gms | German Medical Science

Objective: Additional space-occupying intracerebral hematoma (ICH) in patients suffering from subarachnoid hemorrhage (SAH) is a known predictor for poor outcome. Emergent clot evacuation might be mandatory. However, data concerning the influence of ICH location on outcome is scarce. Therefore, we analyzed the influence of ICH location on clinical course and outcome in patients with SAH and additional ICH

Method: 174 patients were treated with aneurysmal SAH and additional ICH between September 1999 and May 2012. Information including patient characteristics, treatment and radiological findings were prospectively entered into a database. Patients were stratified according to ICH location and neurological outcome. Neurological outcome was assessed according to modified Rankin Scale (mRS).

Results: The most frequent ICH location was temporal (58.6%) followed by frontal (28.7%) and perisylvian ICH (12.6%). 63.6% presented in poor admission status and favourable outcome was achieved in 36.5%. In the multivariate analysis, favourable outcome was associated with young age, ICH < 50 ml, and poor admission status. Favourable outcome was achieved significantly more often in patients with temporal ICH (81.2%) compared to frontal (58.5%) or perisylvian ICH (16.7%).

Conclusions: The current data confirms that a significant number of patients with ICH after aneurysm rupture achieve favourable outcome. Temporal location of the hematoma seems to be a prognostic factor for favourable outcome along with „age“, „size of the hematoma“ and „admission status“. Early treatment with hematoma evacuation and aneurysm obliteration seem to be mandatory to achieve favourable outcome.