Volume of ventricular blood is an important determinant of... : Critical Care Medicine (original) (raw)

Neurologic Critical Care

Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage

Tuhrim, Stanley MD; Horowitz, Deborah R. MD; Sacher, Michael MD; Godbold, James H. PhD

Department of Neurology (Drs. Tuhrim and Horowitz), Department of Radiology (Dr. Sacher), and Department of Community Medicine (Dr. Godbold), Mount Sinai School of Medicine, New York, NY.

Supported, in part, by grants NS29762 and NS27924 from National Institutes of Health (National Institute of Neurologic Disease and Stroke) and a gift for stroke research from the Hess Foundation.

Address requests for reprints to: Stanley Tuhrim, MD, Department of Neurology, Box 1137, Mount Sinal Medical Center, 1 Gustave Levy Place, New York NY 10029.

Abstract

Objective

To determine the prognostic significance and pathophysiologic implication of intraventricular extension of supratentorial intracerebral hemorrhage.

Design

Prospective study.

Setting

Acute stroke and neurointensive care units of a tertiary care hospital.

Patients

One hundred twenty-nine patients with supratentorial intracerebral hemorrhage, managed medically.

Interventions

Two patients had intraventricular catheters placed for external drainage. No patient received thrombolytics or surgical evacuation of clot.

Measurements and Main Results

Of the 129 patients, 47 had intraventricular extension of their hemorrhages. These patients had larger intraparenchymal hemorrhages (36.6 cm3 vs. 15.0 cm3) and lower initial Glasgow Coma Scale scores (mean, 9.6 vs. 13.7). Their 30-day mortality rate was 43% compared with only 9% among those without ventricular extension. Univariate and multivariate logistic regression modeling was used to assess the prognostic significance of various measures of intraventricular hemorrhage. The presence of intraventricular hemorrhage, the number of ventricles containing blood, fourth ventricular blood, and intraventricular hemorrhage volume were each related to 30-day mortality in a univariate analysis, but only intraventricular hemorrhage volume contributed significantly to outcome prediction in the presence of Glasgow Coma Scale score.

Conclusions

Volume of intraventricular hemorrhage is an important determinant of outcome in supratentorial intracerebral hemorrhage. (Crit Care Med 1999; 27:617-621)