London, United Kingdom 2013 Poster Session Blue Cerebrovasc Dis 2013; 35 (suppl 3)1-854 803 862 Intracerebral/subarachnoid haemorrhage and venous diseases Predictors of In-Hospital Mortality in Indian Patients with Intracerebral Hemorrhage: A Pro-spective Study R. Bhatia1, H. Singh2, S. Singh3, M.V. Padma4, K. Prasad5, G. Kumar6, M. Tripathi7, M.B. Singh8 All India Institute of Medical Sciences, New Delhi, INDIA1, All India Institute of Medical Scienc-es, New Delhi, INDIA2, All India Institute of Medical Sciences, New Delhi, INDIA3, All India Insti-tute of Medical Sciences, New Delhi, INDIA4, All India Institute of Medical Sciences, New Delhi, INDIA5, All India Institute of Medical Sciences, New Delhi, INDIA6, All India Institute of Medical Sciences, New Delhi, INDIA7, All India Institute of Medical Sciences, New Delhi, INDIA8 Background Intracerebral hemorrhage (ICH) is associated with high mortality and morbidity. We aimed to study factors associated with in-hospital mortality in patients with intracerebral hemorrhage and observe the disability status of patients (using modified Rankin scale) at the time of discharge. Methods Patients with acute hypertensive ICH were enrolled prospectively. All patients were evaluated for detailed clinical, biochemical and CT findings. Primary outcome was defined as either death or sur-vival within the hospital. mRS at discharge was noted. Results Among a total of 214 patients(193 supratentorial and 21 infratentorial), 70 (32.7%) patients died and 144 (67.3%) survived during the hospital stay. On bivariate analysis, low GCS (Glasgow coma scale), ventilatory assistance, higher baseline hematoma volume, midline shift, hydrocephalous and intraventricular extension of hematoma were associated with mortality. ICH-GS (intracerebral hemorrhage grading scale and ICH (intracerebral hemorrhage score) scores were also statistically higher in patients who died (p<0.0001). 95 (44.6%) patients underwent a neurosurgical intervention with hematoma evacuation in 49 (22.9%) and external ventricular drainage (EVD) in 46 (21.5%). 66 (45.8%) patients among survivors underwent an intervention compared with 29 (41.4%) among the group which died (p=0.54, OR 0.83,95%CI 0.46-1.48), with hematoma evacuation in 37 (56.1%) and 12 (41.4%) respectively (p=0.18, OR 0.55, 95% CI 0.22-1.34). Independent predictors of mor-tality included a higher baseline hematoma volume (p=0.04 OR 1.01, 95%CI 1.00-1.02), lower GCS (p=0.01 OR 2.57, 95%CI 1.25-5.29), intraventricular extension of hematoma (p=0.007 OR 2.66, 95%CI 1.26-5.56) and ventilatory requirement (p<0.0001 OR 8.34, 95%CI 2.75-25.38). Among survivors (n= 144), most were disabled { mRS 0-3, 7(4.8%) and mRS 4-5, 137(95.13%) } at discharge. Conclusions Low GCS, higher baseline ICH volume, presence of IVH and need for ventilatory assistance are in-dependent predictors of mortality. Most of the patients at discharge were disabled. Surgery did not improve mortality or outcome. 863 Intracerebral/subarachnoid haemorrhage and venous diseases Ultrasound Perfusion Imaging After Aneurysmal Subarachnoid Hemorrhage (PSAB) G. Seidel1, B. Fischer2, D. Kücken3 Department of Neurology, AK Nord - Heidberg, Hamburg, GERMANY1, Department of Neu-rology, AK Nord - Heidberg, Hamburg, GERMANY2, Department of Neurology, AK Nord - Heid-berg, Hamburg, GERMANY3 Aim: Spasms after subarachnoid hemorrhage (SAH) are a major complication of the disease. Clin-ical symptoms (DCI = delayed cerebral ischemia) and transcranial Doppler (TCD) detection of spasms are often not clearly related. Currently there is no method available for predicting DCI with high accuracy. Recent studies using perfusion CT show a correlation between perfusion abnormali-ties and the development of DCI. In our prospective monocentric ongoing trial we use perfusionso-nography to predict DCI. Methods: Consecutive SAH patients were prospectively investigated in 2-day intervals within the first 13 days after SAH. Conventional TCD, contrast agent based real-time perfusion-sonogra-phy (UPI = ultrasound perfusion imaging), and clinical course (NIHSS) were assessed. We used a Philips iU22 system: axial investigation plane, 10 cm investigation depth, 2.4 ml of SonoVue™, re-plenishment kinetics, off-line analysis QLAB™: perfusion parameters A and beta in 4 defined ROI as well as qualitative image analysis. At least weekly a cranial CT was performed. Results: The study started in January 2012. Up to date (12/2012) 18 SAH patients were included in the study (13 women, mean age: 57.4 years median 56.5), median Hunt and Hess score: 1.5). In 7 cases (38.8%) transtemporal acoustic bone window was not sufficient. Brain infarction was diag-nosed in five of the 11 patients with sufficient acoustic bone window. UPI showed a complete perfu-sion deficit in the area of infarction in 3 of the 5 patients. For the detection of infarction sensitivity, specificity, positive and negative predictive values of perfusion deficit, TCD-spasm and a combina-tion of perfusion deficit or spasm were: 0.6, 0.8, 1.0 / 1.0, 0.83, 0.83 / 1.0, 0.8, 0.83 / 0.75, 0.83, 1.0. Conclusions: First results of our prospective ongoing trial showed that UPI enables direct visualiza-tion of cerebral infarction after SAH in the early stages at the patient`s bedside. Highest sensitivity for the detection of infarction was achieved by a combination of UPI and TCD (ClinicalTrials.gov ID: NCT01537263).
Karger_ESC London_2013
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