Predictors of Outcome for Spontaneous Intracerebral Hemorrhage in Iraqi Stroke Patients

Abstract

Introduction Intracranial hemorrhage (ICH) accounts for 8-13% of all strokes and results from a wide spectrum of disorders, ICH is most severe, more fatal and disabling and least treatable form of stroke. Between 32% and 50% of patients die within the first month, and 80% of survival are disabled six months after intracerebral bleeding. Tools for prediction of mortality are fundamentally limited and are not designed to predict functional recovery. Substantial displacement of brain parenchyma may cause elevation of intracranial pressure (ICP) and potentially fatal herniation syndromes [1-4]. The aim of this study is to determine hematoma size, serum cholesterol, mean arterial pressure and vital signs readings within first week of intracerebral hemorrhage as potential early predictors of the mortality and morbidity outcomes of primary spontaneous Intracranial hemorrhage. A prospective study of 70 consecutive patients with spontaneous intracerebral hemorrhage (48 men and 22 women) were enrolled in this study, their mean age was 63.34 ± 8.970 years. The patients were admitted in the medical unit in Baghdad teaching hospital in the center of Baghdad between Jan 2010 to Jan 2011. Specialised medical and nursing personnel were taking care of the patients during their stay in hospital and the same protocols of treatment were followed so that it would be unlikely for the outcome to be varied depending on the facilities. Consent from each patient or his companion was taken to be included in the study and the study was approved by ethical committee of Iraqi board council for medical specilization. The inclusion criteria for the current study include presence of intracerebral parenchymatous hemorrhage proved by brain CT scanning and the admission of the patients must be on the first day of their illness. Patients were excluded from the study when there is associated cardiac disease, evidence of chest or urinary infections, evidences of organ failure like renal or hepatic failure and when brain CT scanning was suggestive of other diagnosis like brain tumor or ischemic infarction. Modified Rankin scale (mRS) was used to assess the disability state of the patients and it was done at the onset of the event. Mean arterial pressure (MAP), temperature, pulse rate, respiratory rate, size of the hematoma (by brain CT) and total serum cholesterols were all done at the first day of admission which must be the first day of the ICH. Average of three readings for each variable was taken as a final result. Patients according to the hematoma Size were divided into 3 groups: less than 35 mm, 36-70 mm and more than 71 mm. Patients according to Mean Arterial Pressure (MAP) were divided into 2 groups: Less than 110 and more than 111. Patients according to Pulse rate divided into 2 groups: less than 100 and more than 101 beat /minute. Abstract Background: Intracerebral hemorrhages (ICHs) comprise approximately 10% of all strokes with a thirty-day case fatality rate of 30% to 50%.