gms | German Medical Science

Objective: Spontaneous intracerebral haemorrhage (ICH) accounts for approximately 15% of all strokes and is a leading cause of disability, with a one-month mortality rate of around 40%. Whereas factors predicting short-term mortality are well known, data regarding long-term outcome are scarce and imprecise. We sought to identify possible predictors of poor outcome among patients with spontaneous supratentorial ICH treated in our neurosurgical department over a nine-year period.

Methods: Retrospective evaluation of consecutive patients with primary, spontaneous supratentoriell ICH presenting to and treated by our academic neurosurgical department during the time period 2007-2015. Clinical and CT imaging findings were correlated with functional outcome using the modified Rankin score (mRS) at discharge and as measured at 1 month, 1 year and 2 years follow-up. Outcome was dichotomised according to the mRS (score 0-2, favourable outcome; score 3-6, unfavourable outcome).

Results: 309 patients (160 men and 149 women) with primary supratentorial ICH were identified from our clinical record system. The mean age was 67.6 years. The mean baseline Glasgow coma scale (GCS) score on admission was 9. 52.8% of patients bled under anticoagulant therapy. 80.9% of the patients had arterial hypertension. Associated ventricular haemorrhage was present in 50.2% of patients. 186 patients were treated conservatively and 123 of the patients were treated surgically. Operative treatment was performed in all patients within 72 hours of initial haemorhage. At 2 years, 77 patients had died. 90/309 patients (29.13%) had a mRS score of 0 to 2 and at this timepoint, representing a favourable outcome. In 139 patients (45.0%) the mRS score was between 3 and 6 at this interval, representing an unfavourable outcome. Based on a multivariate analysis with unfavorable outcome (mRS 3 to 6) as the dependent variable, poor baseline neurological status (GCS score <11) and large-volume haemorrhage, (>45 ml) were identified as significant predictors of poor outcome at two years.

Conclusion: We demonstrate in a contemporary clinical cohort that baseline neurological findings and bleed volume on initial CT imaging have a significant impact on long-term functional outcome and morbidity. Surgical intervention was associated with lower mortality but had no impact on morbidity or functional status.