Time course and predictors of neurological deterioration after intracerebral hemorrhage

Aaron S. Lord, Emily Gilmore, H. Alex Choi, Stephan A. Mayer, D. F. Hanley, K. Butcher, S. Davis, B. Gregson, K. R. Lees, P. Lyden, S. Mayer, K. Muir, T. Steiner

Research output: Contribution to journalArticlepeer-review

Abstract

Background and Purpose: Neurological deterioration (ND) is a devastating complication after intracerebral hemorrhage but little is known about time course and predictors. Methods: We performed a retrospective cohort study of placebo patients in intracerebral hemorrhage trials. We performed computed tomographic scans within 3 hours of symptoms and at 24 and 72 hours; and clinical evaluations at baseline, 1-hour, and days 1, 2, 3, and 15. Timing of ND was predefined as follows: hyperacute (within 1 hour), acute (1-24 hours), subacute (1-3 days), and delayed (3-15 days). Results: We enrolled 376 patients and 176 (47%) had ND within 15 days. In multivariate analyses of ND by category, hyperacute ND was associated with hematoma expansion (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.7-7.6) and baseline intracerebral hemorrhage volume (OR, 1.04 per mL; 95% CI 1.02-1.06); acute ND with hematoma expansion (OR, 7.59; 95% CI, 3.91-14.74), baseline intracerebral hemorrhage volume (OR, 1.02 per mL; 95% CI, 1.01-1.04), admission Glasgow Coma Scale (OR, 0.77 per point; 95% CI, 0.65-0.91), and interventricular hemorrhage (OR, 2.14; 95% CI, 1.05-4.35); subacute ND with 72-hour edema (OR, 1.03 per mL; 95% CI, 1.02-1.05) and fever (OR, 2.49; 95% CI, 1.01-6.14); and delayed ND with age (OR, 1.11 per year; 95% CI, 1.04-1.18), troponin (OR, 4.30 per point; 95% CI, 1.71-10.77), and infections (OR, 3.69; 95% CI, 1.11-12.23). Patients with ND had worse 90-day modified Rankin scores (5 versus 3; P<0.001). Conclusions: ND occurs frequently and predicts poor outcomes. Our results implicate hematoma expansion and interventricular hemorrhage in early ND, and cerebral edema, fever, and medical complications in later ND.

Original languageEnglish (US)
Pages (from-to)647-652
Number of pages6
JournalStroke
Volume46
Issue number3
DOIs
StatePublished - Mar 1 2015

Keywords

  • Cerebral hemorrhage
  • Glasgow Coma Scale
  • Neurological disorders

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

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