Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2014, vol. 20, issue 2
Subject Collection: Medicine
Pages: 489-494
DOI: 10.5272/jimab.2014202.489
Published online: 28 March 2014

J of IMAB 2014 Jan-Jun;20(2):489-494
Мaya P. Danovska1 Corresponding Autor, Margarita L. Alexandrova2, Nachko I. Totsev3, Irena I. Gencheva4, Plamen G. Stoev1.
1) Neurology Clinic, University Hospital, Medical University Pleven, Bulgaria
2) Department of Biophysics, Medical University – Pleven, Bulgaria
3) Department of Neuroimaging Studies, University Hospital – Pleven, Bulgaria
4) Medical Diagnostic Clinical Laboratory, University Hospital – Pleven, Bulgaria.

Objective: To define the prognostic value of clinical and neuroimaging parameters on the 30-th day mortality and clinical outcome after spontaneous intracerebral hemorrhage (sICH).
Materials and methods: we examined 88 patients with sICH admitted to Neurology Clinic, UMHAT Pleven within 48 hours after clinical symptoms onset. Glasgow Coma Scale (GCS) score was used to assess the primary stroke severity; neurological deficit on admission was assessed by National Institute of Health Stroke Scale (NIHSS); clinical outcome at discharge was evaluated by modified Rankin Scale (mRS) and by Glasgow Outcome Scale (GOS) on the 30-th day after sICH onset. Hematoma volume was measured by the formula of Kothari: AxBxC/2 in ml. The statistical analysis was performed by SPSS 19.0 and Statgraphics plus 4.1 for Windows.
Results: Initial assessment of primary stroke severity and neurological deficit by GCS и NIHSS, hematoma localization and volume were found strongly correlated with the clinical outcome on the 30-th day after the sICH onset. Age and vascular risk factors did not correlate with the clinical outcome. Male patients had better survival on the 30-th day compared with the female ones.
Discussion: Neurological deficit on admission, hematoma localization and volume were found reliable predictors of the 30-th day clinical outcome that could serve for early stratification of patients and optimal choice of therapeutic approach.

Key words: CT; neurological deficit; sICH; clinical outcome;

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Please cite this article as:
Danovska MP, Alexandrova ML, Totsev NI, Gencheva II, Stoev PG. Clinical and Neuroimaging Studies in Patients with Acute Spontaneous Intracerebral Hemorrhage. J of IMAB. 2014 Jan-Jun;20(2):489-494. doi: 10.5272/jimab.2014202.489.

Correspondence to: Dr. Maya Danovska, Department of Neurology, University Hospital, 8a, Georgi Kochev str., 5800 Pleven, Bulgaria; E-mail:

