A prospective study of radiological predictors of mortality in patients with primary spontaneous intracerebral haemorrhage

Abstract

Introduction: Spontaneous intracerebral hemorrhage (ICH) accounts for approximately 4-14% of all strokes with a higher reported incidence in Asian countries compared to west and is associated with a high morbidity and mortality. Between 32% and 50% of patients die within the first month and only 20% are independent at 6 months. The burden of stroke occurrence, morbidity and mortality is much higher in developing nations. There has been considerable interest in predicting outcome after ICH and a number of studies have investigated the relationship of various clinical and radiological factors and poor outcome.Aims and Objectives: In this study, we want to know whether the radiological parameters obtained from a plain CT scan of brain can be used for prognostication purpose in primary spontaneous ICH.Materials and Methods: This was a prospective observational study done in Telangana hospitals, Khammam, Which is a tertiary level referral hospital in southern part of India. All consecutive patients admitted with primary spontaneous supratentorial ICH to the emergency department of the hospital between May 2019 and December 2020 were recruited for the study. Primary intracerebral haematoma was defined as spontaneous leakage of blood into the brain parenchyma, documented by a plain CT study of the brain. Secondary ICH due to trauma, rupture of arteriovenous malformations, aneurysmal bleeds, patients above 80 years of age and those presenting after 24 hrs, of ictus were excluded from the study. Informed consent was taken from the patients or their attendants. Patient’s attendants were interviewed to obtain a detailed clinical history regarding the onset and progression of headache, seizures and chronology of neurological worsening since ictus. History of hypertension, diabetes mellitus, alcoholism and smoking were recorded. The Glasgow Coma Scale (GCS) score of the patient was documented on admission.
Results: Out of the 138 patients, only 112 patients were finally recruited for the study after making the necessary exclusions. The mortality rate was 28.6% (N= 32). The mean age was 63.20 years (Median 64 years, range 33 to 79 years). There were a total of 68 (60.71%) males and 44 (39.29%) females. Major clinical presentation was headache and altered sensorium in 60 patients (53.57%), loss of consciousness in 35 patients (31.25%) and headache alone in 17 patients (15.18%). The most common risk factor in our study was hypertension 66 (58.9%) followed by smoking 28 (25%), alcohol intake 19 (17%) and diabetes mellitus 18 (16%). The mean GCS was 11 with a median of 13.Conclusion: Plain CT study of brain obtained within 24 hours of the ictus can be reliably used for predicting the prognosis of patients with primary supratentorial ICH.