Background and Purpose
Neurological deterioration (ND) is a devastating complication following intracerebral hemorrhage (ICH) but little is known about time course and predictors.
Methods
We performed a retrospective cohort study of placebo patients in ICH trials. We performed CT scans within 3 hours of symptoms and at 24- and 72-hours; and clinical evaluations at baseline, 1-hour, and days 1, 2, 3, and 15. Timing of ND was predefined: hyperacute (within 1 hour), acute (1-24 hours), subacute (1-3 days), and delayed (3-15 days).
Results
We enrolled 376 patients and 176 (47%) had ND within 15 days. In multivariate analyses of ND by category, hyperacute ND was associated with hematoma expansion (OR 3.6, 95% CI 1.7-7.6) and baseline ICH volume (OR 1.04 per mL, 95% CI 1.02-1.06) ; acute ND with hematoma expansion (OR 7.59, 95% CI 3.91-14.74), baseline ICH volume (OR 1.02 per mL, 95% CI 1.01-1.04), admission GCS (OR 0.77 per point, 95% CI 0.65-0.91) and interventricular hemorrhage (IVH) (OR 2.14, 95% CI 1.05-4.35); subacute ND with 72-hour edema (OR 1.03 per mL, 95% CI 1.02-1.05) and fever (OR 2.49, 95% CI 1.01-6.14); and delayed ND with age (OR 1.11 per year, 95% CI 1.04-1.18), troponin (OR 4.30 per point, 95% CI 1.71-10.77) and infections (OR 3.69, 95% CI 1.11-12.23). Patients with ND had worse 90-day modified Rankin scores (5 vs. 3, p<0.001).
Conclusions
Neurological deterioration occurs frequently and predicts poor outcomes. Our results implicate hematoma expansion and IVH in early ND, and cerebral edema, fever, and medical complications in later ND.