Hydrocephalus: A Previously Unrecognized Predictor of Poor Outcome From Supratentorial Intracerebral Hemorrhage

Abstract

Background and Purpose-Although several factors have been identified that predict outcome after intracerebral hemorrhage (ICH), no previous study has investigated the impact of hydrocephalus. The purpose of this study was to determine whether the presence of hydrocephalus after ICH would predict mortality and functional outcome. Methods-Patients with spontaneous supratentorial ICH were identified in our prospectively collected database to determine the following: age, sex, race, past medical history; Glasgow Coma Scale (GCS) score and blood pressure on admission; use of mechanical ventilation, mannitol, and ventriculostomy; and medical complications. CT scans performed within 24 hours of hemorrhage were retrospectively analyzed to determine lesion size and location, pineal shift, cisternal effacement, intraventricular hemorrhage (IVH), and hydrocephalus. Outcome was determined with use of hospital disposition (dead, nursing home, rehabilitation, home) and functional outcome (Functional Independence Measure [FIM]) at 3 months. Patients with and without hydrocephalus were compared and univariate and multivariate analyses performed to determine whether hydrocephalus was an independent predictor of mortality. Data are presented as meanϮSD. Results-Of the 81 patients studied, 40 had hydrocephalus. Those with hydrocephalus were younger (57Ϯ15 versus 67Ϯ15 years), had lower GCS scores (8.2Ϯ4.2 versus 11Ϯ2.9), were more likely to have ganglionic or thalamic hemorrhages, and were intubated more frequently (70% versus 27%). Hospital mortality was higher in patients with hydrocephalus (51% versus 2%), and fewer patients went home (21% versus 35%). Those who died had higher hydrocephalus scores (9.67Ϯ7.1 versus 5.75Ϯ4.5). Outcome was no different if a ventriculostomy was placed. The final logistic regression model included hydrocephalus score, gender, GCS, and pineal shift, and it correctly predicted 85% of patients as dead or alive. Multivariate analyses indicated that hydrocephalus is an independent predictor of mortality. Conclusions-We conclude that hydrocephalus is an independent predictor of mortality after ICH. (Stroke.1998;29:1352-1357.)

Race‐Specific Predictors of Mortality in Intracerebral Hemorrhage: Differential Impacts of Intraventricular Hemorrhage and Age Among Blacks and Whites

“…Blacks with ICH/IVH presented at a younger age in our study and in others 3, 6, 7. Similarly, hydrocephalus after ICH with IVH occurs more commonly in younger patients 24. Although it is not entirely clear why young IVH patients develop hydrocephalus at a higher and faster rate compared to older patients, the presence of pre‐existing cerebral atrophy in older patients may delay hydrocephalus formation by allowing for some degree of compensation for additional intracranial volume.…”

“…Hematoma expansion was defined as a proportional increase of more than 33% or an absolute increase greater than 6 cc (if baseline ICH volume ≤15 cc) from the initial ICH volume 23. Hydrocephalus was defined as rounding of the frontal horns with increased radius or decreased ventricular angle, increased width of the temporal horns, rounding and enlargement of the atrium with sulcal effacement, increased width of the third ventricle, or ballooning of the fourth ventricle 24. ICH score was computed for each patient as previously described 13.…”

Predictors of Early Mortality in Young Adults After Intracerebral Hemorrhage

“…Hydrocephalus was defined as increased radius or decreased ventricular angle in frontal horns, rounding and enlargement of atrium with sulcal effacement, increased width of third ventricle, or ballooning of fourth ventricle. 3 Herniation was defined as ≥8 mm of horizontal displacement of pineal body from the midline, or any displacement of brain parenchyma behind tentorium, or through the foramen magnum.…”

“…Our results on the general clinicoradiologic prognostic characteristics are in line with previous studies involving younger 1 and older patients. 3,4 These have reported higher mortality in patients with intraventricular extension, hydrocephalus, Glasgow Coma Scale <8, and hematoma volume of >30 mL, as well as infratentorial ICH location. 1,3,4 According to previous randomized trials, no advantage over conservative treatment has been achieved with surgical treatment.…”

“…3,4 These have reported higher mortality in patients with intraventricular extension, hydrocephalus, Glasgow Coma Scale <8, and hematoma volume of >30 mL, as well as infratentorial ICH location. 1,3,4 According to previous randomized trials, no advantage over conservative treatment has been achieved with surgical treatment. 5,6 However, our study and the randomized trials are not comparable because of our study's observational nature, older study populations of the trials, and the fact that trials excluded patients with infratentorial ICH and ICH related to structural causes.…”