Clinical Profile of hemorrhagic stroke and validation of ICH score in Kashmiri population

Abstract

Background: Intracerebral hemorrhage is the second most common subtype of stroke after ischemic stroke and accounts for approximately 10 % to 20 % of all strokes worldwide. In contrast, hemorrhagic stroke in our Kashmir valley accounts for around 65%. Objective: To look for detailed clinical profile and 30 day mortality, and correlate with ICH score, in our population. Study design and Methods: In this hospital based prospective study, All patients of spontaneous intracerebral hemorrhage admitted over a period of 2 years were enrolled. All clinical and lab parameters were recorded. ICH score (which includes Age, GCS, ICH volume, ICH location, and Intraventricular hemorrhage) was calculated at initial assessment. Patients were followed for 1 month to look for 30 day mortality and correlate with ICH score. Observations: Intracerebral hemorrhage constituted 51% of stroke patients after excluding SAH. Mean age of patients was 61.66±12.57 years. There was male preponderence (64%). Major risk factors present include Hypertension (96%), smoking (47%). DM (10.1%), previous stroke (11.3%), Family history (29.2%) and Anticoagulant use (0.85%).Most common site involved was Putamen (46.5%) followed by thalamus (27.8%) and lobar hemorrhage (14.6%). Around 65% patients developed systemic complications including Electrolyte disturbances and infections. Mortality at 30 days in our study was 36.2%. Thirty-day mortality rates for patients with ICH Scores 0f 0, 1, 2,3,4,5 were 0.7%, 4.5%, 17.3%, 62.0%, 94.6% and100.0% respectively. Plotting ICH score ROC curves demonstrated an area under the curve of 0.896, compared to 0.92 for the original ICH score cohort. Conclusion: Hemorrhagic stroke is still predominant stroke type in Kashmir valley. ICH score is an accurate marker to predict 30 day mortality in our population.