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Predicting deterioration in patients with lobar haemorrhages
K D Flemming1, E F Wijdicks, E K St Louis
1Department of Neurology, Neurological and Neurosurgical Intensive Care Unit, Saint Mary's Hospital, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA.
Journal of Neurology, Neurosurgery, and Psychiatry
|April 21, 1999
Summary
Lobar haemorrhages can lead to neurological deterioration. Glasgow coma score less than 14 and large haemorrhage volume on CT scans predict worsening outcomes in patients with lobar brain bleeds.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Lobar haemorrhages represent a significant cause of neurological morbidity.
- Predicting clinical course and identifying early signs of deterioration are crucial for patient management.
Purpose of the Study:
- To investigate the clinical trajectory of patients diagnosed with lobar haemorrhages.
- To identify predictors of neurological deterioration in this patient cohort.
Main Methods:
- A retrospective review of 61 patients with lobar haemorrhages was conducted.
- Neurological deterioration was defined by a decrease in Glasgow Coma Scale score, new deficits, or signs of herniation.
- Univariate logistic regression analysis was employed to identify predictive factors.
Main Results:
- Twenty-six percent of patients experienced neurological deterioration post-admission.
- A Glasgow Coma Scale score below 14 was a significant predictor of deterioration (p<0.0001).
- CT findings such as haemorrhage volume >60 ml, midline shift, and cistern effacement predicted deterioration.
Conclusions:
- Early deterioration is often linked to haemorrhage enlargement, particularly within 12 hours of ictus.
- Delayed deterioration (>12 hours) is associated with increased mass effect from oedema.
- Patients with large lobar haemorrhages and decreased consciousness require close monitoring and potentially early, aggressive intervention.