Analysis of Clinical Profiles and Their Impact on Outcomes in Spontaneous Intracerebral Hemorrhage

Abstract

BACKGROUND: Spontaneous Intracerebral Hemorrhage (SICH) is a critical condition with significant mortality and morbidity. Early outcome assessment is crucial for optimizing treatment efforts. Spontaneous ICH, defined as intraparenchymal bleeding without trauma or surgery, constitutes about 10–20% of all strokes. The incidence of primary ICH varies globally and is influenced by factors such as age, sex, ethnicity, and seasonal changes. It is the second most prevalent type of stroke and a leading cause of death and disability worldwide, with a 30-day fatality rate around 40% and severe disability in most survivors. ICH is a medical emergency; over 20% of patients experience worsening consciousness levels shortly after the initial evaluation, and 15–23% suffer hematoma expansion and neurological decline within hours. Complications from ICH are key predictors of early mortality and adverse outcomes. Specialized neurocritical care centers are essential in delivering medical care and enhancing patient outcomes. This study aims to evaluate the clinical profile and its impact on the outcome of spontaneous intracerebral hemorrhage.

AIM: To assess the clinical profile and its effect on the outcome of spontaneous intracerebral hemorrhage and to determine the association between clinical, biochemical, and radiological parameters with mortality among these cases.

 MATERIAL AND METHOD: This hospital-based, prospective, interventional study was carried out in the Department of General Medicine. Patients were monitored throughout their hospital stay and followed up after three months to evaluate outcomes. The study population consisted of adult patients admitted to the medicine department of the institute with a diagnosis of spontaneous intracerebral hemorrhage. Written informed consent was obtained from the patients or their relatives if the patients were unable to provide consent due to their medical condition. All patients underwent a follow-up CT scan within 24 hours of admission or earlier if there was clinical deterioration.

RESULTS: The mean age of the patients was 41.4±8.0 years, with 65.5% being male. A significant association was found between age and mortality, while the association with sex was not significant. Among the study subjects, 17 had a history of hypertension, 19 had diabetes, 14 were smokers, 16 had a history of irregular treatment, and 15% had a history of a previous stroke. Within the three-month follow-up period, 20 patients died. Hypertension, smoking, and a history of irregular treatment were significantly associated with mortality. Additionally, a Glasgow Coma Scale (GCS) score at admission and an ICH score of 4 or higher were linked to increased mortality.

CONCLUSION: In conclusion, intracerebral hemorrhage is linked to high mortality. Key factors contributing to increased mortality include hypertension, smoking, symptoms such as vomiting and altered sensorium at presentation, lower Glasgow Coma Scale (GCS) scores, high ICH scores, and adverse radiological features like midline shift, larger hematoma size, and infratentorial extension.

KEYWORDS: Clinical, Determinants, Intracerebral hemorrhage score, Prognosis and Radiological