) trial.

Methods: We performed a post hoc analysis of the ATACH-2 trial.

Nontraumatic Intracranial Hemorrhage and Risk of Incident Dementia in US Medicare Beneficiaries.

Background: To study the risk of incident dementia after a nontraumatic intracranial hemorrhage in a diverse US population and evaluate whether this risk is different for the subtypes of intracranial hemorrhage.

Methods: We performed a retrospective cohort study using both inpatient and outpatient claims data on a 5% sample of Medicare beneficiaries per year between January 1, 2008 and December 31, 2018. The exposure was a new diagnosis of nontraumatic intracranial hemorrhage, defined as a composite of intracerebral hemorrhage, subarachnoid hemorrhage, and subdural hemorrhage.

Improving the Robustness of Deep Learning Models in Predicting Hematoma Expansion from Admission Head CT.

Background And Purpose: Robustness against input data perturbations is essential for deploying deep learning models in clinical practice. Adversarial attacks involve subtle, voxel-level manipulations of scans to increase deep learning models' prediction errors. Testing deep learning model performance on examples of adversarial images provides a measure of robustness, and including adversarial images in the training set can improve the model's robustness.

Machine Learning Models for 3-Month Outcome Prediction Using Radiomics of Intracerebral Hemorrhage and Perihematomal Edema from Admission Head Computed Tomography (CT).

: Intracerebral hemorrhages (ICH) and perihematomal edema (PHE) are respective imaging markers of primary and secondary brain injury in hemorrhagic stroke. In this study, we explored the potential added value of PHE radiomic features for prognostication in ICH patients. : Using a multicentric trial cohort of acute supratentorial ICH ( = 852) patients, we extracted radiomic features from ICH and PHE lesions on admission non-contrast head CTs.

Ischemic stroke prevention in patients with atrial fibrillation and a recent ischemic stroke, TIA, or intracranial hemorrhage: A World Stroke Organization (WSO) scientific statement.

Background: Secondary stroke prevention in patients with atrial fibrillation (AF) is one of the fastest growing areas in the field of cerebrovascular diseases. This scientific statement from the World Stroke Organization Brain & Heart Task Force provides a critical analysis of the strength of current evidence on this topic, highlights areas of current controversy, identifies knowledge gaps, and proposes priorities for future research.

Methods: We select topics with the highest clinical relevance and perform a systematic search to answer specific practical questions.

Association between elevated fibrosis-4 index of liver fibrosis and risk of hemorrhagic stroke.

Background: Cirrhosis is associated with an increased risk of hemorrhagic stroke. Liver fibrosis, typically a silent condition, is antecedent to cirrhosis. The objective of this study was to test the hypothesis that elevated Fibrosis-4 (FIB-4) index, indicating a high probability of liver fibrosis, is associated with an increased risk of hemorrhagic stroke.

Emergent Management of Intracerebral Hemorrhage.

Objective: Nontraumatic intracerebral hemorrhage (ICH) is a potentially devastating cerebrovascular disorder. Several randomized trials have assessed interventions to improve ICH outcomes. This article summarizes some of the recent developments in the emergent medical and surgical management of acute ICH.

Association Between Hematoma Volume and Risk of Subsequent Ischemic Stroke: A MISTIE III and ATACH-2 Analysis.

Background: Nontraumatic intracerebral hemorrhage (ICH) is independently associated with a long-term increased risk of major arterial ischemic events. While the relationship between ICH location and ischemic risk has been studied, whether hematoma volume influences this risk is poorly understood.

Methods: We pooled individual patient data from the MISTIE III (Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation Phase 3) and the ATACH-2 (Antihypertensive Treatment of Acute Cerebral Hemorrhage-2) trials.

Cerebral Amyloid Angiopathy and Risk of Isolated Nontraumatic Subdural Hemorrhage.

Importance: Cerebral amyloid angiopathy (CAA) is a common cause of spontaneous intracerebral hemorrhage in older patients. Although other types of intracranial hemorrhage can occur in conjunction with CAA-related intracerebral hemorrhage, the association between CAA and other subtypes of intracranial hemorrhage, particularly in the absence of intracerebral hemorrhage, remains poorly understood.

Objective: To determine whether CAA is an independent risk factor for isolated nontraumatic subdural hemorrhage (SDH).

Mechanistic Evaluation of Diffusion Weighted Hyperintense Lesions After Large Spontaneous Intracerebral Hemorrhage: A Subgroup Analysis of MISTIE III.

Background: Ischemic lesions on diffusion weighted imaging (DWI) are common after acute spontaneous intracerebral hemorrhage (ICH) but are poorly understood for large ICH volumes (> 30 mL). We hypothesized that large blood pressure drops and effect modification by cerebral small vessel disease markers on magnetic resonance imaging (MRI) are associated with DWI lesions.

Methods: This was an exploratory analysis of participants in the Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation phase 3 trial with protocolized brain MRI scans within 7 days from ICH.

Antiplatelet therapy and outcomes after aneurysmal subarachnoid hemorrhage: A systematic review and meta-analysis.

Background: The efficacy of antiplatelet therapy (APT) after aneurysmal subarachnoid hemorrhage (aSAH) remains unclear. We performed a systematic review and meta-analysis to summarize the associations of APT use after aSAH with outcomes.

Methods: We searched published medical literature to identify cohort studies involving adults with aSAH.