HYDROCEPHALUS - A PREVIOUSLY UNRECOGNIZED PREDICTOR OF POOR OUTCOME FROM SUPRATENTORIAL INTRACEREBRAL HEMORRHAGE

Background and Purpose-Although several factors have been identified t hat predict outcome after intracerebral hemorrhage (ICH), no previous study has investigated the impact of hydrocephalus. The purpose of thi s study was to determine whether the presence of hydrocephalus after I CH would predict mortality and functional outcome. Methods-Patients wi th spontaneous supratentorial ICH were identified in our prospectively collected database to determine the following: age, sex, race, past m edical history; Glasgow Coma Scale (GCS) score and blood pressure on a dmission; use of mechanical ventilation, mannitol, and ventriculostomy ; and medical complications. CT scans performed within 24 hours of hem orrhage were retrospectively analyzed to determine lesion size and loc ation, pineal shift, cisternal effacement, intraventricular hemorrhage (IVH), and hydrocephalus. Outcome was determined with use of hospital disposition (dead, nursing home, rehabilitation, home) and functional outcome (Functional Independence Measure [FIM]) at 3 months. Patients with and without hydrocephalus were compared and univariate and multi variate analyses performed to determine whether hydrocephalus was an i ndependent predictor of mortality. Data are presented as mean+/-SD. Re sults-Of the 81 patients studied, 40 had hydrocephalus. Those with hyd rocephalus were younger (57 +/- 15 versus 67 +/- 15 years), had lower GCS scores (8.2+/-4.2 versus 11+/-2.9), were more likely to have gangl ionic or thalamic hemorrhages, and were intubated more frequently (70% versus 27%). Hospital mortality was higher in patients with hydroceph alus (51% versus 2%), and fewer patients went home (21% versus 35%). T hose who died had higher hydrocephalus scores (9.67+/-7.1 versus 5.75/-4.5). Outcome was no different if a ventriculostomy was placed. The final logistic regression model included hydrocephalus score, gender, GCS, and pineal shift, and it correctly predicted 85% of patients as d ead or alive. Multivariate analyses indicated that hydrocephalus is an independent predictor of mortality. Conclusions-We conclude that hydr ocephalus is an independent predictor of mortality after ICH.