Recovery and Outcomes From Stroke
Recovery and Outcomes From Stroke
The investigators will perform follow-up on 500 cases of deep and lobar intracerebral
 hemorrhage to perform advanced neuroimaging before 45 days post stroke, and evaluations of
 motor and cognitive function at baseline, 3 months and 6 months to determine predictors of
 recovery, progressive cognitive or functional impairment.
Stroke is the third leading cause of death and the leading cause of adult disability in the
 United States. More adults are affected by stroke each year than Alzheimer's disease,
 multiple sclerosis, amyotrophic lateral sclerosis or Parkinson's disease. Hemorrhagic strokes
 represent the most severe subtypes of stroke. An estimated 40-50% of hemorrhagic stroke
 victims will die and more than 80% of survivors remain disabled after hemorrhagic stroke. Yet
 the vast majority of analyses on outcome after stroke have focused principally on gross
 measures of functional outcome.

 Furthermore hemorrhagic stroke differs from ischemic stroke where a loss of blood causes the
 area affected to be readily visible on scanning. But with hemorrhagic stroke, not only the
 area that we can directly see, but nearby tracts that have been compressed or stretched by
 the mass of the hemorrhage can be injured.

 The investigators propose to follow-up on 500 cases of deep and lobar ICH to perform serial
 evaluations of motor and cognitive function and advanced neuroimaging to determine predictors
 of recovery, progressive cognitive or functional impairment. Our proposal has the advantages
 of adding onto a prospective ICH study which will identify and recruit cases, ability to
 evaluate for the degree and impact of survival and severity biases, baseline neuroimaging
 which includes baseline MRI, biologic samples including genotyping for apolipoprotein E
 alleles and uniform phenotype definitions as well as expertise in recovery/outcome analyses,
 advanced neuroimaging processes and epidemiologic study. This proposal performs detailed
 cognitive, motor and functional assessments on cases of intracerebral hemorrhage and
 correlates with tractography imaging. The investigators hypothesize that unlike ischemic
 stroke, the mass effect of the hemorrhage itself may disrupt nearby tracts in some patients
 while preserving them in others and will serve as a better predictor of who may recover after
 ICH. This project will represent the largest number of ICH cases in which tractography
 imaging has been performed to date.

 Specific Aim #1: Improve motor recovery prediction after supratentorial ICH by adding
 proportion of tract injury as measured by diffusion tensor imaging (DTI) independent of the
 ICH volume, location, age, gender and intraventricular hemorrhage (IVH).

 Hypothesis #1a: Increasing severity of injury to corticospinal tracts in ICH patients will
 predict worse specific motor deficits assessed at 3-month and 6-month post-stroke.

 Hypothesis #1b. Injury to cortical-cortical tracts including the superior longitudinal
 fasciculus, uncinate fasciculus, cingulum, and arcuate fasciculus, will predict greater
 impairment in corresponding cognitive domains including attention, memory, executive
 function, and language function assessed at 3 and 6-month post-stroke.

 Specific Aim #2: Determine the association of periventricular tract injury in
 intraventricular hemorrhage complicating ICH with subsequent incontinence and gait ataxia.

 Hypothesis #2: Patients with IVH will be associated with greater periventricular tract injury
 than patients without IVH and that this injury will be independently associated with
 long-term neurogenic incontinence and gait instability after controlling for severity of the
 ICH including location and volume, age and gender.
Inclusion Criteria:

 -  Age 18 years or greater, fulfillment of the criteria for Deep, Subcortical or Lobar
 Intracerebral Hemorrhage (ICH)

 -  No evidence of trauma, vascular malformation or aneurysm, or brain tumor as a cause of
 ICH.

 -  Ability of the patient or legal representative to provide informed consent

 Exclusion Criteria:

 -  Brainstem or Cerebellar ICH

 -  Patients Severely Affected by the ICH, Early Mortality, Hospice, or Withdraw of Care
 NOT eligible for ROSE