Original Article: Prognostic Factors of Long-Term Outcome and Functional Status Following Spontaneous Cerebellar Hemorrhage

Chia-Hung Sun,Tsung-Ying Li,Heng-Yi Chu,Yung-Tsan Wu,Shang-Lin Chiang,Shin-Tsu Chang,Liang-Cheng Chen

doi:10.4236/wjcd.2014.43014

Chia-Hung Sun, Tsung-Ying Li + Show 5 more

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https://doi.org/10.4236/wjcd.2014.43014

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Abstract

Cerebellar hemorrhage (CH) has a higher early mortality rate compared with other types of intracranial hemorrhage and the survivors often suffer from momentous disability. Hence, the prognostic factors of long-term outcome beyond 6 months after CH are clinically valuable, however only three studies were reported in the literature. Sixty-one patients with CH were retrospectively analyzed at least 6 months after hemorrhage. The long-term outcome of all patients and long-term functional status of survivors beyond 6 months (the patients who died within 6 months after hemorrhage were excluded) were assessed using the modified Rankin Scale (mRS): favorable outcome (mRS 0 - 2) and unfavorable outcome (mRS 3 - 6). All of the prognostic factors were analyzed by univariate and multivariate Cox proportional hazards regression models. There were 16 (26.2%) patients in the favorable outcome group and 45 (73.8%) in the unfavorable outcome group with respect of long-term outcome in all patients. The radiological brainstem compression (HR = 3; p = 0.015) was shown to be an independent predictor. On the other hand, 46 out of 61 (75.4%) patients survived beyond 6 months. In total, 16 (34.7%) patients had a favorable functional status, and 65.3% (30/46) had a persistent unfavorable functional status. Moreover, only age 365 years (HR = 3; p = 0.019) was an independent predictor. Radiological brainstem compression and age 365 were respectively shown to be a strong prognostic factor for long-term outcome and functional status among survivors beyond 6 months after hemorrhage in patients with CH.

Highlights

Cerebellar hemorrhage (CH) is the least common type of intracranial hemorrhage (ICH), accounting for only 10% of all ICH cases in western countries [1], rising to 20% - 30% in the Taiwanese population [2], due to the higher prevalence of hypertension, which is reported to be a major risk of CH [3] [4]
The lack of statistics regarding long-term outcomes in patients with CH hinders therapeutic decision making for survivors at the sub-acute and chronic stages
The following 4 risk factors were found to be significantly correlated with long-term outcome in the univariate analysis: Glasgow coma scale (GCS) scores ≤ 8 (HR = 3.4; p < 0.001), initial blood glucose/sugar (BS) levels ≥ 140 mg/dl (HR = 2.8; p = 0.002), maximum hematoma diameter ≥ 3 cm (HR = 3.2; p = 0.001), radiological brainstem compression (HR = 6.1; p < 0.001)

Summary

Introduction

Cerebellar hemorrhage (CH) is the least common type of intracranial hemorrhage (ICH), accounting for only 10% of all ICH cases in western countries [1], rising to 20% - 30% in the Taiwanese population [2], due to the higher prevalence of hypertension, which is reported to be a major risk of CH [3] [4]. CH is regarded as a predictive factor of outcome following ICH because of the high risk of brainstem compression [4]. As well as a higher early mortality rate (20% to 75%) compared with other types of ICH (30% - 50%) [1] [3], survivors of the acute phase of CH often suffer from momentous disability [3] [5]. The lack of statistics regarding long-term outcomes in patients with CH hinders therapeutic decision making for survivors at the sub-acute and chronic stages. The purpose of this study was to survey the significant prognostic factors of this topic, and review the existing literature

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