Immediate prognosis of primary intracerebral hemorrhage using an easy model for the prediction of survival
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Abstract:
We reviewed the medical records and CT scans of 138 patients hospitalized for spontaneous supratentorial hemorrhage and conservatively treated. Seventeen clinico-anamnestic variables and five CT desumed findings were collected. Using univariate analysis we found eight significant predictors of 30-day mortality: intraventricular spread (IVS) of blood, volume of the hemorrhage, Glasgow Coma Scale (GCS) score, midline shift, hyperglycemia, pupillary abnormalities, limb paresis and gaze deviation. With multivariate logistic regression analysis we found three independent predictors of 30-day mortality: IVS of blood, volume of the hemorrhage and GCS score. Using these three independent variables we developed an easy model which allows an immediate estimate of the probability of survival with a high degree of sensitivity and specificity.Keywords:
Paresis
Univariate analysis
Midline shift
Univariate
Intracerebral hemorrhage (ICH) with or without Intraventricular hemorrhage (IVH) is a highly morbid disease process due to the mass effect and secondary injury that occurs upon the surrounding brain. We recorded a case of Intracerebral hemorrhage (ICH) in 57 years old male patient.
Spontaneous intracerebral hemorrhage
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The purpose of our study was to compare lesion location between moyamoya disease-related intracerebral hemorrhage (MMD-ICH) and primary intracerebral hemorrhage (P-ICH).Ninety-three patients each with MMD-ICH and P-ICH were compared. In patients with MMD-ICH, angiographic findings were assessed with special attention to the prominent anterior choroidal artery. Follow-up data were obtained through clinical visit and telephone interview.The location of hemorrhage was different between MMD-ICH and P-ICH, the most frequent one being intraventricular region (37.6%) in the former and putaminal region (46.2%) in the latter (P<0.001). Intraventricular hemorrhage was more frequent in MMD-ICH than P-ICH (80.6% versus 20.4%, P<0.001). In MMD-ICH, primary intraventricular hemorrhage was more closely associated with prominent ipsilateral anterior choroidal artery than ICHs without intraventricular hemorrhage (75.0% versus 16.7%, P<0.001). Higher rates of rebleeding and infarction were observed in MMD-ICH than in age- and sex-matched patients with P-ICH.MMD-ICH may differ from P-ICH in hemorrhage location, generally presenting with intraventricular hemorrhage with or without ICH, which may be due to a prominent anterior choroidal artery. Patients with MMD may be more likely to experience recurrent bleeding and infarction.
Moyamoya Disease
Intraparenchymal hemorrhage
Stroke
Anterior choroidal artery
Anterior cerebral artery
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Objective To compare the performance of two previously reported logistic regression models using data independent from those data used to derive the models. Design Prospective. Setting Acute stroke unit of a tertiary care hospital. Patients One hundred twenty-nine patients with supratentorial intracerebral hemorrhage. Measurements and Main Results Model 1 contains the initial Glasgow Coma Scale score, hemorrhage size, and pulse pressure. The more complex model 2 includes, in addition to those three variables, the presence or absence of intraventricular hemorrhage and a term representing the interaction of intraventricular hemorrhage and Glasgow Coma Scale score. The areas under the receiver operating characteristic curves generated for each model were statistically indistinguishable. Conclusions Model 1 predicts 30-day patient status as well as the more complex model 2. Model 1 provides a valid, easy-to-use means of categorizing supratentorial intracerebral hemorrhage patients in terms of their probability of survival. (Crit Care Med 1995; 23:950-954)
Stroke
Glasgow Outcome Scale
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Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all stroke patients. ICH score is a simple tool for outcome prediction for intracerebral hemorrhage patients. The score consists of 5 characteristics including age > 80 years, Glasgow Coma Scale, infratentorial location, hematoma volume and presence of intraventricular hemorrhage that were found to be independent predictors of poor prognosis. The study aimed to validate prediction of 30 days mortality in Thai intracerebral hemorrhage patients. This is a cross-sectional study of patients with ICH in Thammasat University Hospital from 1 January 2011 to 31 December 2011. Independent predictors of 30 days mortality were identifi ed and the ICH score was determined. The study showed that the signifi cant independent parameters were location of hemorrhage, Glasgow Coma Scale, and ICH volume. In multivariate analysis, the signifi cant parameters were infratentorial ICH, Glasgow Coma Scale (3-4), ICH volume > 30 cm 3 , and presence of intraventricular hemorrhage. We conclude that ICH score is a useful and reliable tool to predict 30 days mortality in Thai patients, although age > 80 years is not an independent predictor in this study.
