Abstract
Background/Objective: Intraventricular hemorrhage (IVH) extension after spontaneous supratentorial intracerebral hemorrhage (sICH) is an independent predictor of worse outcome. However, there is a paucity of data looking at the degree of IVH severity and its impact on outcome. This study addresses the contribution of IVH severity to outcome at time of hospital discharge after sICH.Methods: Two hundred and ten patients were included in the study. Baseline demographic and radiologic characteristics were abstracted. First available CT scans were reviewed for hematoma volume and location, IVH extension and presence of hydrocephalus (HCP). IVH severity was calculated using Graeb scale. Multivariate logistic regression models were developed to investigate the association of IVH severity with poor outcomes at hospital discharge, defined as modified Rankin scale score (mRS) >3.Results: Fifty-three percent of patients had IVH extension while 18% had surgical procedures done. Poor outcome (mRS >3) was seen for 56% of patients. Median IVH extension severity on the Graeb scale was two. Presence of IVH was associated with poor outcome in univariate and multivariate analysis (p < 0.005). Compared to patients with no IVH, IVH severity influenced outcome only when Graeb scores were ≥5 (OR = 1.3, 95% CI 0.49–3.23, p = 0.63, and OR = 2.9, 95% CI, 1.1–7.6, p = 0.03 for Graeb <5 and ≥5, respectively.Conclusions: Higher IVH severity (defined as Graeb score ≥5) is associated with worse outcome at time of hospital discharge, while lower IVH severity (Graeb scores 1–4) has similar outcomes to patients without IVH. IVH severity should be used in favor of IVH presence for prognostication purposes.
Highlights
Spontaneous intracerebral hemorrhage has an overall incidence of 24.6 per 100,000 patient-years and the incidence increases with age [1]. sICH accounts for 10–15% of all strokes and is characterized by a 30–50% 3-month mortality rate [2,3,4]
The objective of this study is to determine the contribution of Intraventricular hemorrhage (IVH) severity to outcome after sICH
IVH extension was present in 53% of patients with sICH, and of these, the median Graeb score was 2
Summary
Spontaneous intracerebral hemorrhage (sICH) has an overall incidence of 24.6 per 100,000 patient-years and the incidence increases with age [1]. sICH accounts for 10–15% of all strokes and is characterized by a 30–50% 3-month mortality rate [2,3,4]. Intraventricular hemorrhage (IVH) extension can be seen in up to 54% of sICH and is an independent predictor of worse outcome and neurological deterioration [4,5,6,7,8,9,10,11,12,13]. The ICH score is a prognostic tool commonly used in clinical practice. This includes age ≥80 years, Glasgow coma scale (GCS), infratentorial location, hematoma volume, and IVH Severity and Outcome in ICH presence of IVH. While it is already established that IVH extension is independently associated with high mortality and poor functional outcome, the impact of the degree of IVH severity is not completely understood. The objective of this study is to determine the contribution of IVH severity to outcome after sICH
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