PREDICTORS OF EARLY NEUROLOGICAL DETERIORATION IN PATIENTS WITH ACUTE SPONTANEOUS SUPRATENTORIAL INTRACEREBRAL HAEMORHAGE

Abstract

This study was designed in order to improve diagnostic approaches in acute period of spontaneous intracerebral haemorrhage based on the elaboration of prognostic criteria for detecting early neurological deterioration under the conservative treatment. This prospective study included 339 patients having the first intracerebral haemorrhage. Clinical neurological examinations were carried out over the course of acute period of the disease by using Full Outline of UnResponsiveness scale and National Institute of Health Stroke Scale. The volume of intracerebral and secondary intraventricular haemorrhage, presence and severity of midline shift were detected by neurovisualizing techniques. Early neurological deterioration was chosen as a cumulative endpoint. We considered the signs of deterioration under the therapy during the first 24 – 48 hours following the admission to the hospital: decrease in Full Outline of UnResponsiveness scale score ≥2; increase in the National Institute of Health Stroke Scale score ≥4; lethal outcome. Logistic regressive analysis and ROC-analysis were used for elaboration of the prognostic criteria. Results. Neurological deterioration under the conservative therapy for 24 – 48 hours since the hospitalization was detected in 29,2-33,6% of cases. Multiple logistic regression analysis showed that initial degree of midline shift and volume of secondary intraventricular haemorrhage are the most informative parameters for evaluating risk of early neurological deterioration in patients with hemorrhagic stroke, who received the conservative therapy.
 The volume of secondary intraventricular hemorrhage >13,5 ml (sensitivity 70,5-72,7%, specificity 80,8-82,8%) and mean value of septum pellucidum and pineal gland shift >4,5 mm (sensitivity 60,6-60,7%, specificity 85,8-89,2%) were the predictors for early neurological deterioration. The above-mentioned predictors were integrated into the mathematical models for early neurological deterioration prognosis during 24 hours (AUC (95% CІ) = 0,85 (0,81-0,89), р˂0,0001) and 48 hours since the hospital admission (AUC (95% CІ) = 0,87 (0,83-0,90), р˂0,0001). Conclusions. The informative neurovisualization criteria for early neurological deterioration in patients with spontaneous supratentorial intracerebral haemorrhage were elaborated. They include the integrated degree of midline shift and the volume of secondary intraventricular hemorrhage. These criteria enable to determine the individual cumulative risk of unfavorable outcomes of acute period of the disease under the conservative therapy following 24 – 48 hours since the hospitalization with the accuracy of 81,7-82,9%.