Factors necessary for independent walking in patients with putaminal hemorrhage

Abstract

Putaminal haemorrhage accounts for 30%–40% of all cerebral haemorrhages and is responsible for various neurological symptoms, including motor paralysis. Its prognosis varies according to factors such as age, neurological severity, site and size of hematoma, complications, and choice of treatment. We examined the factors related to independent walking in patients with putaminal hemorrhage who were admitted to a rehabilitation hospital. We evaluated 264 patients with thalamic hemorrhage (172 men and 92 women; age range, 29–88 years) who were admitted to our rehabilitation hospital. The mean duration from symptom onset to rehabilitation hospital admission was 29.9 ± 14.8 days, and the mean rehabilitation hospital stay was 74.6 ± 35.3 days. Patients’ neurological and cognitive functions were examined with the National Institutes of Health Stroke Scale (NIHSS) and Mini-Mental State Examination (MMSE), respectively. The relationship between patients’ scores on these scales and their walking ability at discharge from the rehabilitation hospital was analyzed. Additionally, a decision-tree analysis was used to create a model for predicting independent walking upon referral to the rehabilitation hospital. Among the patients, 143 could walk independently and 121 could not. The two patient groups were significantly different in terms of age, duration from symptom onset to rehabilitation hospital admission, hematoma type, hematoma volume, neurological symptoms, and cognitive function. The decision-tree analysis revealed that the patient's age, motor leg of the NIHSS, MMSE score, and hematoma volume were factors that could predict independent walking. In patients with putaminal hemorrhage, the neurological symptoms, and neuroimaging factors at onset are useful for predicting independent walking.