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Predictors of late neurological deterioration after spontaneous intracerebral hemorrhage

Weiping Sun1, Wenqin Pan, Peter G Kranz

  • 1Duke Clinical Research Institute, Duke University, Durham, NC, USA.

Neurocritical Care
|August 28, 2013
PubMed

Insights

Late neurological deterioration (LND) occurs in 28.9% of intracerebral hemorrhage patients, influenced by hematoma volume, intraventricular hemorrhage, and admission glucose levels. LND significantly worsens patient outcomes.

Area of Science:

  • Neurology
  • Neurosurgery
  • Critical Care Medicine

Background:

  • Intracerebral hemorrhage (ICH) is a significant cause of cerebrovascular disease.
  • Factors contributing to neurological decline beyond 48 hours post-ICH are not well understood.
  • Late neurological deterioration (LND) is a critical concern in ICH patient management.

Purpose of the Study:

  • To determine the incidence and consequences of LND in spontaneous supratentorial ICH.
  • To identify independent predictors associated with LND.
  • To explore potential mechanisms underlying LND.

Main Methods:

  • Analysis of 149 consecutive patients with spontaneous supratentorial ICH from a neuroscience ICU database (2007-2012).
  • LND defined as a ≥2-point decrease in Glasgow Coma Scale or death between 48 hours and 1 week post-ICH.
  • Logistic regression used to identify predictors of LND and association with unfavorable outcomes (modified Rankin Scale >2).

Main Results:

  • LND developed in 28.9% of patients.
  • Independent predictors of LND included hematoma volume, intraventricular hemorrhage, and admission serum glucose.
  • LND was independently associated with unfavorable outcomes (OR=4.000, p=0.017).
  • Increased midline shift, indicating cerebral edema, was associated with LND (OR=3.822, p=0.028).

Conclusions:

  • LND is a common complication following ICH, significantly impacting patient prognosis.
  • Hematoma volume, intraventricular hemorrhage, and admission glucose levels are key predictors of LND.
  • Progression of perihematomal edema may be a contributing mechanism for LND.
Abstract

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