STUDY OF CLINICAL PROFILE AND ITS EFFECT ON THE OUTCOME OF SPONTANEOUS INTRACEREBRAL HEMORRHAGE

Abstract

Spontaneous Intracerebral Haemorrhage (SICH) is a potentially life-threatening condition associated with high mortality and morbidity. Early assessment of outcomes is important to optimize therapeutic efforts. Spontaneous ICH is defined as intraparenchymal bleeding in the absence of trauma or surgery. ICH accounts for approximately 10–20% of all strokes. The incidence rates of primary ICH vary among countries, age, sex, ethnicity, and seasons. It is the second most common type of stroke and the leading cause of morbidity and mortality worldwide with a case fatality rate of approximately 40% at 30 days and severe disability in most of the survivors. ICH is a medical emergency, as 20% or more of patients experience deterioration in their level of consciousness after their initial assessment. Furthermore, 15–23% of patients have hematoma expansion and neurological deterioration within the first few hours. The complications of intracerebral hemorrhage (ICH) are among the major predictors of early mortality and poor outcomes. Specialized neurocritical centers play a crucial role in providing medical care and improving patients’ outcomes. The present study was aimed at assessing the clinical profile and its effect on the outcome of spontaneous intracerebral hemorrhage.
AIM: The aim of the study is to assess the clinical profile and its effect on the outcome of spontaneous intracerebral hemorrhage and to determine the association between clinical, biochemical, and radiological parameters with mortality among these cases.
MATERIAL AND METHOD: This hospital-based, prospective, interventional study was conducted in the Department of General Medicine. The patients were followed-up during their stay in the hospital and follow-up was done after three months to assess the outcome. The study population included adult patients admitted to the medicine department of the institute and diagnosed to be suffering from spontaneous intracerebral hemorrhage. Written informed consent was obtained from participants or their relatives if they were unable to give consent due to their medical condition. All patients had a follow-up CT scan within 24 hours of admission or on clinical deterioration, whichever was earlier.
RESULTS: The mean age was found to be 41.4±8.0 years. 65.5% were males. The association between age and mortality was significant while that with sex was not significant. 17 of the study subjects had a history of hypertension. 19 had diabetes, 14 of them smoked, 16 had histories of irregular treatment, and 15% had a history of previous stroke. 20 of the patients died within three months follow-up period. Hypertension, smoking, and a history of irregular treatment were significantly associated. Hypertension, smoking, and a history of irregular treatment were significantly associated with mortality. GCS score at admission and ICH score of 4 and above were associated with higher mortality.
CONCLUSION: It is concluded that intracerebral hemorrhage is associated with high mortality. Major factors associated with increased mortality are hypertension, smoking, presenting symptoms of vomiting and altered sensorium, lower GCS score and high ICH score, and poor prognostic radiological features of midline shift, larger hematoma, and infratentorial extension.
KEYWORDS: Clinical, Determinants, Intracerebral hemorrhage score, Prognosis and Radiological.