(Stroke. 1995;26:2249-2253.)
© 1995 American Heart Association, Inc.
Articles |
Neurological and Functional Outcome in Patients With Supratentorial Hemorrhages
A Prospective Study
From the Department of Neurology, Edith Wolfson Medical Center, Holon, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Correspondence to Yair Lampl, MD, Department of Neurology, Edith Wolfson Medical Center, Holon 58100, Israel.
Background and Purpose A prospective study was performed to evaluate neurological and functional outcome after spontaneous supratentorial bleeding. The aim of the study was to determine whether clinical or neuroradiological parameters could predict the outcome of these patients during the first hours of hospitalization.
Methods Two hundred seventy-nine patients—52 with thalamic,
87 with putaminal, and 140 with lobar hemorrhages—were
followed prospectively and examined on admission and at 2 weeks, 3
months, and 6 months after onset. The patients underwent clinical
(according to the Glasgow Coma Scale) and neuroradiological
examinations on admission and were scored clinically and functionally
(according to Stroke Severity score and Barthel Index) on the
follow-up periods. Risk factors and the correlation between
findings on admission and the latest clinical and functional results
were calculated with the 
2 test, Pearson
correlation test, and Student's t test.
Multivariate analysis was calculated with the
stepwise regression test.
Results In all of the bleeding locations, lethal outcome was significantly correlated with size of the hematoma (P<.001) and Glasgow Coma Scale score on admission (P<.001). Intraventricular blood expansion was found to have a better prognosis in thalamic bleeding (P<.007) and a worse prognosis in lobar hemorrhage (P<.01). The functional outcome after 6 months was directly correlated with the size of the bleeding area in lobar and putaminal hemorrhages. No correlation was found in thalamic bleeding. A worse functional outcome was found in putaminocapsular bleeding (P=.004) and in patients with ischemic heart disease. A limited better recovery prognosis was found in patients with lobar hematoma in the temporal lobe (P=.052).
Conclusions The probability of lethal outcome can be calculated on admission in all patients with supratentorial bleeding and in correlation with the location and size of the bleeding area and level of consciousness. Intraventricular expansion of blood is a better prognostic factor in thalamic bleeding and a worse one in lobar hematoma. Functional outcome is correlated with size of the bleeding area and level of consciousness on admission in putaminal and lobar hemorrhages but has no correlation to thalamic hemorrhage.
Key Words: hemorrhage • outcome • prognosis
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