title: Time course and predictors of neurological deterioration after intracerebral hemorrhage.
abstract: OBJECTIVE
  Neurological deterioration (ND) is a devastating complication after intracerebral hemorrhage but little is known about time course and predictors.
  
  
  METHODS
  We performed a retrospective cohort study of placebo patients in intracerebral hemorrhage trials. We performed computed tomographic scans within 3 hours of symptoms and at 24 and 72 hours; and clinical evaluations at baseline, 1-hour, and days 1, 2, 3, and 15. Timing of ND was predefined as follows: hyperacute (within 1 hour), acute (1-24 hours), subacute (1-3 days), and delayed (3-15 days).
  
  
  RESULTS
  We enrolled 376 patients and 176 (47%) had ND within 15 days. In multivariate analyses of ND by category, hyperacute ND was associated with hematoma expansion (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.7-7.6) and baseline intracerebral hemorrhage volume (OR, 1.04 per mL; 95% CI 1.02-1.06); acute ND with hematoma expansion (OR, 7.59; 95% CI, 3.91-14.74), baseline intracerebral hemorrhage volume (OR, 1.02 per mL; 95% CI, 1.01-1.04), admission Glasgow Coma Scale (OR, 0.77 per point; 95% CI, 0.65-0.91), and interventricular hemorrhage (OR, 2.14; 95% CI, 1.05-4.35); subacute ND with 72-hour edema (OR, 1.03 per mL; 95% CI, 1.02-1.05) and fever (OR, 2.49; 95% CI, 1.01-6.14); and delayed ND with age (OR, 1.11 per year; 95% CI, 1.04-1.18), troponin (OR, 4.30 per point; 95% CI, 1.71-10.77), and infections (OR, 3.69; 95% CI, 1.11-12.23). Patients with ND had worse 90-day modified Rankin scores (5 versus 3; P<0.001).
  
  
  CONCLUSIONS
  ND occurs frequently and predicts poor outcomes. Our results implicate hematoma expansion and interventricular hemorrhage in early ND, and cerebral edema, fever, and medical complications in later ND.
authors: From the Division of Neurocritical Care, Department of Neurology, New York University School of Medicine (A.S.L.); Division of Neurocritical Care, Department of Neurology, Yale University School of Medicine (E.G.); Division of Neurocritical Care, Department of Neurology, University of Texas, Houston (H.A.C.); and Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, NY (S.A.M.). Aaron.Lord@Nyumc.org.
authors: Aaron S
authors: AS
authors: Lord
authors: From the Division of Neurocritical Care, Department of Neurology, New York University School of Medicine (A.S.L.); Division of Neurocritical Care, Department of Neurology, Yale University School of Medicine (E.G.); Division of Neurocritical Care, Department of Neurology, University of Texas, Houston (H.A.C.); and Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, NY (S.A.M.).
authors: Emily
authors: E
authors: Gilmore
authors: From the Division of Neurocritical Care, Department of Neurology, New York University School of Medicine (A.S.L.); Division of Neurocritical Care, Department of Neurology, Yale University School of Medicine (E.G.); Division of Neurocritical Care, Department of Neurology, University of Texas, Houston (H.A.C.); and Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, NY (S.A.M.).
authors: H Alex
authors: HA
authors: Choi
authors: From the Division of Neurocritical Care, Department of Neurology, New York University School of Medicine (A.S.L.); Division of Neurocritical Care, Department of Neurology, Yale University School of Medicine (E.G.); Division of Neurocritical Care, Department of Neurology, University of Texas, Houston (H.A.C.); and Institute of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, NY (S.A.M.).
authors: Stephan A
authors: SA
authors: Mayer
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000150:complications* / Q000175:diagnosis*; D035061:Control Groups; D005260:Female; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000150:complications* / Q000503:physiopathology*; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Glasgow Coma Scale; cerebral hemorrhage; neurological disorders
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