Background and PurposeHemorrhagic stroke, particularly nontraumatic spontaneous intracerebral hemorrhage (SICH), is a cerebrovascular condition with unfavorable outcomes. The aims of the present study were to evaluate patients who suffered from SICH and investigate the early outcomes in a single‐center study.MethodsDuring a study ‐period of 6 years (2008–2014), 613 consecutive patients (mean age, 72 ± 12.7 years; 51.1% female), who suffered from nontraumatic SICH and were treated at the Department of Neurology at the University Hospital of Schleswig‐Holstein, Campus Lübeck, Germany, were included and prospectively analyzed.ResultsDuring a mean hospitalization time of 12 days, 148 patients (24.1%) died, 47% of those within the first 2 days and 79% within the first week. The patients who died stayed at the hospital for a shorter time (3) than those who survived (p < .001). In the multivariate logistic regression, following parameters were found to be associated with the in‐hospital mortality: female sex (OR, 2.0; 95%‐CI, 1.2–3.4; p = .009), a NIHSS score> 10 (OR, 10.5; 95%‐CI, 5.6–19.5; p < .001), history of hypertension (OR, 0.35; 95%‐CI, 0.19–0.64; p = .001), previous oral anticoagulation (OR, 2; 95%‐CI, 1.0–3.8; p = .032), and intraventricular extension of hemorrhage (OR, 2.8; 95%‐CI, 1.7–4.7; p = .001). At discharge, 192 patients (41.2%) showed favorable outcomes (mRS ≤ 2) whereas the median mRS of patients who survived was 3 (IQR 2–4). The good functional outcome at discharge from the acute hospital was decreased by an age> 70 years (OR, 0.56; 95%‐CI, 0.35–0.9; p = .017), NIHSS score> 10 at admission (OR, 0.07; 95%‐CI, 0.04–0.13; p < .001), and development of pneumonia during hospitalization (OR, 0.35; 95%‐CI, 0.2–0.6; p < .001).ConclusionThe present study showed that SICH is a serious disease causing high mortality and disability, particularly in the early period after event.
Background and Purpose: Early seizures (ESs) in patients with nontraumatic spontaneous intracerebral hemorrhage (sICH) are a frequent complication. The aims of this study were to determine the frequency of ESs in patients with sICH and to investigate the association of ESs with outcomes in a monocenter study. Methods: During a 5-year period (2009-2013), 484 consecutive patients (mean age 72.3 ± 12.6; female sex 51%) with sICH who were admitted to the Department of Neurology at the University of Lübeck, Germany were enrolled and prospectively evaluated. Results: A total of 52 patients (10.7%; 95% CI 8-14) experienced ESs during a mean hospitalization of 12 days. Patients with ESs were less affected on the National Institutes of Health Stroke Scale at admission than those without ESs (7 vs. 10; p = 0.02). With the exception of the localization of hemorrhage (p = 0.008), differences in the baseline characteristics between patients with ESs and those without ESs were not found. The logistic regression analysis revealed an increased ES rate in patients with cortical hemispheric sICH (OR 3.5; 95% CI 1.8-6.7; p < 0.001). During hospitalization, 109 patients (23%) died and the in-hospital mortality was lower in patients with ESs than those without (9.6 vs. 24.0%, respectively; p = 0.02). An association between ESs and good functional outcome on the modified Rankin Scale ≤2 was not found (p = 0.3). Conclusion: ESs appear to be correlated with hemorrhage localization and associated with survival of the sICH.
Higher SEDAN score was associated with an increased risk of sICH and early mortality in this monocenter study.
The most feared complication after therapy with recombinant tissue plasminogen activator (rt-PA) in patients with acute ischemic stroke is the occurrence of symptomatic intracerebral hemorrhage (sICH). Up to 11% of stroke patients who undergo treatment with rt-PA have suffered from sICH, which in turn dramatically increases the in-hospital mortality rate as well as the functional disability [1][2][3][4].Since 1996, when the US Food and Drug Administration approved thrombolysis with rt-PA for the treatment of patients with acute ischemic stroke, several different scores have been proposed to predict the risk of bleeding and outcomes, but none of them has been established in a clinical routine [4][5][6][7]. Strbian et al.[8] introduced a new score (SEDAN score).The SEDAN score (0-6 points), which is based on blood sugar (glucose, 8.1-12.0 mmol/L [145-216 mg/dL] = 1, >12.0 mmol/L [216 mg/dL] = 2), early infarct signs (yes = 1), (hyper) dense cerebral artery sign (yes = 1) on computed tomography (CT) scan at admission, age (>75 years = 1), and National Institutes of Health Stroke Scale (NIHSS) score (≥10 = 1), has been suggested to predict the risk of sICH after IV thrombolysis. The rate of sICH ranged between 1% for 0 score points and 27.8% for 5 score points, with an area under curve (AUC) value of 0.77 (0.71-0.83) [8].We included 542 stroke patients (mean age, 73 AE 13 years; 51% women; median NIHSS score, 11 [IQR,[7][8][9][10][11][12][13][14][15]) who were admitted to the Department of Neurology at the University of L€ ubeck from 2008 to 2013 and administered an IV treatment with rt-PA to validate the SEDAN score in a monocenter study. The data acquisition was a part of the stroke registry at the Department of Neurology at the University of L€ ubeck. All consecutive patients with AIS who were treated with rt-PA were included in our analysis. The baseline characteristics are shown in Table 1.
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