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Predicting Motor Outcome in Acute Intracerebral Hemorrhage.

J Puig1,2, G Blasco2, M Terceño3

  • 1From the Department of Radiology (J.P., M.E., C.R.F.), University of Manitoba. Winnipeg, Manitoba, Canada jpuig@hsc.mb.ca.

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Predicting motor outcomes after intracerebral hemorrhage is improved by combining clinical scores with diffusion tensor imaging (DTI) of corticospinal tract damage. This early assessment accurately forecasts motor function recovery at three months.

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Area of Science:

  • Neurology
  • Radiology
  • Neuroscience

Background:

  • Predicting motor outcomes after intracerebral hemorrhage (ICH) is clinically challenging.
  • Early assessment of neurological deficits and brain injury is crucial for patient management.

Purpose of the Study:

  • To evaluate if a combination of clinical scores and diffusion tensor imaging (DTI) of corticospinal tract (CST) damage within 12 hours of ICH onset can predict motor outcomes at 3 months.

Main Methods:

  • Prospective study of ICH patients with motor deficits within 12 hours of symptom onset.
  • Multimodal MRI including DTI to assess ICH, perihematomal edema, and CST involvement.
  • Quantification of CST damage using fractional anisotropy and diffusivity metrics.
  • Motor function assessed using modified National Institutes of Health Stroke Scale (NIHSS) scores.

Main Results:

  • Forty-three patients were included; 30.23% had poor motor outcomes at 3 months.
  • Significant predictors of motor outcome included admission and 72-hour NIHSS scores, posterior limb of the internal capsule (PLIC) involvement, and ICH volume.
  • A combined assessment of modified NIHSS (>6) and PLIC involvement showed high predictive accuracy (AUC=0.89) for poor motor outcome.

Conclusions:

  • Combined assessment of motor function and PLIC damage in acute ICH accurately predicts motor outcomes.
  • Early DTI-based evaluation of CST integrity offers valuable prognostic information.