August 1, 1994Neurology
Neurologic deterioration in noncomatose patients with supratentorial intracerebral hemorrhage
Authors
Discussion
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Implication
Cohort study reveals frequent early neurologic worsening linked to hematoma volume in conscious intracerebral hemorrhage, indicating initial imaging best identifies high-risk individuals.
Key Points
- To determine the incidence, timing, and predictors of neurologic deterioration in noncomatose patients presenting with supratentorial intracerebral hemorrhage.
- Analyzed 46 noncomatose patients (Glasgow Coma Scale score ≥ 8) with intracerebral hemorrhage from the Stroke Data Bank examined within 24 hours of onset (mean, 13.6 hours).
- Monitored patients via serial neurological assessments, defining deterioration as a ≥2-point decrease in Glasgow Coma Scale score, a ≥1-point increase in weakness score, or a new deficit unrelated to complications.
- Neurologic deterioration occurred in 33% of patients (15 of 46), peaking on the first hospital day (8 of 15 patients) and involving hematoma enlargement in 27% (4 of 15).
- Patients who deteriorated had significantly larger initial hematoma volumes (mean 45 ml vs. 16 ml, p < 0.01) and higher rates of marked mass effect (60% vs. 19%, p < 0.01) without differences in baseline Glasgow Coma Scale score or blood pressure.
- Thirty-day case fatality was significantly higher in patients with neurologic deterioration than in those with stable deficits (47% vs. 3%, p = 0.001).
Cite This Study
Mayer et al. (1994) studied this question.