***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — The purpose of this study was to evaluate the incidence and prognosis of intracerebral hemorrhage . Methods — We analyzed data referring to our prospect i ve population -based registry , including patients with a first-ever stroke followed up to 10 years . Results — In a 5-year period , we included 549 patients ( 247 men and 302 women ; mean age±SD , 73.6±12.5 years ) with an intracerebral hemorrhage .  The crude annual incidence rate was 36.9 per 100 000 ( 95 % CI , 33.8 to 40.0 ) , 32.9 per 100 000 when st and ardized to the 2006 European population , and 15.9 per 100 000 when st and ardized to the world population . The case-fatality rate was 34.6 % ( 95 % CI , 30.6 to 38.6 ) at 7 days ; it increased to 50.3 % ( 95 % CI , 46.1 to 54.5 ) at 30 days and to 59.0 % ( 95 % CI , 54.9 to 63.1 ) at 1 year . Diabetes mellitus and posterior fossa hemorrhage were associated with an increased risk of 7- and 30-day mortality , whereas older age was associated with an increased risk of 30-day mortality only . At the Kaplan – Meier analysis , the 10-year survival rate was 24.1 % ( 95 % CI , 20.1 to 28.1 ) . Conclusions — Intracerebral hemorrhage is characterized by a severe prognosis , mostly in the short term . Because of the high proportion of fatal events that occurs early after the stroke , it is m and atory to identify and apply specific therapeutic strategies for patients with intracerebral hemorrhage Background and Purpose — Intracerebral hemorrhage ( ICH ) is the most fatal and disabling stroke subtype . Widely used tools for prediction of mortality are fundamentally limited in that they do not account for effects of withdrawal of care and are not design ed to predict functional recovery . We developed an acute clinical score to predict likelihood of functional independence . Methods — We prospect ively characterized 629 consecutive patients with ICH at hospital presentation . Predictors of functional independence ( Glasgow Outcome Score ≥4 ) at 90 days were used to develop a logistic regression-based risk stratification scale in a r and om subset of two thirds and vali date d in the remaining one third of the cohort . Results — At 90 days , 162 ( 26 % ) patients achieved independence . Age , Glasgow Coma Scale , ICH location , volume ( all P<0.0001 ) , and pre-ICH cognitive impairment ( P=0.005 ) were independently associated with Glasgow Outcome Score ≥4 . The FUNC score was developed as a sum of individual points ( 0–11 ) based on strength of association with outcome . In both the development and validation cohorts , the proportion of patients who achieved Glasgow Outcome Score ≥4 increased steadily with FUNC score . No patient assigned a FUNC score ≤4 achieved functional independence , whereas > 80 % with a score of 11 did . The predictive accuracy of the FUNC score remained unchanged when restricted to ICH survivors only , consistent with absence of confounding by early withdrawal of care . Conclusions — FUNC score is a valid clinical assessment tool that identifies patients with ICH who will attain functional independence  and thus , can provide guidance in clinical decision-making and patient selection for clinical trials Background and Purpose — CT angiography spot sign predicts hematoma expansion in patients with acute intracerebral hemorrhage ( ICH ) . The spot sign may represent a site of active extravasation , a locus of arrested hemorrhage forming fibrin globes , or represent associated epiphenomena such as hypertensive microaneurysms . We sought to describe the evolution of spot signs over 60 seconds in acute ICH using dynamic CT angiography and determine whether they grow and diffuse into the hematoma as would be expected with active extravasation . Methods — We prospect ively identified consecutive patients presenting with spontaneous ICH < 6 hours from symptom onset that completed dynamic CT angiography imaging over a 60-second acquisition protocol . We determined spot positivity , quantified spot volumes , and then used repeated- measures ANOVA to assess changes in spot volume over time . Results — We collected data on 35 patients ; 13 of 35 ( 37 % ) patients were spot-positive . Spot-positive patients had larger median ICH volume compared with spot-negative patients ( median 10.7 versus 49.2 mL ; P=0.007 ) . Maximal spot sign volumes ranged from 0.02 to 2.8 mL ( median 0.17 mL ) . Spot sign volumes increased significantly with time ( P<0.001 ) and seemed to disperse into the hematoma in all cases . Three of 13 ( 