Predictors of Late Neurological Deterioration After Spontaneous Intracerebral Hemorrhage
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ORIGINAL ARTICLE
Predictors of Late Neurological Deterioration After Spontaneous Intracerebral Hemorrhage Weiping Sun • Wenqin Pan • Peter G. Kranz • Claire E. Hailey • Rachel A. Williamson • Wei Sun Daniel T. Laskowitz • Michael L. James
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Ó Springer Science+Business Media New York 2013
Abstract Background Although intracerebral hemorrhage (ICH) is a common form of cerebrovascular disease, little is known about factors leading to neurological deterioration occurring beyond 48 h after hematoma formation. The purpose of this study was to characterize the incidence, consequences, and associative factors of late neurological deterioration (LND) in patients with spontaneous ICH. Methods Using the Duke University Hospital Neuroscience Intensive Care Unit database from July 2007 to June 2012, a cohort of 149 consecutive patients with spontaneous supratentorial ICH met criteria for analysis. LND was defined as a decrease of two or more points in Glasgow Coma Scale score or death during the period from 48 h to W. Sun W. Pan D. T. Laskowitz Duke Clinical Research Institute, Duke University, Durham, NC, USA W. Sun W. Sun Department of Neurology, Peking University First Hospital, Beijing, People’s Republic of China P. G. Kranz Department of Radiology (Neuroradiology), Duke University, Durham, NC, USA C. E. Hailey R. A. Williamson D. T. Laskowitz M. L. James Department of Anesthesiology, Duke University, DUMC-3094, Durham, NC 27710, USA D. T. Laskowitz M. L. James Department of Neurology, Duke University, Durham, NC, USA D. T. Laskowitz M. L. James (&) Brain Injury Translational Research Center, Duke University, Durham, NC, USA e-mail: [email protected]
1 week after ICH symptom onset. Unfavorable outcome was defined as a modified Rankin Scale score of >2 at discharge. Results Forty-three subjects (28.9 %) developed LND. Logistic regression models revealed hematoma volume (OR = 1.017, 95 % CI 1.003–1.032, p = 0.019), intraventricular hemorrhage (OR = 2.519, 95 % CI 1.142–5.554, p = 0.022) and serum glucose on admission (OR = 2.614, 95 % CI 1.146–5.965, p = 0.022) as independent predictors of LND. After adjusting for ICH score, LND was independently associated with unfavorable outcome (OR = 4.000, 95 % CI 1.280–12.500, p = 0.017). In 65 subjects with follow-up computed tomography images, an increase in midline shift, as a surrogate for cerebral edema, was independently associated with LND (OR = 3.822, 95 % CI 1.157–12.622, p = 0.028). Conclusions LND is a common phenomenon in patients with ICH; further, LND appears to affect outcome. Independent predictors of LND include hematoma volume, intraventricular hemorrhage, and blood glucose on admission. Progression of perihematomal edema may be one mechanism for LND. Keywords Intracerebral hemorrhage Neurological deterioration Predictors Outcome Brain edema
Introduction Primary intracerebral hemorrhage (ICH) is a major public health problem with an annual incidence of 10–30 per 100,000 population, accounting for 2 million (10–15 %) of about 15 millio
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