Predicting deterioration in patients with lobar haemorrhages

Kelly Flemming, E. F M Wijdicks, Erik K St Louis, Hongzhi Li

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Objective. To study the clinical course and determine predictors of deterioration in patients with lobar haemorrhages). Methods. A comprehensive review of 61 consecutive patients with lobar haemorrhages was performed. Neurological deterioration was defined as (1) decrease in Glasgow coma sum score by 2 points, (2) new neurological deficit, or (3) clinical signs of brain herniation. A univariate logistic regression was performed and expressed in odds ratios. Results. Sixteen of 61 (26%) patients with lobar haemorrhages deteriorated after admission. In a univariate analysis, only a Glasgow coma score < 14 predicted deterioration (75% of deteriorators v 24% who did not deteriorate; p < 0.0001). Initial CT characteristics predictive of deterioration included haemorrhage volume > 60 ml (63% v 16%, p < 0.0001), shift of the septum pellucidum (75% v 36%, p < 0.01), effacement of the contralateral ambient cistern (33% v 0%, p < 0.0001), and widening of the contralateral temporal horn (50% v 0%, p < 0.0001). Patients presenting and deteriorating within 12 hours of ictus declined due to enlargement of the haemorrhage. Those who deteriorated more than 12 hours after initial neurological symptoms, showed increased mass effect secondary to oedema. Conclusion. Patients with lobar haemorrhages presenting immediately after ictus are at risk for deterioration from enlargement of the haemorrhage and predictors of deterioration may be absent. Patients with large volume lobar haemorrhages presenting to the emergency department with decreased level of consciousness and shift on CT are at risk for further deterioration from worsening oedema. These patients require close observation and early aggressive management may be warranted.

Original languageEnglish (US)
Pages (from-to)600-605
Number of pages6
JournalJournal of Neurology Neurosurgery and Psychiatry
Volume66
Issue number5
StatePublished - May 1999

Fingerprint

Hemorrhage
Coma
Edema
Septum Pellucidum
Temporal Lobe
Consciousness
Hospital Emergency Service
Logistic Models
Odds Ratio
Observation
Brain

Keywords

  • Coma
  • CT
  • Emergency room
  • Intracerebral haemorrhage
  • Outcome

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Neuroscience(all)
  • Neuropsychology and Physiological Psychology

Cite this

Predicting deterioration in patients with lobar haemorrhages. / Flemming, Kelly; Wijdicks, E. F M; St Louis, Erik K; Li, Hongzhi.

In: Journal of Neurology Neurosurgery and Psychiatry, Vol. 66, No. 5, 05.1999, p. 600-605.

Research output: Contribution to journalArticle

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abstract = "Objective. To study the clinical course and determine predictors of deterioration in patients with lobar haemorrhages). Methods. A comprehensive review of 61 consecutive patients with lobar haemorrhages was performed. Neurological deterioration was defined as (1) decrease in Glasgow coma sum score by 2 points, (2) new neurological deficit, or (3) clinical signs of brain herniation. A univariate logistic regression was performed and expressed in odds ratios. Results. Sixteen of 61 (26{\%}) patients with lobar haemorrhages deteriorated after admission. In a univariate analysis, only a Glasgow coma score < 14 predicted deterioration (75{\%} of deteriorators v 24{\%} who did not deteriorate; p < 0.0001). Initial CT characteristics predictive of deterioration included haemorrhage volume > 60 ml (63{\%} v 16{\%}, p < 0.0001), shift of the septum pellucidum (75{\%} v 36{\%}, p < 0.01), effacement of the contralateral ambient cistern (33{\%} v 0{\%}, p < 0.0001), and widening of the contralateral temporal horn (50{\%} v 0{\%}, p < 0.0001). Patients presenting and deteriorating within 12 hours of ictus declined due to enlargement of the haemorrhage. Those who deteriorated more than 12 hours after initial neurological symptoms, showed increased mass effect secondary to oedema. Conclusion. Patients with lobar haemorrhages presenting immediately after ictus are at risk for deterioration from enlargement of the haemorrhage and predictors of deterioration may be absent. Patients with large volume lobar haemorrhages presenting to the emergency department with decreased level of consciousness and shift on CT are at risk for further deterioration from worsening oedema. These patients require close observation and early aggressive management may be warranted.",
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