Poor outcome increase with baseline severity of lateral striatocapsular hemorrhages

Intracranial hemorrhage (ICH) presents with varying outcomes based on location. Lateral striatocapsular hemorrhage (LSCH), located near the brain surface and outside the motor area, is surgically accessible, and evacuation may reduce mass effect and neurological sequelae. We aimed to determine prognosis and main predictors of poor outcomes in patients with acute LSCH.

We retrospectively analyzed LSCH patients admitted to our unit from January 2005 to October 2019. Factors associated with poor outcomes (mRS >2) were identified using logistic regression. The performance of identified predictors (alone and in combination) was assessed by calculating the area under the receiver operating characteristic curve (AUC) and its 95 % confidence intervals (CI).

Of 224 patients with acute deep ICH, 84 (36.7 %) had LSCH. At 6 months, 41 (51.2 %) exhibited poor outcomes. Univariable analysis identified age, baseline NIHSS, hematoma volume, intraventricular hemorrhage, and midline deviation as factors associated with poor outcomes. In multivariable analysis, baseline NIHSS (OR for NIHSS>14: 5.82; 95 % CI 1.82-18.65; p = 0.003) and volume (OR per 10 mL increase: 1.94; 95 % CI 1.21-3.11; p = 0.0059) were significantly associated with mRS >2. The optimal cutoff for hematoma volume was 19.37 mL (AUC = 0.79), and for NIHSS, it was 13 (AUC = 0.86).

Half of LSCH patients had poor outcomes under medical treatment. Baseline NIHSS and hematoma volume accurately appeared as emergent predictor of poor outcomes and may be considered for risk stratification in this population.