Spectrum of Intracerebral Hemorrhage in a Tertiary Hospital

Abstract

Introduction: Intracerebral hemorrhage is a devastating  type of stroke that leads to profound morbidity and carries high mortality. Survivors of  hemorrhagic stroke  suffer  not only from physical  and social decline but also results in loss of productivity and financial burden.

Causes of hemorrhagic stroke are hypertension, coagulopathic condition, diabetes mellitus and cardiovascular diseases. lesional hemorrhagic stroke can be due to subarachnoid hemorrhage from intracranial aneurysm,  arteriovenous malformation, dural arteriovenous fistula etc.

Methods: A retrospective cross sectional study carried out at KISTMCTH. Data from six years duration was analysed from hospital records, outpatient department records. Patients that presented with intracranial hemorrhage were included. Post operative patients and traumatic intracerebral hemorrhage cases were not included.

Results:  Total of 112 patients was included in the study. 73 (65.1%) of them were male and 39 (34.8%) were female. putamen and caudate region were most common 47 (41.9%) followed by subarachnoid region 27 (24.1%), thalamus 19 (16.9%), cerebellum 9 (8.04%) , lobar region 8 (7.1%) and brainstem 2 (1.7%). Intracranial hemorrhage was more common in age group of 41-60 years 59 (52.6%)  followed by age group 61- 100 years 42 (37.5%). 14 (51.8%) female had subarachnoid hemorrage in comparision to 13 male (48.1%). Anterior communicating artery aneurysm had highest occurrence 10 (37%) followed by middle cerebral artery aneurysm 6 (22.2%) , paraclinnoidal / anterior choroidal/posterior communicating artery aneurysm 5 (18.5%),  vertebral artery aneurysm 3 (11.1%), distal anterior cerebral artery aneurysm 1 (3.7%).

Intracranial hemorrhage had highest occurrence on the month of January (15%)  and lowest on the month of November (3.57%). 29 (25.8%) of total intracranial hemorrhage patient had intraventricular extension of hemorrhage. Intraventricular extension was more common in thalamic hematoma 15 (13.39%) followed by caudate/putaminal hematoma 10 (8.9%), cerebellum 3 (2.6%).Modified Rankin Scale ( MRS) outcome score was found to be highest as MRS 6 for 34 (30.6%) patients . while good outcome in terms of MRS 1 , MRS 2 and MRS 3  were observed for  7 (6.2%), 26 (23.2%), 25 (22.3%) patients respectively.

Conclusion: Hypertension remains one of the major risk factor that results in various location specific hemorrhage   and it  shows specific peak seasonal variation. Proper blood pressure control is recommended  for prevention of  intracranial hemorrhages.