Abstract
BackgroundCerebellar hemorrhage is a potentially life-threatening condition and neurologic deterioration during hospitalization could lead to severe disability and poor outcome. Finds out the factors influencing neurologic deterioration during hospitalization is essential for clinical decision-making.MethodsOne hundred fifty-five consecutive patients who suffered a first spontaneous cerebellar hemorrhage (SCH) were evaluated in this 10-year retrospective study. This study aimed to identify potential clinical, radiological and clinical scales risk factors for neurologic deterioration during hospitalization and outcome at discharge.ResultsNeurologic deterioration during hospitalization developed in 17.4% (27/155) of the patient cohort. Obliteration of basal cistern (p≦0.001) and hydrocephalus (p≦0.001) on initial brain computed tomography (CT), median Glasgow Coma Scale (GCS) score at presentation (p≦0.001) and median intracerebral hemorrhage (ICH) score (P≦0.001) on admission were significant factors associated with neurologic deterioration. Stepwise logistic regression analysis showed that patients with obliteration of basal cistern on initial brain CT scan had an odds ratio (OR) of 9.17 (p = 0.002; 95% confidence interval (CI): 0.026 to 0.455) adjusted risk of neurologic deterioration compared with those without obliteration of basal cistern. An increase of 1 point in the ICH score on admission would increase the neurologic deterioration rate by 83.2% (p = 0.010; 95% CI: 1.153 to 2.912). The ROC curves showed that the AUC for ICH score on presentation was 0.719 (p = 0.000; 95% CI: 0.613–0.826) and the cutoff value was 2.5 (sensitivity 80.5% and specificity 73.7%).ConclusionPatients had obliteration of basal cistern on initial brain CT and ICH score greater or equal to 3 at admission implies a greater danger of neurologic deterioration during hospitalization. Cautious clinical assessments and repeated brain images study are mandatory for those high-risk patients to prevent neurologic deterioration during hospitalization.
Highlights
Cerebellar hemorrhage is a potentially life-threatening condition and neurologic deterioration during hospitalization could lead to severe disability and poor outcome
The prognostic risk factors of outcome in patients with Spontaneous cerebellar hemorrhage (SCH) including hyperglycemia and platelet count at admission, a larger hematoma volumes or diameter, a lower Glasgow Coma Scale (GCS) at admission, and imaging findings that reveal the initial presence of hydrocephalus, intraventricular hemorrhage (IVH), the appearance of the fourth ventricle, or basal cistern obliteration have been reported in several studies [2, 6, 8,9,10,11,12]
Flemming et al [15] followed 61 patients with spontaneous supratentorial intracerebral hemorrhage and they demonstrated that the large volume lobar hematoma with consciousness disturbance (GCS < 14) and midline shift on computed tomography (CT) are at risk for further deterioration
Summary
Cerebellar hemorrhage is a potentially life-threatening condition and neurologic deterioration during hospitalization could lead to severe disability and poor outcome. The prognostic risk factors of outcome in patients with SCH including hyperglycemia and platelet count at admission, a larger hematoma volumes or diameter, a lower Glasgow Coma Scale (GCS) at admission, and imaging findings that reveal the initial presence of hydrocephalus, intraventricular hemorrhage (IVH), the appearance of the fourth ventricle, or basal cistern obliteration have been reported in several studies [2, 6, 8,9,10,11,12]. This study aimed to identify potential clinical, radiological and clinical scales risk factors to predict neurologic deterioration during hospitalization and outcome at discharge in patients with SCH
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