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Related Concept Videos

Hemorrhagic Stroke l: Introduction01:17

Hemorrhagic Stroke l: Introduction

A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
Hemorrhagic Stroke ll: Pathophysiology01:29

Hemorrhagic Stroke ll: Pathophysiology

A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
Cerebral Edema ll: Pathophysiology01:22

Cerebral Edema ll: Pathophysiology

Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...
Increased Intracranial Pressure l: Introduction01:14

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
Increased Intracranial Pressure ll: Pathophysiology01:29

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...

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Related Experiment Video

Updated: May 8, 2026

Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
09:01

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Published on: October 15, 2021

Outcome-defining Hematoma Expansion in Intracerebral Hemorrhage: A CT-based Risk Stratification Study.

Huiming Li1, Yu Cai1, Yuefen Li2

  • 1Department of Radiology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu, China (H.L., Y.C., Y.C., C.L.).

Academic Radiology
|May 6, 2026
PubMed
Summary

Hematoma expansion in spontaneous intracerebral hemorrhage is heterogeneous. A new CT-based model accurately predicts high-risk expansion, enabling targeted patient stratification for better outcomes.

Keywords:
Computed tomographyHematoma expansionIntracerebral hemorrhageRadiomicsRisk stratification

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Area of Science:

  • Neurology
  • Radiology
  • Medical Imaging

Background:

  • Hematoma expansion (HE) significantly impacts outcomes in spontaneous intracerebral hemorrhage (sICH).
  • Current targeted therapies for HE have shown limited efficacy.
  • Predicting outcome-defining expansion is crucial for clinical management.

Purpose of the Study:

  • To predict threshold-crossing hematoma expansion in sICH.
  • To develop a clinically actionable risk stratification framework for HE.
  • To differentiate between HE and severe HE (sHE) for outcome prediction.

Main Methods:

  • Retrospective analysis of 407 patients with small-to-moderate baseline hematomas.
  • Development and comparison of three predictive models: radiomics-only (R), radiomics-imaging (RI), and integrated radiomics-imaging-clinical (RI-CL).
  • Model performance evaluated using Area Under the Receiver Operating Characteristic Curve (AUC); risk stratification derived from the optimal sHE model using SHapley Additive exPlanations (SHAP).

Main Results:

  • The integrated RI-CL model showed superior performance for predicting HE (AUC=0.768) and sHE (AUC=0.723) on the test set.
  • Key predictors identified by SHAP analysis included basal ganglia involvement, irregular hematoma shape, and lymphocyte percentage.
  • Risk stratification revealed a significant gradient in sHE incidence (5.2% in low-risk to 27.6% in high-risk groups), with all high-risk expansion events being clinically malignant.

Conclusions:

  • Hematoma expansion in sICH is clinically heterogeneous, with threshold-crossing expansion driving malignant outcomes.
  • A multimodal CT-based model effectively estimates the risk of clinically significant hematoma expansion.
  • The developed risk stratification system identifies patients at the highest risk for outcome-defining expansion, facilitating targeted interventions.