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CSF-Based Volumetric Imaging Biomarkers Highlight Incidence and Risk Factors for Cerebral Edema After Ischemic Stroke

Overview
Journal Neurocrit Care
Specialty Critical Care
Date 2023 May 15
PMID 37188885
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Abstract

Background: Cerebral edema has primarily been studied using midline shift or clinical deterioration as end points, which only captures the severe and delayed manifestations of a process affecting many patients with stroke. Quantitative imaging biomarkers that measure edema severity across the entire spectrum could improve its early detection, as well as identify relevant mediators of this important stroke complication.

Methods: We applied an automated image analysis pipeline to measure the displacement of cerebrospinal fluid (ΔCSF) and the ratio of lesional versus contralateral hemispheric cerebrospinal fluid (CSF) volume (CSF ratio) in a cohort of 935 patients with hemispheric stroke with follow-up computed tomography scans taken a median of 26 h (interquartile range 24-31) after stroke onset. We determined diagnostic thresholds based on comparison to those without any visible edema. We modeled baseline clinical and radiographic variables against each edema biomarker and assessed how each biomarker was associated with stroke outcome (modified Rankin Scale at 90 days).

Results: The displacement of CSF and CSF ratio were correlated with midline shift (r = 0.52 and - 0.74, p < 0.0001) but exhibited broader ranges. A ΔCSF of greater than 14% or a CSF ratio below 0.90 identified those with visible edema: more than half of the patients with stroke met these criteria, compared with only 14% who had midline shift at 24 h. Predictors of edema across all biomarkers included a higher National Institutes of Health Stroke Scale score, a lower Alberta Stroke Program Early CT score, and lower baseline CSF volume. A history of hypertension and diabetes (but not acute hyperglycemia) predicted greater ΔCSF but not midline shift. Both ΔCSF and a lower CSF ratio were associated with worse outcome, adjusting for age, National Institutes of Health Stroke Scale score, and Alberta Stroke Program Early CT score (odds ratio 1.7, 95% confidence interval 1.3-2.2 per 21% ΔCSF).

Conclusions: Cerebral edema can be measured in a majority of patients with stroke on follow-up computed tomography using volumetric biomarkers evaluating CSF shifts, including in many without visible midline shift. Edema formation is influenced by clinical and radiographic stroke severity but also by chronic vascular risk factors and contributes to worse stroke outcomes.

Citing Articles

The Blood-Cerebrospinal Fluid Barrier Dysfunction in Brain Disorders and Stroke: Why, How, What For?.

Mathias K, Machado R, Cardoso T, Tiscoski A, Piacentini N, Prophiro J Neuromolecular Med. 2024; 26(1):38.

PMID: 39278883 DOI: 10.1007/s12017-024-08806-0.

References
1.
Simard J, Kent T, Chen M, Tarasov K, Gerzanich V . Brain oedema in focal ischaemia: molecular pathophysiology and theoretical implications. Lancet Neurol. 2007; 6(3):258-68. PMC: 2725365. DOI: 10.1016/S1474-4422(07)70055-8. View

2.
Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R . 'Malignant' middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol. 1996; 53(4):309-15. DOI: 10.1001/archneur.1996.00550040037012. View

3.
Battey T, Karki M, Singhal A, Wu O, Sadaghiani S, Campbell B . Brain edema predicts outcome after nonlacunar ischemic stroke. Stroke. 2014; 45(12):3643-8. PMC: 4295905. DOI: 10.1161/STROKEAHA.114.006884. View

4.
Dhar R . Automated quantitative assessment of cerebral edema after ischemic stroke using CSF volumetrics. Neurosci Lett. 2020; 724:134879. PMC: 7179744. DOI: 10.1016/j.neulet.2020.134879. View

5.
Kimberly W, Battey T, Wu O, Singhal A, Campbell B, Davis S . Novel Imaging Markers of Ischemic Cerebral Edema and Its Association with Neurological Outcome. Acta Neurochir Suppl. 2015; 121:223-6. DOI: 10.1007/978-3-319-18497-5_40. View