Abstract
The purpose of this study was to develop integrated clinical and neuroimaging criteria for the prediction of spontaneous supratentorial intracerebral hemorrhage (SSICH) acute period outcome. Materials and methods. Complex clinical and neuroimaging study was conducted in 105 patients (56 men and 49 women, mean age 63.6 ± 1.2 years) with SSICH in acute period of the disease receiving conservative therapy. The examination included computer tomography of the brain and clinical assessment using National Institute of Health Stroke Scale (NIHSS), Glasgow Coma Scale (GCS). The disability level was detected in accordance with the modified Rankine Scale (mRS) on the 21st day of the disease. Results. Lethal outcome (21.9 %), unfavourable functional outcome in the form of 4–5 points in accordance with the mRS (33.4 %) and favourable functional outcome in the form of ≤3 points in accordance with the aforementioned scale on the 21st day of SSICH (45.7 %) were registered. The mathematical model has been elaborated for the prediction of lethal outcome of SSICH acute period, which takes into account the initial level of neurological deficit in accordance with NIHSS, the lesion volume and septum pellucidum displacement at the onset of the disease (AUC = 0.91 (0.84–0.96), P < 0.01). The mathematical model has been elaborated for the prediction of functional outcome of SSICH acute period, which takes into account the patient’s age, the level of neurological deficit in accordance with NIHSS, the lesion volume at the onset of the disease (AUC = 0.89 (0.80–0.95), P < 0.01). Conclusions. Integral clinical and neuroimaging predictors of the lethal outcome of SSICH acute period (Se = 91.3 %; Sp = 82.9 %; accuracy of prediction = 85.7 %) and mRS score ≤3 on the 21st day of the disease (Se = 85.4 %; Sp = 82.4 %; accuracy of prediction = 80.5 %) were determined.
Highlights
In spite of the significant progress in fundamental sciences and clinical vascular neurology, cerebral hemorrhagic stroke and its most common form – spontaneous supratentorial intracerebral hemorrhage (SSICH) continues to be one of the most significant and, still unresolved medical and social problems of our time, taking leading positions in the structure of death and disability of the adult population in most countries of the world [7,11].At the present day there is no doubt in the significance of individual vital and functional prognosis verification that are among the reasons for the differentiated choice of tactics in the acute period of SSICH [1,2,5]
On the basis of nonparametric analysis of variance it has been determined that patients with lethal outcome of SSICH acute period had a higher level of neurologic deficit in accordance with the National Institute of Health Stroke Scale (NIHSS), a more pronounced cerebral syndrome in accordance with the Glasgow Coma Scale (GCS) as well as a bigger lesion volume and more pronounced indexes (Table 1)
The following multivariant mathematical model in the form of binary logistic regression equation was elaborated within the informative criteria study for the SSICH acute period outcome prediction: β1 = 0.122 × P1 + 0.021 × P2 + 0.118 × P3 – 4.52
Summary
At the present day there is no doubt in the significance of individual vital and functional prognosis verification that are among the reasons for the differentiated choice of tactics in the acute period of SSICH [1,2,5]. Numerous studies have convincingly proved the relationship between the initial neurological deficiency level, lesion volume, the dislocation syndrome severity with the disease outcome [4,9,10]. Informative criteria for the prediction of SSICH acute period outcome, which would take into consideration the clinical and neurological symptomatology and the results of CT scan of brain at the onset of disease, are not currently available [6]. Purpose of this study was to develop integrated clinical and neuroimaging criteria for the prediction of SSICH acute period outcome
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