NEUROLOGIC DETERIORATION IN NONCOMATOSE PATIENTS WITH SUPRATENTORIAL INTRACEREBRAL HEMORRHAGE

Objective. To determine the frequency, time course, and predictors of neurologic deterioration (ND) in noncomatose patients with supratentor ial intracerebral hemorrhage (ICH). Background. Patients with worsenin g ICH may benefit from therapy aimed at reducing mass effect due to ac tive bleeding or cerebral edema. Methods. We analyzed 46 noncomatose ( Glasgow Coma Scale [GCS] score greater than or equal to 8) patients wi th ICH in the Stroke Data Bank (SDB). All subjects were examined withi n 24 hours of onset (mean, 13.6 hours) and were prospectively followed with serial examinations during hospitalization. ND was defined as (1 ) a greater than or equal to 2-point decrease in the GCS score, (2) a greater than or equal to 1-point increase in the SDB weakness score, o r (3) a new deficit, unrelated to medical or surgical complications. R esults, ND occurred in 15 of 46 patients (33%). The frequency of ND wa s greatest on the first hospital day (eight of 15 patients) and decrea sed progressively thereafter. Patients with ND had larger hemorrhages (mean volume, 45 ml versus 16 ml, p < 0.01) and more frequently demons trated marked mass effect (60% versus 19%, p < 0.01) on initial CT tha n those with stable deficits, but did not differ with regard to mean G ;CS score, mean blood pressure, or other clinical variables on admissi on. Hematoma enlargement was judged to be the cause of worsening in fo ur of 15 (27%) patients. Thirty-day case fatality was 47% in those wit h ND compared with 3% in those with stable deficits (p = 0.001). Concl usions. ND occurs in one-third of noncomatose patients with supratento rial ICH and carries a poor prognosis. Large hematoma volume on CT, ra ther than clinical predictors, identifies patients at high risk for su bsequent worsening.