1. Velcheva I, Antonova N, Titianova E, Dimitrov N, Dimitrova V, Damianov P. Hemorheological Disturbances and Risk Factors for Cerebrovascular Disease: Comparative Studiesal. Neurosonology and Cerebral Hemodynamics. 2007; 3(2):85-92. [in Bulgarian]
2. Lesev M, Taneva N. Emergency neuroradiology. Sofia. 1999. [in Bulgarian]
3. Popova M, Danovska M, Simeonova V, Rouseff R, Denchev D, Lilovski Ch, Tzvetanov P. Leukocyte count, body temperature and vegetative symptoms in patients with spontaneous intracerebral hemorrhage. Scientific sessions of Higher Medical Institute Plovdiv. 1995. 27-28. [in Bulgarian]
4. Stamenov E, Stamenova P. Hemorrhagic stroke. Medicina I fizkultura. 1988. [in Bulgarian]
5. Titianova E, Velcheva I, Stamenov B. Treatment of Acute Ischemic Stroke with Thrombolysis in Bulgaria. Neurosonology and Cerebral Hemodynamics. 2010; 6(1):9-14.
6. Bessenyei M, Fekete I, Csiba L, Bereczki D. Characteristics of 4 stroke scales for the detection of changes in clinical signs in the acute phase of stroke. J Stroke Cerebrovasc Dis. 2001 Mar-Apr;10(2):70-78. [PubMed] [CrossRef]
7. Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G. Volume of intracerebral hemorrhage. A powerful and easy to use predictor of 30-day mortality. Stroke. 1993 Jul;24(7):987-93. [PubMed] [CrossRef]
8. Carandag R, Sudha S, Beiser A, Kelly-Hayes M, Kase CS, Kannel WB, et al. Trends in incidence, lifetime, risk, severity and 30-day mortality of stroke over the past 50 years. JAMA. 2006 Dec 27;296(24):2939-2946. [PubMed] [CrossRef]
9. Castellanos M, Leira R, Tejada J, Gil-Peralta A, Davalos A, Castillo J. Predictors of good outcome in medium to large spontaneous supratentorial intracerebral hemorrhages. J Neurol Neurosurg Psychiatry. 2005 May;76(5):691-5. [PubMed] [CrossRef]
10. Davis SM, Broderick J, Hennerici M, Brun NC, Diringer MN, Mayer SA, et al. Hematoma growth is determinant of mortality and poor outcome after intracerebral hemorrhage Neurology. 2006 Apr 25;66(8):1175-86. [PubMed]
11. Dennis, MS. Outcome after Brain Haemorrhage. Cerebrovasc Dis. 2003; 16 Suppl 1:9-13. [PubMed] [CrossRef]
12. Fogelholm R, Murros K, Rissanen A, Avikainen S. Long term survival after primary intracerebral hemorrhage: A retrospective population based study. J Neurol Neurosurg Psychiatry. 2005 Nov;76(11):1534-8. [PubMed] [CrossRef]
13. Hall K, Cope N, Rappaport M. Glasgow outcome scale and disability rating scale: comparative usefulness in following recovery in traumatic head injury. Arch Phys Med Rehabil. 1985 Jan;66(1):35-37. [PubMed]
14. Hosomi N, Naya T, Ohkita H, Mukai M, Nakamura T, Veno M, et al. Predictors of intracerebral hemorrhage severity and its outcome in Japanese stroke patients. Cerebrovasc Dis. 2009; 27(1):67. [PubMed] [CrossRef]
15. Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, et al. The ABCs of measuring intracerebral hemorrhage volume Stroke. 1996 Aug;27(8):1304-5. [PubMed] [CrossRef]
16. Li F, Chen H, Wang Y, Yang Y, Li C, Dong Z, et al. A new prognostic model and score to predict short-term outcome after intracerebral hemorrhage. Scientific Research and Assays. 2011 May 18;6(10): 2063-2068.
17. Morgenstern L, Hemphill C, Anderson C, Becker K, Broderick J, Conolly S, et al. Guideliness for the management of spontaneous intracerebral hemorrhage. A Guideline for healthcare professionals from the American Heart Association/Association. Stroke. 2010; 41:2108-2129 [CrossRef]
18. Nag C, Das K, Ghosh M, Khandakar MR. Prediction of clinical outcome in acute hemorrhagic stroke from a single CT scan on admission. North Am J Med Sci. 2012 Oct;4(10):463-467. [PubMed] [CrossRef]
19. Narayan SK, Sivaprasad P, Sushma S, Sahoo RK, Dutta TK. Etiology and outcome determinants of intracerebral hemorrhage in a south Indian population. A hospital-based study. Ann Indian Acad Neurol. 2012 Oct;15(4):263-6. [PubMed] [CrossRef]
20. Qureshi AI, Mendelow AD, Hanley DF. Intracerebral hemorrhage. Lancet. 2009 May 9;373(9675):1632-44. [PubMed] [CrossRef]
21. Rathor M, Rani M, Jamalludin A, Amran M, Shahrin T, Shah A. Prediction of functional outcome in Patients with Primary Intracerebral Hemorrhage by clinical-computed tomographic correlations. J Res Med Sci, 2012 Nov;17(11):1056-62. [PubMed]
22. Ribo M, Grotta JC. Latest advances in intracerebral hemorrhage. Curr Neurol Neurosci Rep. 2006 Jan;6(1):17-22. [PubMed]
23. Rost NS, Smith EE, Chang Y, Snider RW, Chanderraj R, Schwab K, et al. Prediction of functional outcome in patients with primary intracerebral hemorrhage: The FUNC score. Stroke. 2008 Aug;39(8):2304-9. [PubMed] [CrossRef]
24. Shaya M, Dubey A, Berk C, Gonzales-Toledo E, Zhang J, Caldito G, et al. Factors influencing outcome of intracerebral hematoma: a simple, reliable and accurate method to grade intracerebral hemorrhage. Surgical Neurology. 2005 Apr;63(4):343-348. [PubMed] [CrossRef]
25. Staikov D, Huttner H, Köhrmann M, Bardutzky J, Schellinger P. Novel approaches to the treatment of intracerebral haemorrhage. Int J Stroke. 2010 Dec;5(6):457-465. [PubMed] [CrossRef]
26. Steiner T, Peterson J, Al-Shahi Salman R, Christensen H, Cordonnier C, Csiba L, et al. European research priorities for intracerebral hemorrhage. Cerebrovasc Dis. 2011; 32(5):409-19. [PubMed] [CrossRef]
27. Teasdale G, Jennet B. Assessment of coma and impaired consciousness. Lancet. 1974 Jul 13;304 (7872):81-84. [PubMed] [CrossRef]
28. Tetri S, Juvela S, Saloheimo P, Pyhtinen J, Hillbom M. Hypertension and diabetes as predictors of early death after spontaneous intracerebral hemorrhage. J Neurosurg. 2009 Mar;110(3): 411-417. [PubMed] [CrossRef]
29. Van Swieten JC, Koudstaal PJ, Visser MC, Schoutten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988 May;19(5):604-607. [PubMed] [CrossRef]

Received: 19 December 2013
Published online: 28 March 2014

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