Presentation of intracerebral haemorrhage in a community.
BACKGROUND
Studies on intracerebral haemorrhage (ICH) from tertiary care centres may not be an accurate representation of the true spectrum of disease presentation.


OBJECTIVE
To describe the clinical and imaging presentation of ICH in a community devoid of the referral bias of an academic medical centre; and to investigate factors associated with lower Glasgow coma scale (GCS) score at presentation, as GCS is crucial to early clinical decision making.


METHODS
The study formed part of the BASIC project (Brain Attack Surveillance in Corpus Christi), a population based stroke surveillance study in a bi-ethnic Texas community. Cases of first non-traumatic ICH were identified from years 2000 to 2003, using active and passive surveillance. Clinical data were collected from medical records by trained abstractors, and all computed tomography (CT) scans were reviewed by a study physician. Multivariable linear regression was used to identify clinical and CT predictors of a lower GCS score.


RESULTS
260 cases of non-traumatic ICH were identified. Median ICH volume was 11 ml (interquartile range 3 to 36) with hydrocephalus noted in 45%. Median initial GCS score was 12.5 (7 to 15). Hydrocephalus score (p = 0.0014), ambient cistern effacement (p = 0.0002), ICH volume (p = 0.014), and female sex (p = 0.024) were independently associated with lower GCS score at presentation, adjusting for other variables.


CONCLUSIONS
ICH has a wide range of severity at presentation. Hydrocephalus is a potentially reversible cause of a lower GCS score. Since early withdrawal of care decisions are often based on initial GCS, recognition of the important influence of hydrocephalus on GCS is warranted before withdrawal of care decisions are made.
Stroke Program, University of Michigan Medical School, Ann Arbor, MI 48109-0316, USA.
D B
DB
Zahuranec
N R
NR
Gonzales
D L
DL
Brown
L D
LD
Lisabeth
P J
PJ
Longwell
S V
SV
Eden
M A
MA
Smith
N M
NM
Garcia
J T
JT
Hoff
L B
LB
Morgenstern
D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D005260:Female; D015600:Glasgow Coma Scale; D006764:Hospitals, Community; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013781:Texas; D014057:Tomography, X-Ray Computed