Glasgow Outcome Scale
Coma (optics)
Spontaneous intracerebral hemorrhage
Stroke
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Intro: Ischemic stroke of the middle cerebral artery often results in malignant cerebral edema leading to rapid clinical decline and midline shift. Decompressive hemicraniectomy (DHC) has been shown to improve clinical outcome in cases of malignant infarct but indications of when to perform it have not been well classified. This study focuses on patients who suffered malignant middle cerebral artery (MMCA) infarct and entered with mild brain injury (initial Glasgow Coma Scale≥13). Survival rates were compared among patients who received DHC versus medical treatment with a focus on midline shift. Hypothesis: Patients entering for MMCA with a Glascow Coma Scale ≥13who develop midline shift will have reduced mortality due to DHC relative to those with an entirely medical treatment. Methods: Retrospective review was performed on all cases consulted for neurological surgery from 2007-2012 at University Hospital. Patients were selected on the criteria of MMCA infarct. Midline shifts used were recorded prior to surgery or in the absence of surgery, 2-4 days post infarct. The primary endpoint was mortality at discharge. Multiple regression analysis was performed comparing the patient outcome to the degree of midline shift and if DHC occurred. Results: In total, 91 patients were referred to neurological surgery and 34 qualified with an initial Glasgow Coma Scale ≥13. Of those, 10 received a DHC, all with a midline shift and a survival rate of 70% (7/10). Exclusively medical treatment was done on 24 patients, 7 had midline shift reported with a survival rate of 29% (2/7) and 17 with no shift had a survival rate of 100% (17/17).The total medical survival rate was 79% (19/24). Regression analysis showed statistical significance (p<0.05) with mortality as the dependent variable and degree of midline shift (mm) and if DHC occurred as independent variables with GraphPad InStat 3.10. Conclusion: A statistically significant increase in survival has been found with use of DHC for MMCA infarct patients with a high Glasgow Coma Scale who have midline shift.
Midline shift
Glasgow Outcome Scale
Stroke
Coma (optics)
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Trauma Center
Stroke
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Background Intraventricular hemorrhage is a severe subtype of intracerebral hemorrhage associated with high mortality and poor outcome. Aim We analyzed various intraventricular hemorrhage scores at baseline to find common parameters associated with increased mortality. Methods Consecutive intracerebral hemorrhage patients treated in Helsinki University Central Hospital during 2005— 2010 were included in the Helsinki Intracerebral Hemorrhage Study registry and analyzed for three-month mortality. Results After excluding lost-to-follow-up patients, 967 intracerebral hemorrhage patients were included, out of whom 398 (41%) had intraventricular hemorrhage. Intraventricular hemorrhage patients, compared with nonintraventricular hemorrhage patients, had lower baseline Glasgow Coma Scale [median 12 (IQR 6–15) vs. 15 (13–15); P < 0·001] and higher National Institutes of Health Stroke Scale [18 (10–27) vs. 7 (3–14); P < 0·001] scores; larger intracerebral hemorrhage volumes [17 ml (7·2–42) vs. 6·8 (2·4–18); P < 0·001] and more often hydrocephalus (51% vs. 9%; P < 0·001); and higher mortality rates (54% vs. 18%; P < 0·001). In multivariable analysis, the presence of intraventricular hemorrhage was independently associated with mortality [OR 2·05 (95% CI 1·36–3·09)] when adjusted for well-known prognostic factors of intracerebral hemorrhage, i.e. age, gender, baseline National Institutes of Health Stroke Scale, intracerebral hemorrhage volume, infratentorial location, and etiology. Conclusions The presence of intraventricular hemorrhage was independently associated with increased mortality, and all the intraventricular hemorrhage scores were strong predictors of three-month mortality.
