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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23NS059774-04
Application #
8220960
Study Section
NST-2 Subcommittee (NST)
Program Officer
Moy, Claudia S
Project Start
2009-03-01
Project End
2014-02-28
Budget Start
2012-03-01
Budget End
2013-02-28
Support Year
4
Fiscal Year
2012
Total Cost
$169,609
Indirect Cost
$12,281
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02199
Prins, Bram P; Mead, Timothy J; Brody, Jennifer A et al. (2018) Exome-chip meta-analysis identifies novel loci associated with cardiac conduction, including ADAMTS6. Genome Biol 19:87
Boulouis, Gregoire; Morotti, Andrea; Charidimou, Andreas et al. (2017) Noncontrast Computed Tomography Markers of Intracerebral Hemorrhage Expansion. Stroke 48:1120-1125
Elmer, Jonathan; Yamane, David; Hou, Peter C et al. (2017) Cost and Utility of Microbiological Cultures Early After Intensive Care Unit Admission for Intracerebral Hemorrhage. Neurocrit Care 26:58-63
van den Berg, Marten E; Warren, Helen R; Cabrera, Claudia P et al. (2017) Discovery of novel heart rate-associated loci using the Exome Chip. Hum Mol Genet 26:2346-2363
Morotti, Andrea; Jessel, Michael J; Brouwers, H Bart et al. (2016) CT Angiography Spot Sign, Hematoma Expansion, and Outcome in Primary Pontine Intracerebral Hemorrhage. Neurocrit Care 25:79-85
Dowlatshahi, Dar; Brouwers, H Bart; Demchuk, Andrew M et al. (2016) Predicting Intracerebral Hemorrhage Growth With the Spot Sign: The Effect of Onset-to-Scan Time. Stroke 47:695-700
Radmanesh, Farid; Falcone, Guido J; Anderson, Christopher D et al. (2015) Rare Coding Variation and Risk of Intracerebral Hemorrhage. Stroke 46:2299-301
Brouwers, H Bart; Battey, Thomas W K; Musial, Hayley H et al. (2015) Rate of Contrast Extravasation on Computed Tomographic Angiography Predicts Hematoma Expansion and Mortality in Primary Intracerebral Hemorrhage. Stroke 46:2498-503
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
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

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