Anatomical Relationship and Clinical Outcome of Patients with Intracerebral Hemorrhage with Intraventricular Extension. - A Cross Sectional Study at KLES Dr. Prabhakar kore Hospital and MRC

Abstract

Background and objectives Spontaneous ICH remains a formidable disease that continues to disable and kill the majority of its victims. Stroke places a tremendous burden on health resources throughout the world. Most cases are attributed to hypertension or amyloid angiopathy. ICH occurs most frequently in the putamen (35 to 50%), followed by lobar (30%), thalamus (10 to 15%), pons (5 to 12%), caudate (7%), and the cerebellum (5%).Various studies showed that outcome in patients with ICH is related to age, clinical presentation, alcoholism, hematoma volume, IV extension etc. The objectives of present study were to study the relationship between anatomical site, clinical presentations, hematoma volume and intraventricular extension with outcome of the patients based on modified rankin scale. Methods The present cross sectional study was conducted on patients with intracerebral hemorrhage admitted to medicine and neurology wards in KLES Dr Prabhakar Kore Hospital and Medical Research Centre, Belagavi from Jan 2015 to Dec 2015. Relevant data was collected by a detailed interview with either patient or the attender, clinical examination and with the help of a predesigned and pretested proforma. Anatomical site of intracerebral hemorrhage and volume of ventricular bleed will be made out from CT/MRI scans. Clinical outcome was assessed based on Modified rankin scale score. Statistical test –Mann whitney-U test and Chi-square tests also may be used for analysis. Results We found ICH was common in the age group 51-70 years. The ICH was more common in males compared to females with M:F ratio 3.66:1. The most common clinical presentations were with neuro deficits, speech disorder and cranial nerve dysfunction. Hypertension was the most important risk factor found among patients. Most of patients with hypertension were newly detected cases. The duration and severity of hypertension didn’t have any bearing on the study group. The age and gender of the patient didn’t show any influence on the outcome of the patients in our study. The outcome of the patients were significantly affected by presentation of patients with neurodeficits/altered sensorium.The volume of bleed significantly influenced the outcome of the patients. ICH with intraventricular extension had poorer outcome as compared to ICH without intraventricular extension. Conclusion In the present involving 56 patients with intracerebral bleed, the outcome was significantly influenced by clinical presentation, volume of ICH, intraventricular extension and midline shift in the CT/MRI. The age, gender and habits didnt show any correlation with the outcome of the patient. We feel it is worthy to study by adjusting comorbid conditions like hypertension, age, sex, habits and site of bleed to know whether these patients have true association. Owing to our small sample size, studies with large sample size is required to overcome these limitations.