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Etiology
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Background and Purpose—Conjugate eye deviation (CED) occurs frequently in patients with acute stroke. The purpose of this study was to elucidate the factors that correlate with CED as well as the relationship between CED and outcomes in patients with acute intracerebral hemorrhage. Methods—A total of 211 patients with acute supratentorial intracerebral hemorrhage were recruited in a multicenter, prospective study. CED was assessed with a National Institutes of Health Stroke Scale “best gaze” subscore of ≥1. Hematoma location and volume were assessed on CT. Results—Forty-five percent of the patients had CED. On multivariable analysis, right-sided lesion (OR, 2.36; 95% CI, 1.18–4.93), hematoma volume (OR, 1.07; 95% CI, 1.04–1.10 per 1 mL), and baseline Glasgow Coma Scale score (OR, 0.66; 95% CI, 0.53–0.80 per 1 point) were independently associated with CED. After adjusting for sex, age, intraventricular extension of the hematoma, baseline Glasgow Coma Scale score, and hematoma volume, the presence of CED bo...
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Intraventricular hemorrhage (IVH) after intracerebral hemorrhage (ICH) is a strong independent predictor of poor outcomes. Although the location and volume of ICH are associated with IVH, our knowledge concerning the mechanism of IVH after ICH is still limited. This study aimed to investigate the relationship between hematoma morphology and IVH in patients with supratentorial deep ICH.We retrospectively analyzed adult patients (aged ≥18 years) with spontaneous supratentorial deep ICH who underwent computed tomography (CT) within 48 h after ICH symptom onset in Peking University First Hospital between January 2017 and August 2022. We collected the clinical and imaging data of the patients and assessed hematoma morphology using several quantitative radiological parameters including hematoma volume, sphericity index, A/B ratio (A: the largest area of hematoma; B: the largest diameter 90° to A on the same slice), and our newly proposed largest diameter-midline angle (LMA). Multivariable logistic regression analysis was used to analyze the relationship between these parameters and the presence of IVH on the initial CT scan.Among 114 patients with spontaneous supratentorial deep ICH, 41 (36.0%) had IVH. In patients with IVH, the sphericity index was lower than that in individuals without IVH, while the LMA was larger. Multivariate logistic regression analysis showed that sphericity index [0.1-unit odds ratio (OR) =0.252; 95% CI: 0.089-0.709; P=0.009] and the LMA (10-unit OR =1.281; 95% CI: 1.007-1.630; P=0.04) were independently associated with the presence of IVH in patients with supratentorial deep ICH. Univariate analyses showed that hematoma volume, A/B ratio, sphericity index, and the LMA were significantly associated with poor outcomes at discharge.Two quantitative parameters of hematoma morphology, sphericity index and the LMA, were significantly associated with the presence of IVH in patients with supratentorial deep ICH. Further prospective studies with larger sample sizes are needed to validate our results.
Intracerebral hematoma
Morphology
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Introduction. Spontaneous intracerebral hemorrhage is not a monophasic event, but a condition characterized by hematoma expansion with mechanical damage to the surrounding tissue. The development of multiple complications is associated with a high mortality rate of 40%. In order to make therapeutic decisions, it is important to know what factors predict the outcome in these patients. The aim of this study was to evaluate outcome prediction scales in patients with spontaneous intracerebral hemorrhage according to functional outcome at 7 and 30 days after the onset. Material and Methods. A three-year retrospective study (2017 - 2019) included 116 patients treated at the Emergency Center, Clinical Center of Vojvodina, Novi Sad, Serbia. The collected data included the National Institutes of Health Stroke Scale, the original intracerebral hemorrhage score, the modified Graeb score and Glasgow coma scale. Demographic data, localization, shape and volume of hematomas, as well as occurrence of intraventricular hemorrhage were compared. Results. In the group of 116 patients, male gender was dominant (82%) as well as the age over 65 years (56%); Glasgow coma scale: 1.5 interquartile range = 1 - 2 points, National Institutes of Health Stroke Scale 24, interquartile range = 15 - 32, intracerebral hemorrhage score 3 - 4 (68.1%). Intraventricular hemorrhage was found in 82.3% and oval hematoma in 71.6% of patients. The mortality rate was highest in the first 7 days (41.4%). The 7-day and 30-day mortality was significantly associated with the intracerebral hemorrhage score (p = 0.000) and the intracerebral hemorrhage volume (p = 0.014). Conclusion. Elderly men with known vascular risk factors are prone to spontaneous intracerebral hemorrhage. The intracerebral hemorrhage score and hematoma volume may be the potential indicators of poor outcome in the first 7 days of spontaneous intracerebral hemorrhage.
Interquartile range
Spontaneous intracerebral hemorrhage
Stroke
Glasgow Outcome Scale
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