NEUROLOGICAL AND FUNCTIONAL OUTCOME IN PATIENTS WITH SUPRATENTORIAL HEMORRHAGES - A PROSPECTIVE-STUDY

Background and Purpose A prospective study was performed to evaluate n eurological and functional outcome after spontaneous supratentorial bl eeding. The aim of the study was to determine whether clinical or neur oradiological parameters could predict the outcome of these patients d uring the first hours of hospitalization. Methods Two hundred seventy- nine patients-52 with thalamic, 87 with putaminal, and 140 with lobar hemorrhages-were followed prospectively and examined on admission and at 2 weeks, 3 months, and 6 months after onset. The patients underwent clinical (according to the Glasgow Coma Scale) and neuroradiological examinations on admission and were scored clinically and functionally (according to Stroke Severity score and Barthel Index) on the follow-u p periods. Risk factors and the correlation between findings on admiss ion and the latest clinical and functional results were calculated wit h the chi(2) test, Pearson correlation test, and Student's t test. Mul tivariate analysis was calculated with the stepwise regression test. R esults In all of the bleeding locations, lethal outcome was significan tly correlated with size of the hematoma (P<.001) and Glasgow Coma Sca le score on admission (P<.001). Intraventricular blood expansion was f ound to have a better prognosis in thalamic bleeding (P<.007) and a wo rse prognosis in lobar hemorrhage (P<.01). The functional outcome afte r 6 months was directly correlated with the size of the bleeding area in lobar and putaminal hemorrhages. No correlation was found in thalam ic bleeding. A worse functional outcome was found in putaminocapsular bleeding (P=.004) and in patients with ischemic heart disease. A limit ed better recovery prognosis was found in patients with lobar hematoma in the temporal lobe (P=-.052). Conclusions The probability of lethal outcome can be calculated on admission in all patients with supratent orial bleeding and in correlation with the location and size of the bl eeding area and level of consciousness. Intraventricular expansion of blood is a better prognostic factor in thalamic bleeding and a worse o ne in lobar hematoma. Functional outcome is correlated with size of th e bleeding area and level of consciousness on admission in putaminal a nd lobar hemorrhages but has no correlation to thalamic hemorrhage.