title: Perihematomal edema as predictor of outcome in spontaneous intracerebral hemorrhage.
abstract: BACKGROUND
  Spontaneous intracerebral hemorrhage (SICH) is a form of cerebrovascular accident with a very high rate of morbidity and mortality. The determinants of prognosis include the demographic, clinical, laboratory, and radiologic factors. It is long known that the hematoma size has a negative impact on the outcome in SICH. The influence of perihematomal edema (PHE) is not established to the extent same as that of hematoma volume. Hence, we planned this study to determine as to what role does PHE plays in the outcome in SICH.
  
  
  OBJECTIVE
  To evaluate the prognostic influence of absolute and relative edema (ratio of absolute edema to hematoma volume) in the patients of SICH.
  
  
  METHODS
  This is a prospective case-controlled study. A total of 44 patients were enrolled after excluding the confounding factors. The patients were evaluated and their disability was assessed using modified Rankin scale (MRS). The imaging was done in the interval between 24 and 72 h and the hematoma volume, absolute edema volume, and the relative edema were calculated. The outcome was reassessed at 12 weeks and defined as favorable if MRS < 3.
  
  
  RESULTS
  A total of 69 patients were found to be having SICH on imaging; however, 25 patients were excluded as they had one of the criterion for exclusion. Hence, only 44 patients were included in the study. On univariate analysis, none of the demographic characteristics of the patients, vascular risk factors, presenting complaints, blood pressure, Glasgow coma scale, and MRS at admission, laboratory parameters were not significantly different in the two outcome groups. The hematoma volume was significantly higher in the poor outcome group (P < 0.0001) and the relative edema was associated with a favorable outcome at 12 weeks (P < 0.0001). On multivariate logistic regression, the hematoma volume and relative edema were found to have effect on the outcome similar to that seen on univariate analysis.
  
  
  CONCLUSIONS
  In SICH, a larger hematoma volume is a predictor of poor outcome and a relative edema is associated with a better functional status.
authors.affiliation: Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Mani
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Verma
authors.affiliation: Department of Radiodiagnosis, King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Anit
authors.initials: A
authors.lastname: Parihar
authors.affiliation: Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Ravindra K
authors.initials: RK
authors.lastname: Garg
authors.affiliation: Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Maneesh K
authors.initials: MK
authors.lastname: Singh
authors.affiliation: Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India.
authors.forename: Hardeep S
authors.initials: HS
authors.lastname: Malhotra
keywords: Hematoma volume; modified rankin scale score; perihematomal absolute edema; relative edema; spontaoneous intracerebral hemorrhage
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