Predictors and Outcomes of Hematoma Expansion and Neurological Decline in Intracerebral Hemorrhage: A Multisite Mobile Stroke Unit Study

Authors

• Asish K Gulati
• Tianwen Ma
• Isaiah Rolle
• Ryan Peterson
• Bianca Pirlog
• Justine Chen
• Megan Heckathorn
• Jonathan Ratcliff
• Nicolas Bianchi
• Carol Fleming
• Michael Frankel
• James Grotta
• Ritvij Bowry
• Stephanie Parker
• William Hicks
• Digvijaya Navalkele

Language

English

Publication Date

1-1-2025

Journal

STROKE: Vascular and Interventional Neurology

DOI

10.1161/SVIN.124.001546

PMID

41608401

PMCID

PMC11864578

PubMedCentral® Posted Date

12-25-2024

PubMedCentral® Full Text Version

Post-print

Abstract

Background: Hemorrhagic stroke, particularly intracerebral hemorrhage, is one of the leading causes of permanent disability worldwide. Early hematoma expansion (HE) is a key factor in neurological deterioration (ND) and functional outcomes post intracerebral hemorrhage. This observational cohort study examines the predictors and outcomes of HE and ND in spontaneous intracerebral hemorrhage patients using data from 3 Mobile Stroke Units (MSUs) in the United States.

Methods: Patients diagnosed with spontaneous intracerebral hemorrhage within 4 hours of last known well were included. Data collection involved initial and follow-up non-contrast (computerized tomography) CT scans from MSUs and emergency departments, from which the rate of HE and ND were determined. The interrater reliability for radiographic signs of HE was also assessed. Predictive factors were analyzed using multiple logistic regression models.

Results: Of the 55 patients who met the inclusion criteria, 27% experienced HE within the first 4 hours from last known well with the majority of HE occurring within the first 60 to120 minutes. Significant predictors of HE were a history of diabetes and blend sign on initial MSU CT scans. Predictors of ND included initial hematoma volume and the presence of hydrocephalus. Patients with HE and ND had a higher discharge modified-Rankin Scale score and mortality rates. Interrater agreement on radiographic signs of HE varied, with moderate agreement on some signs and little to none on others.

Conclusion: Highest HE was seen within 60 to120 minutes from last known well for patients between MSU and emergency department transport. The blend sign and a history of diabetes emerged as key predictors of HE, whereas initial hematoma volume and hydrocephalus were significant for ND. Interventions to prevent HE and ND should be tested on the MSU in future studies.

Published Open-Access

yes

Recommended Citation

Gulati, Asish K; Ma, Tianwen; Rolle, Isaiah; et al., "Predictors and Outcomes of Hematoma Expansion and Neurological Decline in Intracerebral Hemorrhage: A Multisite Mobile Stroke Unit Study" (2025). Faculty, Staff and Student Publications. 3853.
https://digitalcommons.library.tmc.edu/uthmed_docs/3853