23 % ) spot-positive patients presented with 2 distinct spot signs , but the remaining patients either had only 1 spot sign or different contiguous components of an irregularly shaped spot sign . Conclusions — In this dynamic CT angiography study of ICH , spot signs evolve consistent with sites of active extravasation Background : Hematoma expansion ( HE ) is a surrogate marker in intracerebral hemorrhage ( ICH ) trials . However , the amount of HE necessary to produce poor outcomes in an individual is unclear ; there is no agreement on a clinical ly meaningful definition of HE . We compared commonly used definitions of HE in their ability to predict poor outcome as defined by various cutpoints on the modified Rankin Scale ( mRS ) . Methods : In this cohort study , we analyzed 531 patients with ICH from the Virtual International Stroke Trials Archive . Primary outcome was mRS at 90 days , dichotomized into 0–3 vs 4–6 . Secondary outcomes included other mRS cutpoints and mRS “ shift analysis . ” Sensitivity , specificity , and predictive values for commonly used HE definitions were calculated . Results : Between 13 % and 32 % of patients met the commonly used HE definitions . All definitions independently predicted poor outcome ; positive predictive values increased with higher growth cutoffs but at the expense of lower sensitivities . All HE definitions showed higher specificity than sensitivity . Absolute growth cutoffs were more predictive than relative cutoffs when mRS 5–6 or 6 was defined as “ poor outcome . ” Conclusion : HE robustly predicts poor outcome regardless of the growth definition or the outcome definition . The highest positive predictive values are obtained when using an absolute growth definition to predict more severe outcomes . Given that only a minority of patients may have clinical ly relevant HE , hemostatic ICH trials may need to enroll a large number of patients , or select for a population that is more likely to have HE Objective : Uncertainty exists over the size of potential beneficial effects of medical treatments targeting hematoma growth in intracerebral hemorrhage ( ICH ) . We report associations of hematoma growth parameters on clinical outcomes in the pilot phase , Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial ( INTERACT1 ) ( Clinical Trials.gov NCT00226096 ) . Methods : In r and omized patients with both baseline and 24-hour brain CT ( n = 335 ) , associations between measures of absolute and relative hematoma growth and 90-day poor outcomes of death and dependency ( modified Rankin Scale score 3–5 ) were assessed in logistic regression models , with data reported as odds ratios ( OR ) and 95 % confidence intervals ( CI ) . Results : A total of 10.7 mL ( 1 SD ) increase in hematoma volume over 24 hours was strongly associated with poor outcome ( adjusted OR 1.72 , 95 % CI 1.19–2.49 ; p = 0.004 ) . An association was also evident for relative growth ( adjusted OR 1.67 , 95 % 1.22–2.27 ; p = 0.001 for 1 SD increase ) . The analyses were adjusted for age , sex , achieved systolic blood pressure , elevated NIH Stroke Scale score ( ≥14 ) , hematoma location , baseline hematoma volume , intraventricular extension , antithrombotic therapy , baseline glucose , time from ICH to baseline CT scan , and time from baseline to repeat CT scan . A 1 mL increase in hematoma growth was associated with a 5 % ( 95 % CI 2%–9 % ) higher risk of death or dependency . Conclusion : Medical treatments , such as rapid intensive blood pressure lowering , could achieve ∼2–4 mL absolute attenuation of hematoma growth . There is hope that this could translate into modest but still clinical ly worthwhile ( ∼10%–20 % better chance ) outcome from ICH Approximately 10 % of all strokes in industrialized countries are due to intraparenchymal hemorrhage ( IPH ) . Mortality following IPH is high , with nearly one-third of patients dying in hospital and over half dead at 1 year ( 1–3 ) . To date , no medical therapies or interventions have been shown in controlled trials , to improve favorable outcomes in patients with spontaneous IPH , although surgery likely decreases mortality ( 4 ) . Observational studies suggest that mortality in IPH can be predicted by a number of different clinical and imaging characteristics . The two variables most associated with outcome include the neurological status ( Glasgow Coma Scale score ) and hematoma volume at presentation , neither of which is modifiable ( 2 ) . Hemorrhage growth is common in IPH , with at least 38 % of patients who present