Dr. Goldstein is an emergency physician with a long-term goal of improving the care of patients with neurological emergencies. Intracerebral hemorrhage (ICH) is the most fatal form of stroke, and no proven therapies are available. Hematoma expansion is the most feared complication of this disease, and therapies targeting this expansion are likely to be critical for improving outcome. A bedside predictor of expansion would allow acute therapies to be specifically targeted to those patients likely to benefit, while sparing those who will not develop expansion from the side effects of such therapies. Dr. Goldstein has an established foundation in basic and clinical research, and seeks further training in research methods and faculty development under the mentorship of two nationally recognized experts in ICH and emergency medicine. Drs. Greenberg and Camargo have a track record of independent extramural funding, and of mentoring clinicians who have developed into active clinical investigators. This proposal includes the close integration of clinical specialists in neurology, neuroradiology, emergency medicine, and biostatistics. This prospective observational study of patients with acute intracerebral hemorrhage has the following aims: 1) Determine whether contrast extravasation visualized on CT angiography (CTA) predicts subsequent hematoma expansion;2) Determine whether contrast extravasation independently predicts poor long-term outcome;3) Determine whether serum biomarkers in the acute setting predict hematoma expansion;4) Develop a prediction rule that can be used to acutely guide therapy;5) Obtain formal training in neuroradiology and the use of imaging to emergently risk-stratify patients;6) Obtain formal training in biostatistics and epidemiology through a Master's level program at the Harvard School of Public Health. The proposal will lay the foundations for future trials guiding acute therapy to patients at risk of hematoma expansion. This training grant will provide critical support for Dr. Goldstein's transition into an independent clinical scientist who performs patient-oriented research in neurologic emergencies.

Public Health Relevance

The most deadly form of stroke is bleeding in the brain. While some treatments may help, they also have side effects, and we don't know which people will receive more benefit than harm from these therapies. This proposal will establish a way to use CT scans and blood tests to decide who will benefit from which treatment.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
Application #
Study Section
NST-2 Subcommittee (NST)
Program Officer
Moy, Claudia S
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Massachusetts General Hospital
United States
Zip Code
Radmanesh, Farid; Falcone, Guido J; Anderson, Christopher D et al. (2014) Risk factors for computed tomography angiography spot sign in deep and lobar intracerebral hemorrhage are shared. Stroke 45:1833-5
Woo, Daniel; Falcone, Guido J; Devan, William J et al. (2014) Meta-analysis of genome-wide association studies identifies 1q22 as a susceptibility locus for intracerebral hemorrhage. Am J Hum Genet 94:511-21
Brouwers, H Bart; Raffeld, Miriam R; van Nieuwenhuizen, Koen M et al. (2014) CT angiography spot sign in intracerebral hemorrhage predicts active bleeding during surgery. Neurology 83:883-9
Brouwers, H Bart; Chang, Yuchiao; Falcone, Guido J et al. (2014) Predicting hematoma expansion after primary intracerebral hemorrhage. JAMA Neurol 71:158-64
Ciura, Viesha A; Brouwers, H Bart; Pizzolato, Raffaella et al. (2014) Spot sign on 90-second delayed computed tomography angiography improves sensitivity for hematoma expansion and mortality: prospective study. Stroke 45:3293-7
Falcone, Guido J; Biffi, Alessandro; Devan, William J et al. (2013) Burden of blood pressure-related alleles is associated with larger hematoma volume and worse outcome in intracerebral hemorrhage. Stroke 44:321-6
Devan, William J; Falcone, Guido J; Anderson, Christopher D et al. (2013) Heritability estimates identify a substantial genetic contribution to risk and outcome of intracerebral hemorrhage. Stroke 44:1578-83
Falcone, Guido J; Biffi, Alessandro; Brouwers, H Bart et al. (2013) Predictors of hematoma volume in deep and lobar supratentorial intracerebral hemorrhage. JAMA Neurol 70:988-94
Brouwers, H Bart; Backes, Daan; Kimberly, W Taylor et al. (2013) Computed tomography angiography spot sign does not predict case fatality in aneurysmal subarachnoid hemorrhage with intraparenchymal extension. Stroke 44:1590-4
Elmer, Jonathan; Hou, Peter; Wilcox, Susan R et al. (2013) Acute respiratory distress syndrome after spontaneous intracerebral hemorrhage*. Crit Care Med 41:1992-2001

Showing the most recent 10 out of 24 publications