Progression of mass effect after intracerebral hemorrhage

Background and Purpose-While the evolution of mass effect after cerebral in farction is well characterized, similar data regarding intracerebral hemorr hage (ICH) are scant. Our goal was to determine the time course and cause f or progression of mass effect after ICH. Methods-Patients with spontaneous supratentorial ICH who underwent greater than or equal to 2 CT scans were identified in our prospectively collected database. CT lesion size and midline shift of the pineal and septum pelluci dum were retrospectively measured and correlated with clinical and CT chara cteristics. Causes for increased midline shift were determined by 2 indepen dent observers. Results-Seventy-six patients underwent 235 scans (3.1+/-1.3 per patient). I nitial CT was obtained within 24 hours of ICH in 66. Twenty-five scans were repeated on day 1, 80 on days 2 through 7, 31 on days 8 through 14, and 24 >14 days after ICH. Midline shift was present on 88% of the initial scans. There were 17 instances of midline shift progression: 10 occurred early (0 .2 to 1.7 days) and were associated with hematoma enlargement, and 7 occurr ed late (9 to 21 days) and were associated with edema progression. Progress ion of mass effect due to edema occurred with larger hemorrhages (P<0.05). Of 65 scans repeated for clinical deterioration, only 10 were associated wi th increased mass effect. Conclusions-Progression of mass effect after ICH occurred at 2 distinct tim e points: within 2 days, associated with hematoma enlargement, and in the s econd and third weeks, associated with increase in edema. The clinical sign ificance of later-developing edema is unclear.