within 3 h of symptom onset demonstrating hemorrhage expansion ( 433 % increase in hematoma volume ) within 20 h of their initial CT ( 5 ) . This finding suggests that bleeding continues in the hours following presentation ; furthermore , patients who experience hemorrhage expansion are more likely to exhibit neurological deterioration than those who do not ( 5 ) . The risk for hemorrhage growth is associated with many different clinical variables , including , age , blood pressure , antithrombotic use , and liver disease . A number of radiographic findings also appear to predict hematoma expansion . One of these findings is extravasation of radiographic contrast into the hemorrhage bed during CT angiography ( CTA ) . We showed that 46 % of patients with IPH had active extravasation of radiographic contrast into the hemorrhage following CTA ; when controlling for other prognostic factors , this finding was associated with a fivefold increase in mortality ( 6 ) . More recent studies have shown what was implied in our study – that contrast extravasation is associated with hemorrhage growth ( 7,8 ) . A focus of enhancement within a hemorrhage bed ( the ‘ spot sign ’ ) is also seen during CTA and occurs in about 33 % of patients with IPH scanned within 3 h of symptom onset ; 77 % of patients with the ‘ spot sign ’ demonstrate hemorrhage expansion on subsequent imaging ( 8) . The risk of hemorrhage expansion appears to be time dependent , given that patients scanned earlier after symptom onset are more likely to demonstrate hemorrhage growth ( 5 ) . In concert , these observations suggest that a strategy to prevent hematoma expansion should be a viable therapeutic intervention in patients with IPH . For instance , if hematoma expansion results from ongoing bleeding , promoting hemostasis at the site of bleeding could be an effective therapy . Based on this rationale , the utility of recombinant-activated factor VIIa ( rFVIIa ) , a drug that acts locally at the site of bleeding to promote thrombosis , was assessed in patients with spontaneous IPH . A multicenter , double-blind , r and omized , controlled , dose-escalation , proof-of-concept trial showed that rFVIIa could limit hemorrhage expansion ; the study also suggested that rFVIIa could decrease mortality and improve outcome ( 9 ) . Unfortunately , the larger phase III study showed that rFVIIa did not improve neurological outcome even though it limited hemorrhage growth . These findings could imply that hemorrhage growth may be a marker for some other process associated with neurological deterioration and by itself is not responsible for poor outcome . Alternatively , despite the effect of rFVIIa on limiting hemorrhage growth , the drug could have unidentified untoward actions that affect neurological outcome , thus stressing the importance of functional outcomes over surrogate outcomes in clinical treatment trials . Yet another possibility for the negative outcome in this trial is that the study included too many patients who were unlikely to benefit from therapy . In observational studies , hemorrhage expansion is only seen in 13–38 % of patients ( 5,7,8 ) , suggesting that the majority of treated patients would not benefit from hemostatic therapy . If treatments to stem IPH growth could be limited to those patients most likely to experience hemorrhage growth , there might be increased power to identify a benefit of therapy . Given the widespread availability of CTA and the rapidity at which the scanning can be performed , it would be possible to design a study that included only those individuals who demonstrate a ‘ spot sign ’ or contrast extravasation following CTA . Based on the study by Wada et al. ( 8) , this strategy could appropriately target those most likely to experience hemorrhage expansion , given that the positive predictive value of extravasation for IPH expansion was 83 % and the negative predictive value of the ‘ spot sign ’ was 96 % . While many studies have identified elevated blood pressure as a risk factor for hematoma enlargement , more recent studies Correspondence : Kyra Becker , PO Box 359775 HMC , 325 9th Ave , Seattle , WA 98104 - 2499 . Tel : 1206 731 3251 ; Fax : 1206 731 8787 ; e-mail : kjb@u.washington.edu University of Washington School of 
    Output:
    
This will be the first systematic review and meta- analysis to evaluate the association of HE following ICH with Hypomagnesemia .
We look forward to the results will offer scientific proof to predict HE for ICH patients with low serum magnesium level .