Occurrence of Secondary Brain Insults in Intracerebral Hemorrhage
Objective: Secondary brain insults (SBIs) include hypotension, hypoxia, fever, and seizures. SBIs are known to worsen outcome after head trauma and ischemic stroke, but their role in intracerebral hemorrhage (ICH) has not been well studied. Methods: Records of patients presenting with acute ICH to San Francisco General Hospital from July 1 through December 31, 1997 were retrospectively reviewed for the occurrence of SBIs at any point during hospitalization. Episodes of hypoxia (PaO2 < 60 mm Hg or an O2 saturation < 90% for over 5 minutes), hypotension (systolic blood pressure (BP) < 90 mm Hg for greater than 5 minutes), fever (T > 38.5O C), or generalized seizures were noted. Results: Overall 30-day mortality was 39% (14 of 36 total patients). In-hospital seizures were uncommon as was systemic hypoxia, the latter perhaps due to early intubation in comatose patients. However, fever and hypotension were much more common in patients who died, despite the fact that most ICH patients presented acutely with elevated BP. Among patients who died, 57% had at least one episode of T > 38.5O C and 71% had at least one episode of BP < 90 mm Hg, compared to only 9% of surviving patients (P < 0.01). Conclusions: SBIs, especially hypotension and fever, are common after ICH and are associated with higher 30-day mortality. Whether this indicates worsened ICH-related brain injury, as in head trauma or ischemic stroke, or is a result of secondary complications in severely affected patients remains to be clarified.