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Factors Impacting Hydrocephalus Incidence in Intracerebral Hemorrhage: A Retrospective Analysis
Jacob Gluski1, Richard J Garling1, Ari Kappel2
1Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA.
Insights
Intracerebral hemorrhage (ICH) characteristics like volume and location influence hydrocephalus development and patient outcomes. Cerebellar hemorrhages showed better outcomes, while bleed location did not predict shunt dependency.
Area of Science:
- Neurology
- Neurosurgery
- Critical Care Medicine
Background:
- Intracerebral hemorrhage (ICH) is a severe neurological condition.
- Hydrocephalus is a common complication of ICH, impacting patient prognosis.
- Understanding factors influencing hydrocephalus and outcomes is crucial for effective management.
Purpose of the Study:
- To identify intracerebral hemorrhage (ICH) characteristics that predict hydrocephalus incidence.
- To analyze the impact of these characteristics on patient outcomes.
- To investigate factors influencing the need for external ventricular drains (EVDs) and long-term shunt dependency.
Main Methods:
- Retrospective analysis of 560 patients with ICH.
- Utilized International Classification of Diseases codes for patient identification.
- Generalized linear modeling to assess modified Rankin Scale (mRS) scores and length of stay.
Main Results:
- Hydrocephalus incidence correlated with ICH volume, intraventricular hemorrhage (IVH) status, and bleed location.
- External ventricular drain (EVD) placement rates varied significantly by hemorrhage location.
- Cerebellar ICH location was associated with better discharge mRS scores.
Conclusions:
- ICH characteristics significantly influence hydrocephalus development and patient outcomes.
- Hemorrhage location predicts outcomes but not shunt dependency.
- Cerebellar hemorrhages are linked to improved functional recovery.
Objective:
To test which intracerebral hemorrhage (ICH) characteristics impact incidence of hydrocephalus and characterize subsequent impact on outcomes.
Methods:
A search of the electronic medical record of Sinai Grace Hospital between January 2009 and April 2018 using International Classification of Diseases, Ninth Revision and Tenth Revision codes for ICH identified 847 patients. After excluding patients with hemorrhagic conversion of stroke, subarachnoid hemorrhage, and traumatic hemorrhage, 560 patients remained for analysis. Generalized linear modeling was used to assess variance in modified Rankin Scale (mRS) score and length of stay.
Results:
Incidence of hydrocephalus on arrival varied with ICH volume (P < 0.001), intraventricular hemorrhage (IVH) status (P < 0.001), bleed location (P < 0.001), and external ventricular drain (EVD) status (P < 0.001). An EVD was inserted in 47% of patients presenting with IVH (n = 102/217), while 4% of patients without IVH received an EVD (n = 14/343) (P < 0.001). Hemorrhage locations had different rates of EVD placement: thalamic 43%, basal ganglia 22%, cerebellar 28%, brainstem 21%, lobar 7% (P < 0.001). Shunt dependency did not vary between bleed locations (P = 0.072). Variance in mRS score was explained by IVH, bleed location, hydrocephalus on arrival, and ICH volumes. In particular, cerebellar hemorrhage location was associated with better outcomes (mean discharge mRS score of 3.3 vs. 3.9, P < 0.001).
Conclusions:
Bleed characteristics affect incidence of hydrocephalus on admission, rates of long-term shunt dependency, and outcomes. Hemorrhage location did not predict shunt dependency; however, it did predict outcomes. Specifically, cerebellar ICH was associated with a better discharge mRS score.
