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I thank Dr. Munakomi for the comment on our article.1 We also analyzed relative perihemorrhagic edema (rPHE) evolution, but did not find an independent association of rPHE with functional outcome on day 90 (data not in our article).1 Others have found no association2 or an inverse association of increased rPHE with favorable outcome.3,4 As hematoma volume is a strong predictor of absolute PHE volume,1,5 rPHE—as defined by the absolute PHE volume divided by the absolute hematoma volume—was intended to represent a measure that was independent of intracerebral hemorrhage (ICH) volumes. However, due to the calculation of rPHE with hematoma volume as the denominator, rPHE is inversely correlated with hematoma volume.5 Thus, the correlation of rPHE with outcome may overestimate the influence of hematoma volumes, which may explain the inverse results compared to absolute PHE volumes. Consequently, in accordance with other authors,2 the use of rPHE is not recommended when performing outcome evaluation in PHE research. As our results showed an independent association of absolute PHE volumes with functional day 90 outcome, we consider absolute PHE an adequate measure for outcome evaluation in patients with ICH.
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Author disclosures are available upon request (journal{at}neurology.org).
- © 2018 American Academy of Neurology
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