Outcome Prediction by Combining Initial Clinical Severity With Corticospinal Tract Lesion Load in Patients With Intracerebral Hemorrhage

OBJECTIVE: This study aimed to assess the predictive accuracy of motor outcomes in patients with intracerebral hemorrhage by integrating the initial severity of hemiparesis and the corticospinal tract lesion load (CST-LL). MATERIALS AND METHODS: A retrospective analysis was conducted on patients diagnosed with putaminal and/or thalamic hemorrhage who underwent computed tomography (CT) shortly after stroke onset. The CT images were aligned with a standardized brain template to calculate CST-LL. The initial severity of hemiparesis was evaluated using the summed Brunnstrom Recovery Stage (BRS total; range: 3-18). Motor outcomes at the time of discharge from a rehabilitation facility were assessed using the motor component total score of the Stroke Impairment Assessment Set (SIAS-motor total; range: 0-25). A multivariate regression analysis was performed with BRS total and CST-LL as independent variables and SIAS-motor total as the dependent variable. RESULTS: A total of 61 patients were included in the analysis. The median CST-LL was 1.974 mL (interquartile range (IQR): 1.113-3.311 mL), the median BRS total was 8 (IQR: 4-13), and the median SIAS-motor total was 20 (IQR: 9.5-24.5). Both BRS total and CST-LL were found to be significant predictors of motor outcomes. The estimated t-values were 4.79 for BRS total and -3.29 for CST-LL, indicating comparable contributions of both factors. The developed regression model explained 60.4% of the variance in SIAS-motor outcomes. CONCLUSIONS: The combination of initial clinical severity and CST-LL enhances the predictive accuracy of motor recovery in patients with intracerebral hemorrhage.