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A Murine Model of Subarachnoid Hemorrhage
Published on: November 21, 2013
Predictors of Outcome in Patients with Medullary Hemorrhage
Emre Kumral1, Fatma Ece Bayam2, Rana Özerol1
1Neurology Department, Ege University, Medical School Hospital, İzmir, Turkey.
Background:
Isolated medullary hemorrhage (MH) is an uncommon presentation of spontaneous intraparenchymal hemorrhage. The relationship between MH and neurological outcome is not well known. This study aims to assess predictive parameters for the outcome of medullary hemorrhage.
Methods:
We conducted an extensive search of the literature for cases with spontaneous, isolated MH. The study was conducted according to the statement of Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA). Forty-three cases diagnosed by CT or MRI have been reported in the literature, to which we add three confirmed by MRI. The ventrodorsal size of hemorrhage was taken into account as a parameter of outcome. Early neurologic deterioration (END) was defined as an incremental increase in the National Institutes of Health Stroke Scale score by ≥1 point in motor power, or ≥2 points in the total score within the first week after admission. Modified Rankin Score (mRS) 0-2 was presumed as favorable outcome (FO) and mRS 3-6 score as unfavorable outcome (UO) at discharge and at 3 months after stroke.
Results:
We enrolled 46 patients, and 17 (37%) patients were diagnosed with END. The cause of medullary hemorrhage was mostly vascular malformations, including cavernous malformation (33%) and arteriovenous malformation (11%). In univariate analyses, neither arteriovenous malformations (OR, 1.04; 95%CI, 0.10-10.53; P = 0.68) nor cavernomas (OR, 1.04; 95%CI, 0.22-4.89; P = 0.62) were associated with UO. Acute respiratory distress syndrome was higher in patients with UO group (44%) compared to those with FO group (16%), but this difference did not reach to a significant level (OR, 4.13; 95%CI, 0.85-20.04; P = 0.09). The diameter of hemorrhage was significantly larger (≥1 cm) in patients with UO compared to those with FO (OR, 16.67; 95%CI, 1.87-148.89; P = 0.003). Three months after stroke, 37 patients (80%) had FO and 9 (19.5%) had UO, and 5 (11%) died. Multiple logistic regression analysis using predetermined variables found to be significant in univariate analyses (END, consciousness disturbance at admission, hemorrhage size, and hypertension) showed that END at stroke onset was significantly associated with UO (OR, 4.97; CI95%, 1.13-21.94; P = 0.03).
Conclusions:
These results suggest that the END is a predictor for UO in patients with medullary hemorrhage. The extent of the medullary hemorrhage along the conduction tract may contribute to deterioration.
Insights
Early neurological deterioration predicts unfavorable outcomes in medullary hemorrhage patients. Larger hemorrhage size also indicates a worse prognosis, highlighting the importance of early assessment for these rare strokes.
Area of Science:
- Neurology
- Neurosurgery
- Stroke Medicine
Background:
- Isolated medullary hemorrhage (MH) is a rare form of spontaneous intraparenchymal hemorrhage.
- The prognostic factors and neurological outcomes associated with MH are not well-established.
- This study investigates predictors of outcome in patients with medullary hemorrhage.
Purpose of the Study:
- To identify parameters that predict neurological outcome in patients with isolated medullary hemorrhage.
- To assess the association between hemorrhage characteristics and patient outcomes.
- To evaluate the role of early neurological deterioration in predicting long-term outcomes.
Main Methods:
- A systematic literature review adhering to PRISMA guidelines was performed.
- Data from 46 patients with medullary hemorrhage (diagnosed via CT or MRI) were analyzed.
- Key outcome measures included early neurological deterioration (END) and modified Rankin Scale (mRS) scores at discharge and 3 months.
Main Results:
- Seventeen percent of patients experienced early neurological deterioration (END).
- Hemorrhage size (≥1 cm) was significantly associated with unfavorable outcomes (UO).
- END at stroke onset was a significant predictor of UO (OR, 4.97; P = 0.03).
Conclusions:
- Early neurological deterioration is a significant predictor of unfavorable outcomes in medullary hemorrhage.
- The extent of hemorrhage along neural conduction tracts may influence patient deterioration.
- Further research is needed to fully elucidate the pathophysiology and management of MH.
