HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

Correspondence to:

ARTICLES: R. Leira, A. Dávalos, Y. Silva, A. Gil-Peralta, J. Tejada, M. Garcia, and J. Castillo Early neurologic deterioration in intracerebral hemorrhage: Predictors and associated factors Neurology 2004; 63: 461-467 [Abstract] [Full text] [PDF]

Correspondence: Submit a response to this article

Correspondence published:

Reply to Godoy et al

Rogelio Leira, J. Castillo   (19 October 2004)

Early neurologic deterioration in intracerebral hemorrhage: Predictors and associated factors

Daniel A Godoy, MD, Andres Boccio   (19 October 2004)

Reply to Godoy et al 19 October 2004
Rogelio Leira, Neurology Department Hospital Clínico, Universitario de Santiago, SPAIN, J. Castillo Send Correspondence to journal: Re: Reply to Godoy et al rleiram{at}meditex.es Rogelio Leira, et al.	We thank Godoy and Bocco for their interest in our article. We agree with the comments about the presence of inflammatory response in acute intracerebral hemorrhage. We published an article on the role of inflammation and excitotoxicity in acute intracerebral hemorrhage. [1] Our results showed that high plasma levels of proinflammatory molecules within 24 hours of intracerebral hemorrhage onset correlated with the magnitude of the subsequent perihematoma brain edema, whereas poor neurologic outcome and the volume of the residual cavity were related to increased plasma glutamate levels. Results of molecular inflammatory markers of the current study will be published next month in Stroke. [2] Reference 1) Castillo J, Davalos A, Alvarez-Sabin J, et al. Molecular signatures of brain injury after intracerebral hemorrhage. Neurology 2002;58:624-629. 2) Silva Y, Leira R, Tejada J, Lainez JM, Castillo J, Dávalos A. Molecular signatures of vascular injury are associated with early growth of intracerebral hemorrhage. by the Stroke Project, Cerebrovascular Diseases Group of the Spanish Neurological Society. Stroke (in press).
Early neurologic deterioration in intracerebral hemorrhage: Predictors and associated factors 19 October 2004
Daniel A Godoy, MD, Neurocritical Care Rivadavia 66 Piso 2 Dep 3 , 6000 Junin, Buenos Aires, Argentina, Andres Boccio Send Correspondence to journal: Re: Early neurologic deterioration in intracerebral hemorrhage: Predictors and associated factors godoyjunin{at}hotmail.com Daniel A Godoy, MD, et al.	In the study by Leira et al [1], the authors attempt to identify predictors associated with early neurologic deterioration in patients with spontaneous intracerebral hemorrhage (SICH). The presence of neurologic deterioration in 22.9% of the population was defined as a decrease of one point or more on the Canadian Stroke Scale. Through logistical regression analysis, independent deterioration variables were identified at admission: temperature > 37.5 °C, neutrophil count increase and fibrinogen levels > 523mg/dl, whereas predictors of deterioration at 48 hours were:hematoma growth, intraventricular bleeding and high systolic blood pressure. Systemic Inflammatory Response Syndrome (SIRS) is a well-know phenomenon that follow various types of insults infectious and non infectious. [2] We published a series of 62 patients with SICH to establish the incidence of SIRS including: moment of apparition, factors associated with its development, relationship with validated prognosis predictors, and the outcome valued through mortality at 30 days of the ictus. 53.2% of the population presented SIRS, mostly (82%) within the first 72 hours upon admission. In this subgroup, with the intent to determine causes,55.5% presented SIRS associated with neurologic deterioration, defined by a two or more points decreased on the Glasgow Coma Scale(GCS). The others causes of SIRS were: gravity of initial insult (33.3%), sepsis (7.4%) and unknown (3.7%). On the other hand, SIRS was correlated to a lesser punctuation on the GCS (p<0.001), higher hematoma volumes (p<0.01), ventricular bleeding(p<0.005) and mortality at 30 days (p<0.005). Subarachnoid hemorrhage and ischemic stroke are entities know to produce an inflammatory reponse with an increase of white blood count in peripheral blood as well as an increase in body core temperature. [4-5] There is still little known about such response in SICH. There is growing evidence that inflammation has a major role in the pathophysiology of this disease. In spite of the limitations of our study, we believed that our data may contribute to the development of well-designed studies clarifying the obscure panorama of a very invalidating and high mortality disease. References 1. Leira R, Davalos A, Silva Y, et al. Early neurologic deterioration in intracerebral hemorrhage . Predictors and associated factors. Neurology 2004;63:461–467. 2. American College of Chest Physician / Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992;20:864–874. 3. Godoy D, Boccio A, Nafissi H. Systemic Inflammatory Response Syndrome and primary or spontaneous intracerebral hemorrhage.Rev Neurol 2002;35:1101–1105 (Spanish). 4. Yoshimoto Y, Tanaka Y, Hoya K.Acute inflammatory response syndrome in subarachnoid hemorrhage. Stroke 2001;32:1989–1993. 5. Boysen G, Christensen H. Stroke severity determines body temperature in acute stroke. Stroke 2001;32:413–417.