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Long-term prognosis of hypertensive intracerebral hemorrhage
Insights
Computerized tomography (CT) aids intracerebral hemorrhage (ICH) diagnosis. Most survivors achieve independence, with prognosis influenced by alertness, EKG, and clinical impression upon admission.
Area of Science:
- Neurology
- Radiology
- Public Health
Background:
- Intracerebral hemorrhage (ICH) diagnosis is precise with CT scans.
- Long-term prognosis of ICH remains poorly understood.
- Hypertensive ICH is a significant concern, particularly in specific demographics.
Purpose of the Study:
- To investigate the long-term prognosis of patients with primary intracerebral hemorrhage.
- To identify prognostic factors influencing outcomes after ICH.
- To assess mortality and functional recovery in ICH survivors.
Main Methods:
- Study included seventy consecutive patients with primary ICH (hypertension excluded) confirmed by CT scan.
- A comprehensive follow-up averaging 2.5 years was conducted for all patients.
- Prognostic factors analyzed included alertness, EKG, and clinical impression on admission.
Main Results:
- Acute in-hospital mortality was 40%.
- An additional 17% died during long-term follow-up, none from cerebrovascular disease.
- 92% of survivors were ambulatory, with most achieving independence.
Conclusions:
- Alertness, EKG, and clinical impression are significant prognostic indicators for ICH.
- Mortality correlates with hematoma size and ventricular rupture.
- Hypertensive ICH has a lower mortality than previously thought, and survivors benefit from rehabilitation.
Abstract:
The diagnosis of intracerebral hemorrhage (ICH) has become precise with the advent of computerized tomography (CT). Little, however, is known concerning the long-term prognosis. Seventy consecutive patients with primary intracerebral hemorrhage (all known etiologies except hypertension excluded) proven by CT scan were studied. Follow up, averaging 2 1/2 years, was successful in all cases. The status of alertness, EKG, and clinical impression on admission were significant prognostic factors. As expected, mortality increased with size of the hematoma and ventricular rupture. Acute in hospital mortality was 40%. Another 17% died during the long-term follow up, but none of them from cerebrovascular disease. Ninety-two percent of the survivors were ambulatory at follow up. Hypertensive intracerebral hemorrhages, unlike aneurysms, rarely, if ever, rebleed. Patients are not likely to have a second bleed in another location. Hypertensive intracerebral hemorrhage is more common in blacks, especially young adult males with severe hypertension, but overall mortality is lower than thought prior to the CT scan. Most survivors can achieve independence and deserve aggression rehabilitation efforts.