Transcranial Duplex Ultrasound as an Outcome Predictor Tool in Spontaneous Intracerebral Hemorrhage

To assess the usefulness of transcranial color-coded duplex (TCCD) ultrasound for monitoring intracerebral hemorrhage (ICH) and to analyze its prognostic predictive performance.

Prospective observational study of consecutive patients with spontaneous supratentorial ICH admitted to a stroke unit between 2017 and 2020. Clinical characteristics, ICH volume and midline shift (MLS) measured by computed tomography (CT) and TCCD were recorded at first 24 hours and at 2 and 7 days. ICH volume and MLS were correlated with CT and TCCD. Adjusted logistic regression analyses were performed to determine the association with 3-month dependence/death. A receiver operating characteristic analysis was used to identify the MLS cut-off point with the highest predictive value.

Sixty-five patients were included, 23 (35%) women, with a mean age of 67 (standard deviation 15) years and an National Institutes of Health Stroke Scale on admission of 12 (standard deviation 7). Strong positive correlations were observed between CT and TCCD at 24, 48 hours, and 7 days for ICH volume (r = 0.871, r = 0.839, r = 0.700) and moderate positive correlations for MLS (r = 0.658, r = 0.637, r = 0.593). A higher TCCD-MLS at 48 hours was independently associated with greater mortality and a higher TCCD-ICH volume at 48 hours with poorer functional outcomes. MLS ≥7 mm predicted mortality with a sensitivity of 80% and specificity of 99% (area under the curve 0.924).

TCCD-ICH volume and MLS could be used as predictive markers for dependency and mortality at three months, respectively. TCCD is a useful tool for monitoring patients with supratentorial ICH; however, these findings should be confirmed with larger studies.