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Hydrocephalus Growth: Definition, Prevalence, Association with Poor Outcome in Acute Intracerebral Hemorrhage
Wen-Song Yang1,2, Yi-Qing Shen1,2, Xiao-Dong Zhang3
1Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Insights
Hydrocephalus growth after intracerebral hemorrhage (ICH) predicts mortality and poor outcomes. This finding may aid clinical decision-making in managing ICH patients.
Area of Science:
- Neurology
- Neurosurgery
- Critical Care Medicine
Background:
- Intracerebral hemorrhage (ICH) is a severe condition often complicated by hydrocephalus.
- Predicting outcomes in ICH patients remains challenging, necessitating novel prognostic markers.
Purpose of the Study:
- To define hydrocephalus growth in ICH patients.
- To investigate the association between hydrocephalus growth and patient outcomes.
Main Methods:
- Analysis of 321 consecutive ICH patients presenting within 6 hours of symptom onset.
- Evaluation of hydrocephalus using Diringer et al. score on serial CT scans.
- Multivariate logistic regression to assess hydrocephalus growth as a predictor of mortality and poor outcome.
Main Results:
- Hydrocephalus growth was identified in 64 patients, often concurrent with hematoma or intraventricular hemorrhage expansion.
- Hydrocephalus growth independently predicted 30-day mortality, 90-day mortality, and poor 90-day outcome.
- Hydrocephalus growth demonstrated higher predictive accuracy than intraventricular hemorrhage growth or hematoma expansion alone.
Conclusions:
- Hydrocephalus growth is a significant predictor of short- and long-term mortality and poor outcomes in ICH.
- This novel definition of hydrocephalus growth can assist clinicians in patient management and decision-making.
Background/Objectives:
To propose a novel definition for hydrocephalus growth and to further describe the association between hydrocephalus growth and poor outcome among patients with intracerebral hemorrhage (ICH).
Methods:
We analyzed consecutive patients who presented within 6 h after ICH ictus between July 2011 and June 2017. Follow-up CT scans were performed within 36 h after initial CT scans. The degree of hydrocephalus were evaluated by the hydrocephalus score of Diringer et al. The optimal increase of the hydrocephalus scores between initial and follow-up CT scan was estimated to define hydrocephalus growth. Poor long-term outcome was defined as a modified Rankin Scale of 4-6 at 3 months. Multivariate logistic regression analysis was performed to investigate the hydrocephalus growth for predicting 30-day mortality, 90-day mortality, and poor long-term outcome.
Results:
A total of 321 patients with ICH were included in the study. Of 64 patients with hydrocephalus growth, 34 (53.1%) patients presented with both concurrent hematoma expansion and intraventricular hemorrhage (IVH) growth. After adjusting for potential confounding factors, hydrocephalus growth independently predicted 30-day mortality, 90-day mortality, and 90-day poor long-term outcome in multivariate logistic regression analysis. Hydrocephalus growth showed higher accuracy for predicting 30-day mortality, 90-day mortality, and poor long-term outcome than IVH growth or hematoma expansion, respectively.
Conclusions:
Hydrocephalus growth is defined by strongly predictive of short- or long-term mortality and poor outcome at 90 days, and might be a potential indicator for assisting clinicians for clinical decision-making.
