Clinical Course and Outcomes of Small Supratentorial Intracerebral Hematomas.
OBJECTIVE
Intracerebral hemorrhage (ICH) volume, particularly if ≥30 mL, is a major determinant of poor outcome. We used a multinational ICH data registry to study the characteristics, course, and outcomes of supratentorial hematomas with volumes <30 mL.


METHODS
Basic characteristics, clinical and radiological course, and 30-day outcomes of these patients were recorded. Outcomes were categorized as early neurological deterioration (END), hematoma expansion, Glasgow Outcome Scale (GOS), and in-hospital death. Poor outcome was defined as composite of in-hospital death and severe disability (GOS ≤ 3). Comparison was conducted based on hemorrhage location. Logistic regression using dichotomized outcome scales was applied to determine predictors of poor outcome.


RESULTS
Among 375 cases of supratentorial ICH with volumes <30 mL, expansion and END rates were 19.2% and 7.5%, respectively. Hemorrhage growth was independently associated with END (odds ratio: 28.7, 95% confidence interval [CI]: 8.51-96.5; P < .0001). Expansion rates did not differ according to ICH location. Overall, 13.9% (exact binomial 95% CI: 10.5-17.8) died in the hospital and 29.1% (CI: 24.5-34.0) had severe disability at 30 days; there was a cumulative poor outcome rate of 42.9% (CI: 37.9-48.1). Age, admission Glasgow Coma Scale, intraventricular extension, and END were independently associated with poor outcome. There was no difference in poor outcome rates between lobar and deep locations (40.2% versus 43.8%, P = .56).


CONCLUSIONS
Patients with supratentorial ICH <30 mL have high rates of poor outcome at 30 days, regardless of location. Nearly 1 in 5 hematomas <30 mL expands, leading to END or death.
Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, Texas. Electronic address: behrouz@uthscsa.edu.
Réza
R
Behrouz
Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, Texas.
Vivek
V
Misra
The Neurointensive Care Unit, Sanatorio Pasteur, Catamarca, Argentina; The Intensive Care Unit, Hospital Interzonal de Agudos "San Juan Bautista", Catamarca, Argentina.
Daniel A
DA
Godoy
Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, Texas.
Christopher H
CH
Topel
Department of Internal Medicine, Santa Maria Nuova Hospital, Florence, Italy.
Luca
L
Masotti
Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University of Nijmegen Medical Centre, Nijmegen, The Netherlands.
Catharina J M
CJM
Klijn
Comprehensive Stroke Centre, Manchester Academic Health Sciences, Salford Royal NHS Foundation Trust, Salford, UK.
Craig J
CJ
Smith
Comprehensive Stroke Centre, Manchester Academic Health Sciences, Salford Royal NHS Foundation Trust, Salford, UK; The Stroke and Vascular Centre, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK.
Adrian R
AR
Parry-Jones
School of Healthcare Science, Manchester Metropolitan University, Manchester, UK.
Mark A
MA
Slevin
Department of Neurology, Alpert Medical School, Brown University, Providence, Rhode Island.
Brian
B
Silver
Department of Neurology, Columbia University College of Physician and Surgeons, New York, New York.
Joshua Z
JZ
Willey
Department of Neurology, Ramón y Cajal University Hospital, Alcalá University, Madrid, Spain.
Jaime
J
Masjuán Vallejo
Stroke Unit, Centro Hospitalar do Algarve; and Biomedical and Medicine Department, University of Algarve, Algarve, Portugal.
Hipólito
H
Nzwalo
University of Medicine and Pharmacy of Craiova, Craiova, Romania; Department of Psychiatry, Aging and Psychiatric Disorders Group, Rostock University Medical School, Rostock, Germany.
Aurel
A
Popa-Wagner
The Palm Beach Neuroscience Institute, West Palm Beach, Florida; Comprehensive Stroke Center, St. Mary's Medical Center, West Palm Beach, Florida.
Ali R
AR
Malek
Department of Neurology, School of Medicine, University of Texas Health Science Center, San Antonio, Texas.
Shaheryar
S
Hafeez
Neurological Service, San Camillo de' Lellis General Hospital, Rieti, Italy; The Neurological Section, SMDN, Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy.
Mario
M
Di Napoli
D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D016208:Databases, Factual; D004185:Disability Evaluation; D018450:Disease Progression; D005060:Europe; D005260:Female; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D007843:Latin America; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States
Intracerebral hemorrhage; all cerebrovascular diseases; outcomes; prognosis