PROGNOSTIC VALUE OF INTEGRATED BRAIN STRUCTURES AFFECTION ASSESSMENT IN PATIENTS IN ACUTE PERIOD OF SPONTANEOUS SUPRATENTORIAL INTRACEREBRAL HEMORRHAGE

Abstract

SUMMARY. The aim of the study – to improve diagnostic approaches in patients with spontaneous supratentorial intracerebral hemorrhage (SSICH) by elaboration of prognostic criteria for the disease clinical course and outcome on the ground of integrated quantitative estimation of brain structure affection severity according to neurovisualization investigation.

Material and Methods. The prospective, cohort, comparative study of 344 patients with first episode of hypertensive SSICH. The diagnosis was made on the basis of computed tomography which was made during first 24 hours from the disease onset. The following quantitative parameters were evaluated: intracerebral hemorrhage volume (ICHV), midline shift (MS), secondary intraventricular hemorrhage volume (SIVHV), total intracranial hemorrhage volume (TICHV). Clinical neurological investigation included level of neurological deficit estimation according to the National Institute of Health Stroke Scale and coma Full Outline of UnResponsiveness scale. Unfavorable clinical disease course variants (early neurological deterioration (ENT) during 48 hours from the admission) and SSICH outcome (death, unfavorable functional outcome as 4–5 score by Rankin scale on the 21st day of the disease) on the ground of conservative treatment were taken as the end points. Surgical intervention was done in 30 patients. Cluster analysis was used for identification of integrated neurovisualization patterns (NP). Relative risk (RR) ratio was defined.

Results. Diagnostic criteria of five types of neurovisualization pattern were elaborated. They take into consideration the combination of computed tomography indicators (ICHV, MS, SIVHV, TICHV) and match with integrated quantitative estimation of cerebral structures affection in patients with SSICH. Patterns were ranked in order of TICHV increasing (c²= 129,7, p<0,0001) and grades of acute period outcome on the ground of conservative therapy (c²=241,2, p<0,0001). Favorable functional outcome predominates (72.2 %) in patients with type I of NP (n=158) opposite to NP type II (n=67) where unfavorable functional outcome predominates (64.2 %). It was detected that NP types ІІІ–V are the diagnostic criteria of END (RR (95 % CІ)=5.32 (3.81–7.42), р<0.0001) and lethal outcome (RR (95 % CІ)=9.71 (6.25–15.10), р<0.0001).

Conclusions. Proposed grading of integrated neurovisualization severity of cerebral structures affection estimation in patients with SSICH are associated with clinical neurological data and are the informative criteria of disease acute period course and outcome prognosis.