TY - JOUR
T1 - Natural History of Infratentorial Intracerebral Hemorrhages
T2 - Two Subgroups with Distinct Presentations and Outcomes
AU - Patel, Viren D.
AU - Garcia, Roxanna M.
AU - Swor, Dionne E.
AU - Liotta, Eric M.
AU - Maas, Matthew B.
AU - Naidech, Andrew
N1 - Funding Information:
Funding Sources: This work was supported in part by K18 HS023437 and R01 NS110779 to Dr. Naidech, and by K23 NS092975 to Dr. Maas. For Dr. Liotta, research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences , Grant Number UL1TR001422 and Grant Number KL2 TR001424 . Dr. Garcia served as the StrokeNet research fellow under grant U24 NS107233-01 and Fogarty Global Health Trainee under award D43 TW010543 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Drs. Patel and Swor have no disclosures to report.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/8
Y1 - 2020/8
N2 - Background/Objective: Infratentorial intracerebral hemorrhage (ICH) is associated with worse prognosis than supratentorial ICH; however, infratentorial ICH is often excluded or underrepresented in clinical trials of ICH. We sought to evaluate the natural history of infratentorial ICH stratified by brainstem or cerebellar location using a prospective observational study inclusive of all spontaneous ICH. Methods: Using a prospective, single center cohort of patients with spontaneous ICH between 2008-2019, we conducted a descriptive analysis of baseline demographics, severity of injury scores, and long-term functional outcomes of infratentorial ICH stratified by cerebellar or brainstem location. Results: Infratentorial ICH occurred in 82 (13%) of 632 patients in our ICH cohort. Among infratentorial ICH, cerebellar ICH occurred in 45 (55%) and brainstem ICH occurred in 37 (45%). Compared to cerebellar ICH, patients with brainstem ICH had significantly worse severity of injury scores, including lower admission Glasgow Coma Scale (median 14 [7.0 – 15.0] versus 4 [3.0 – 8.0], respectively; P < 0.001) and higher ICH Score (median 2 [1.0 – 3.0] versus 3 [2.75 – 4.0], respectively; P = 0.02). Patients with cerebellar ICH were more likely to be discharged home or to acute rehabilitation (OR 4.8, 95% CI 1.8 – 12.8) but there was no difference in in-hospital mortality (OR 0.4, 95% CI 0.1 – 1.1, P = 0.08) or cause of death (P = 0.5). Modified Rankin Scale scores at 3 months were significantly better in patients with cerebellar ICH compared to brainstem ICH (median 3.5 [1.8 - 6.0] versus median 6 [5.0 - 6.0], P = 0.03). Conclusions: Location of infratentorial ICH is an important determinant of admission severity and clinical outcome in unselected patients with ICH. Patients with cerebellar ICH have less severe symptoms at presentation and more favorable functional outcomes compared to patients with brainstem ICH.
AB - Background/Objective: Infratentorial intracerebral hemorrhage (ICH) is associated with worse prognosis than supratentorial ICH; however, infratentorial ICH is often excluded or underrepresented in clinical trials of ICH. We sought to evaluate the natural history of infratentorial ICH stratified by brainstem or cerebellar location using a prospective observational study inclusive of all spontaneous ICH. Methods: Using a prospective, single center cohort of patients with spontaneous ICH between 2008-2019, we conducted a descriptive analysis of baseline demographics, severity of injury scores, and long-term functional outcomes of infratentorial ICH stratified by cerebellar or brainstem location. Results: Infratentorial ICH occurred in 82 (13%) of 632 patients in our ICH cohort. Among infratentorial ICH, cerebellar ICH occurred in 45 (55%) and brainstem ICH occurred in 37 (45%). Compared to cerebellar ICH, patients with brainstem ICH had significantly worse severity of injury scores, including lower admission Glasgow Coma Scale (median 14 [7.0 – 15.0] versus 4 [3.0 – 8.0], respectively; P < 0.001) and higher ICH Score (median 2 [1.0 – 3.0] versus 3 [2.75 – 4.0], respectively; P = 0.02). Patients with cerebellar ICH were more likely to be discharged home or to acute rehabilitation (OR 4.8, 95% CI 1.8 – 12.8) but there was no difference in in-hospital mortality (OR 0.4, 95% CI 0.1 – 1.1, P = 0.08) or cause of death (P = 0.5). Modified Rankin Scale scores at 3 months were significantly better in patients with cerebellar ICH compared to brainstem ICH (median 3.5 [1.8 - 6.0] versus median 6 [5.0 - 6.0], P = 0.03). Conclusions: Location of infratentorial ICH is an important determinant of admission severity and clinical outcome in unselected patients with ICH. Patients with cerebellar ICH have less severe symptoms at presentation and more favorable functional outcomes compared to patients with brainstem ICH.
KW - Brain hemorrhage
KW - Cerebral hemorrhage
KW - Intracranial hemorrhages
KW - Posterior fossa hemorrhage
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U2 - 10.1016/j.jstrokecerebrovasdis.2020.104920
DO - 10.1016/j.jstrokecerebrovasdis.2020.104920
M3 - Article
C2 - 32423853
AN - SCOPUS:85085153176
SN - 1052-3057
VL - 29
JO - Journal of Stroke and Cerebrovascular Diseases
JF - Journal of Stroke and Cerebrovascular Diseases
IS - 8
M1 - 104920
ER -