Early neurological deterioration prediction in patients with hemorrhagic hemispheric stroke on the ground of quantitative evaluation of secondary interventricular hemorrhage severity

Abstract

The early neurological deterioration criteria in patients with hemorrhagic hemispheric stroke (HHS) were elaborated on the ground of quantitative evaluation of secondary interventricular hemorrhage (IVH) severity. The prospective study with 339 patient’s involvement with the participation of patients with an average age (64.8±0.6) years old with spontaneous (hypertensive) supratentorial intracerebral hemorrhage. The diagnosis was made by brain computed tomography with quantitative evaluation of secondary intraventricular hemorrhage severity by using Graeb, Leroux and Intraventricular Hemorrhage (IVH). Early neurological deterioration (END) was taken as a combined clinical end-point. END was detected as one of the following criteria onset: reduction of the summary score according to Full Outline of UnResponsiveness coma scale > 2; increasing of the summary score on National Institute of Health Stroke Scale > 4; lethal outcome. Statistic processing of the results was made with the use of Mann-Whitney criteria and ROC-analysis. Combined clinical end-point was registered in 29.2 % cases. It was detected that patients with END are characterized with higher values of summary score according to Graeb (7 [4–8] vs 0 [0–4], p<0.0001), Leroux (9 [5–12] vs 0 [0–5], p<0.0001) and IVH scales (17 [13–20] vs 0 [0–12], p<0.0001). While the mentioned scales do not differ in diagnostic informativeness when individual END detection prognosis in patients with HHS (AUC is 0.80-0.81). Summary score according to Graeb > 5 (Se = 68.7%, Sp = 82.9%), Leroux > 4 (Se = 76.8%, Sp = 74.6%) and IVH > 13 (Se =72.7%, Sp = 80.8%) scales are predictors of END in patients with HHS. It was detected that in case of FOUR score < 13, volume of intracerebral hemorrhage > 40 ml and midline shift > 5 mm, positive predictive value of these criteria exceeds 90%, while in general cohort – does not reach 65%. The threshold values of summary score in Graeb, Leroux and IVH scales are the informative criteria of END prognosis in patients with HHS. Keywords: hemorrhagic stroke, intraventricular hemorrhage, early neurological deterioration, prognosis.