N. Gupta, A. Pradhan, Sufyan Ibrahim, Benak S, Ajay Hegde, G. Menon
{"title":"原发性脑干出血——来自中风登记的机构系列和结果决定因素的评估","authors":"N. Gupta, A. Pradhan, Sufyan Ibrahim, Benak S, Ajay Hegde, G. Menon","doi":"10.1177/25166085231186377","DOIUrl":null,"url":null,"abstract":"Primary brainstem hemorrhage (PBH) carries poor prognosis and the need for aggressive management is a matter of debate especially in developing countries with limited resources. The aim of this study was to analyze the prognostic factors in mortality prediction following PBH in a series of 59 consecutive patients. A single institutional, retrospective, cohort study with a study period of 6 years (2016-2021). All patients with computerized tomography-proven intracerebral hematoma in the midbrain, pons, or medulla, alone or in combination were included in the study. Outcome was analyzed using a modified Rankin score (mRS) and was categorized into good (mRS 0, 1, 2, and 3), poor (mRS 4 and 5), and death. Statistical analysis was done using univariate regression analysis followed by multivariate regression analysis and a P value < .05 was considered significant. A total of 59 patients diagnosed with primary brainstem hematoma were included in the study. Of the 59 patients, 40 (67.79%) were males and 19 (32.2%) were females, with a mean age of 55.51 ± 13.46 (range of 29-93 years). The median admission GCS score on admission was 6. No definite history of hypertension could be elicited in 18 patients (30.50%). The most common site for a brain stem hematoma was the pons 47 (79.9%) followed by pons-midbrain combination (06 10.2%). The average clot volume was 7.78 ± 6.5 mL. Fourth ventricular extension was seen in 18 patients (28.8%%) of whom 15 (27.2%) developed hydrocephalus. All patients were managed conservatively. At 3 months, 34 patients (57.62%) succumbed to the illness while 25 survived (42.37%) of whom only 12 had a good outcome (mRS 0-3). In addition to GCS score < 8, ( P < .001) large clot volume (>10 mL) ( P < .001), high systolic blood pressure on admission, and intraventricular extension, a high admission neutrophil-to-lymphocyte ratio (NLR) ( P < .03) was found to have significant correlation with mortality. Brainstem hemorrhage has a high mortality and few patients have good clinical outcome. Admission GCS, clot volume, hypertensive in etiology, and a high NLR are poor prognostic factors. Low GCS on admission is the most important and independent predictor of mortality and poor outcome.","PeriodicalId":93323,"journal":{"name":"Journal of stroke medicine","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Primary Brainstem Hemorrhage—An Institutional Series From a Stroke Register and Evaluation of Outcome Determinants\",\"authors\":\"N. Gupta, A. Pradhan, Sufyan Ibrahim, Benak S, Ajay Hegde, G. Menon\",\"doi\":\"10.1177/25166085231186377\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Primary brainstem hemorrhage (PBH) carries poor prognosis and the need for aggressive management is a matter of debate especially in developing countries with limited resources. The aim of this study was to analyze the prognostic factors in mortality prediction following PBH in a series of 59 consecutive patients. A single institutional, retrospective, cohort study with a study period of 6 years (2016-2021). All patients with computerized tomography-proven intracerebral hematoma in the midbrain, pons, or medulla, alone or in combination were included in the study. Outcome was analyzed using a modified Rankin score (mRS) and was categorized into good (mRS 0, 1, 2, and 3), poor (mRS 4 and 5), and death. Statistical analysis was done using univariate regression analysis followed by multivariate regression analysis and a P value < .05 was considered significant. A total of 59 patients diagnosed with primary brainstem hematoma were included in the study. Of the 59 patients, 40 (67.79%) were males and 19 (32.2%) were females, with a mean age of 55.51 ± 13.46 (range of 29-93 years). The median admission GCS score on admission was 6. No definite history of hypertension could be elicited in 18 patients (30.50%). The most common site for a brain stem hematoma was the pons 47 (79.9%) followed by pons-midbrain combination (06 10.2%). The average clot volume was 7.78 ± 6.5 mL. Fourth ventricular extension was seen in 18 patients (28.8%%) of whom 15 (27.2%) developed hydrocephalus. All patients were managed conservatively. At 3 months, 34 patients (57.62%) succumbed to the illness while 25 survived (42.37%) of whom only 12 had a good outcome (mRS 0-3). In addition to GCS score < 8, ( P < .001) large clot volume (>10 mL) ( P < .001), high systolic blood pressure on admission, and intraventricular extension, a high admission neutrophil-to-lymphocyte ratio (NLR) ( P < .03) was found to have significant correlation with mortality. Brainstem hemorrhage has a high mortality and few patients have good clinical outcome. Admission GCS, clot volume, hypertensive in etiology, and a high NLR are poor prognostic factors. 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Primary Brainstem Hemorrhage—An Institutional Series From a Stroke Register and Evaluation of Outcome Determinants
Primary brainstem hemorrhage (PBH) carries poor prognosis and the need for aggressive management is a matter of debate especially in developing countries with limited resources. The aim of this study was to analyze the prognostic factors in mortality prediction following PBH in a series of 59 consecutive patients. A single institutional, retrospective, cohort study with a study period of 6 years (2016-2021). All patients with computerized tomography-proven intracerebral hematoma in the midbrain, pons, or medulla, alone or in combination were included in the study. Outcome was analyzed using a modified Rankin score (mRS) and was categorized into good (mRS 0, 1, 2, and 3), poor (mRS 4 and 5), and death. Statistical analysis was done using univariate regression analysis followed by multivariate regression analysis and a P value < .05 was considered significant. A total of 59 patients diagnosed with primary brainstem hematoma were included in the study. Of the 59 patients, 40 (67.79%) were males and 19 (32.2%) were females, with a mean age of 55.51 ± 13.46 (range of 29-93 years). The median admission GCS score on admission was 6. No definite history of hypertension could be elicited in 18 patients (30.50%). The most common site for a brain stem hematoma was the pons 47 (79.9%) followed by pons-midbrain combination (06 10.2%). The average clot volume was 7.78 ± 6.5 mL. Fourth ventricular extension was seen in 18 patients (28.8%%) of whom 15 (27.2%) developed hydrocephalus. All patients were managed conservatively. At 3 months, 34 patients (57.62%) succumbed to the illness while 25 survived (42.37%) of whom only 12 had a good outcome (mRS 0-3). In addition to GCS score < 8, ( P < .001) large clot volume (>10 mL) ( P < .001), high systolic blood pressure on admission, and intraventricular extension, a high admission neutrophil-to-lymphocyte ratio (NLR) ( P < .03) was found to have significant correlation with mortality. Brainstem hemorrhage has a high mortality and few patients have good clinical outcome. Admission GCS, clot volume, hypertensive in etiology, and a high NLR are poor prognostic factors. Low GCS on admission is the most important and independent predictor of mortality and poor outcome.