Insufficient cerebral venous drainage in patients with acute intracerebral hemorrhage (ICH) is strongly associated with large relative perihematomal edema (PHE) volume at 24 hours after the acute event, according to study results published in Neurology.

Previous studies have demonstrated the important role of the venous system in cerebral hemodynamics, and a recent study described a strong association between jugular venous reflux with PHE volume after ICH. Researchers hypothesized that ipsilateral cerebral venous drainage might be disrupted after ICH, leading to PHE. This study explored the association between absent ipsilateral venous filling and the development of relative PHE in patients with acute ICH.

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The study cohort included 138 patients (mean age 63±13 years, 29.0% women) with acute spontaneous supratentorial ICH who underwent baseline CT (computed tomography) perfusion within 6 hours of onset and underwent non-contrast CT at 24 hours. The absence of ≥1 of 5 targeted ipsilateral veins (superficial middle cerebral vein, vein of Trolard, vein of Labbé, basal vein of Rosenthal, and internal cerebral vein) was identified as absent ipsilateral venous filling.

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Median absolute PHE volume on follow-up CT was 3.5 (1.0-9.3) mL, and relative PHE, the ratio of PHE volume to hematoma volume, was 24.3% (9.0%-49.4%).

A total of 38 patients (27.5%) had 1 absent ipsilateral vein, and 5 patients (3.6%) had 2 absent veins. Statistical analyses showed an independent association between the presence of absent ipsilateral venous filling and large relative PHE at 24 hours (odds ratio [OR] 4.032; 95% CI, 1.739-9.347, P <.001). Furthermore, large PHE (OR 1.109; 95% CI, 1.009-1.218; P =.031), age (OR 1.078; 95% CI, 1.035-1.122; P <.001), and baseline National Institutes of Health Stroke Scale score (OR 1.206; 95% CI, 1.070-1.359; P =.002) were all independently associated with poor outcome.

The researchers noted the study had several limitations, including those attributed to variation in cerebral venous drainage, the retrospective study design, the relatively low rate of hematoma expansion and small hematoma volumes, as well as the low rates of treatment with oral anticoagulant and antiplatelet drugs.

“Further prospective studies to determine the significance and to address the correlation with functional outcome are needed because venous filling status may represent a promising imaging prognostic marker and potential therapeutic target in acute ICH,” concluded the researchers.


Chen L, Xu M, Yan S, Luo Z, Tong L, Lou M. Insufficient cerebral venous drainage predicts early edema in acute intracerebral hemorrhage. Neurology. 2019;93:e1463-e1473.