Abstract
ObjectiveTo investigate the relationship between hematoma ventricle distance (HVD) and clinical outcome in patients with intracerebral hemorrhage (ICH).MethodsWe prospectively enrolled consecutive patients with ICH in a tertiary academic hospital between July 2011 and April 2018. We retrospectively reviewed images for all patients receiving a computed tomography (CT) within 6 h after onset of symptoms and at least one follow-up CT scan within 36 h. The minimum distance of hematoma border to nearest ventricle was measured as HVD. Youden index was used to evaluate the cutoff of HVD predicting functional outcome. Logistic regression model was used to assess the HVD data and clinical poor outcome (modified Rankin Scale 4–6) at 90 days.ResultsA total of 325 patients were included in our final analysis. The median HVD was 2.4 mm (interquartile range, 0–5.7 mm), and 119 (36.6%) patients had poor functional outcome at 3 months. After adjusting for age, admission Glasgow coma scale, intraventricular hemorrhage, baseline ICH volume, admission systolic blood pressure, blood glucose, hematoma expansion, withdrawal of care, and hypertension, HVD ≤ 2.5 mm was associated with increased odds of clinical poor outcome [odd ratio, 3.59, (95%CI = 1.72–7.50); p = 0.001] in multivariable logistic regression analysis.ConclusionHematoma ventricle distance allows physicians to quickly select and stratify patients in clinical trials and thereby serve as a novel and useful addition to predict ICH prognosis.
Highlights
Intracerebral hemorrhage (ICH) is the most severe and devastating stroke subtype, with an up to 40% mortality at 30 days (van Asch et al, 2010; Krishnamurthi et al, 2014; Poon et al, 2014)
We demonstrated that the distance between ventricle and hematoma on computed tomographic (CT) was independently associated with poor clinical outcome in patients with ICH
We have proposed a novel parameter called “hematoma ventricle distance” that represents the anatomic location of hematoma to ventricles
Summary
Intracerebral hemorrhage (ICH) is the most severe and devastating stroke subtype, with an up to 40% mortality at 30 days (van Asch et al, 2010; Krishnamurthi et al, 2014; Poon et al, 2014). Baseline hematoma volume (Broderick et al, 1993), infratentorial location (Delcourt et al, 2017), and the presence of intraventricular hemorrhage (Witsch et al, 2015; IVH) are independent predictors of functional outcome. The hematoma volume is the most powerful predictor of poor functional outcome. Several imaging markers such as computed tomographic (CT) angiography spot sign and non-contrast CT markers are predictive of outcome (Sporns et al, 2018). Few studies focused on specific brain structures and functional outcome. We hypothesized that hematomas located in the deep brain structures or close to the ventricles are more likely to have worse functional outcome than superficially located hematomas. We hypothesized that patients may have poor outcome if the hematoma disrupts deep brain structures. Ventricles are located in the deep brain area, and the distance from the hematoma border to the ventricle may reflect the extent of involvement of deep brain structures
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