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Published on: October 2, 2014
Prognostic Factors For Functional Outcome in Patients with Mesencephalic Hemorrhage
Ece Özdemir Öktem1, Emre Kumral2, Fatma Ece Bayam3
1Alaaddin Keykubat University, Medical School, Department of Neurology and Neuroscience, Alanya, Antalya, Turkey.
Introduction:
Mesencephalic hemorrhage (MH) is a rare presentation of spontaneous intraparenchymal hemorrhage. This study aims to evaluate prognostic parameters of the MH outcome.
Methods:
We conducted an extensive search in the literature for cases with spontaneous, isolated mesencephalic hemorrhage. The study was conducted according to the statement of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Sixty-two eligible cases have been reported in the literature as proven by CT or MRI, and to these, we added six cases confirmed by MRI. The modified Rankin Scale (mRS) was dichotomized into two groups as the favorable outcome (FO; score, 0-2) and unfavorable outcome (UO; score, 3-6).
Results:
Of the 68 patients studied, 26 (38%) presented with normal consciousness, 22 (32%) with lethargy , and 20 (29%) with stupor or coma. There was no cause of hemorrhage in 26 (65%) patients with FO and 12 (43%) with UO (p=0.059). In univariate analyses, neither arteriovenous malformations (p=0.33) nor cavernomas (p=0.19) were associated with outcome. Multiple logistic regression analysis revealed that hypertension (OR, 51.22; CI95%, 1.92-1370.24; P=0.019), consciousness (OR, 133.54; CI95%, 1.61-1113.3; P=0.03), NIHSS at admission (OR, 57.23; CI95%, 2.87-1141.2; p=0.008), and ventrodorsal hemorrhage size (≥1 cm) (OR, 61.83; CI95%, 2.15-1779.2; p=0.016) were significantly associated with UO. Three months after stroke, 40 patients (59%) had FO, 28 (41%) had UO, and 8 (12%) died.
Conclusion:
These results suggest that ventrodorsal size of hemorrhage and clinical severity at stroke onset are possible predictors of functional outcome after mesencephalic hemorrhage.
Insights
Mesencephalic hemorrhage outcomes are predicted by hemorrhage size and clinical severity at stroke onset. Hypertension, consciousness level, NIHSS score, and ventrodorsal hemorrhage size significantly impact unfavorable outcomes.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Mesencephalic hemorrhage (MH) is a rare form of spontaneous intraparenchymal hemorrhage.
- Understanding prognostic factors is crucial for managing MH outcomes.
Purpose of the Study:
- To identify prognostic parameters influencing the outcome of mesencephalic hemorrhage.
- To evaluate the association between clinical factors and hemorrhage characteristics with patient outcomes.
Main Methods:
- A systematic literature review was conducted following PRISMA guidelines.
- Sixty-eight cases of spontaneous, isolated mesencephalic hemorrhage were analyzed.
- Outcomes were dichotomized using the modified Rankin Scale (mRS) into favorable (0-2) and unfavorable (3-6) groups.
Main Results:
- Hypertension, impaired consciousness, higher NIHSS scores, and larger ventrodorsal hemorrhage size (≥1 cm) were significantly associated with unfavorable outcomes.
- Arteriovenous malformations and cavernomas did not show a significant association with outcome.
- Of 68 patients, 59% achieved a favorable outcome, 41% had an unfavorable outcome, and 12% died within three months.
Conclusions:
- Ventrodorsal hemorrhage size and clinical severity at stroke onset are significant predictors of functional outcome in MH.
- Early identification of these factors can guide clinical management and prognostication.
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