From the Department of Neurology(M.N.D., D.F.E., A.R.Z.) and Program in
Occupational Therapy (M.N.D., D.F.E.), Neurology/Neurosurgery Intensive Care
Unit, Washington University School of Medicine, St Louis, Mo.
Background and Purpose—Although
several factors have been identified that predict outcome after
intracerebral hemorrhage (ICH), no previous
study has investigated the impact of hydrocephalus. The purpose of this
study was to determine whether the presence of hydrocephalus after ICH
would predict mortality and functional outcome.
Methods—Patients with spontaneous
supratentorial ICH were identified in our
prospectively collected database to determine the following: age, sex,
race, past medical history; Glasgow Coma Scale (GCS) score and blood
pressure on admission; use of mechanical ventilation, mannitol, and
ventriculostomy; and medical complications. CT scans performed within
24 hours of hemorrhage were retrospectively analyzed to
determine lesion size and location, 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
multivariate analyses performed to determine
whether hydrocephalus was an independent predictor of mortality. Data
are presented as mean±SD.
Results—Of the 81 patients studied, 40 had hydrocephalus. Those
with hydrocephalus 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
ganglionic or thalamic hemorrhages, and were intubated more
frequently (70% versus 27%). Hospital mortality was higher in
patients with hydrocephalus (51% versus 2%), and fewer patients went
home (21% versus 35%). Those 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 dead or alive.
Multivariate analyses indicated that
hydrocephalus is an independent predictor of mortality.
Conclusions—We conclude that hydrocephalus is an independent
predictor of mortality after ICH.
© 1998 American Heart Association, Inc.
Original Contributions
Hydrocephalus: A Previously Unrecognized Predictor of Poor Outcome From Supratentorial Intracerebral Hemorrhage
Key Words: hydrocephalus • intracerebral hemorrhage • intraventricular hemorrhage • stroke outcome
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