Association Between Hematoma Edema Complex and Outcomes of Primary Intracerebral Hemorrhage

Intracerebral hematoma (ICH) expansion occurs within 24 h, but perihematoma edema (PHE) may increase later due to blood breakdown products, leading to clinical deterioration and poor outcomes. There is a paucity of prospective studies evaluating the role of hematoma edema complex (HEC) and PHE in the death and disability of patients with ICH. We report the association between day 1 and day 7 HEC and PHE and outcomes at 3 months in patients with ICH.

Patients with primary ICH admitted within 24 h of ictus were included. Their demographic details, stroke risk factors, and Glasgow Coma Scale and National Institutes of Health Stroke Scale scores were recorded. A cranial computerized tomographic (CT) scan was done at admission and on the 7th day or earlier if there was clinical deterioration. Volumes of ICH, HEC, PHE, relative PHE, and midline shift were measured. Outcomes at 3 months were measured using the modified Rankin Scale.

Ninety patients with a median age of 57 (range 38-80) years were included. The majority had ganglionic or thalamic ICH (70 patients, 77.8%), and 20 patients (22.2%) had lobar ICH. HEC, PHE, and midline shift significantly increased on the repeat CT scan. Baseline ICH volume correlated with expansion in HEC (r = 0.97, P < 0.0001) and PHE (r = 0.54, P < 0.001). There was an independent association between HEC on the repeat CT scan and death (adjusted odds ratio 1.05, 95% confidence interval 1.02-1.08, P < 0.001) and poor outcome (adjusted odds ratio 0.87; 95% confidence interval 0.78-0.98, P = 0.02).

There was an independent association between HEC and outcomes in patients with primary ICH.