Prediction of 30-day mortality in spontaneous cerebellar hemorrhage

Safatli, Diaa Al; Guenther, Albrecht; McLean, Aaron Lawson; Waschke, Albrecht; Kalff, Rolf; Ewald, Christian

doi:10.4103/sni.sni_479_16

Cited by 12 publications

(14 citation statements)

References 39 publications

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“…Spontaneous cerebellar hemorrhage (SCH) account for represent 5 to 13% of all cases of spontaneous intracerebral hemorrhage and about 15% of cerebellar strokes [1–6]. It is often due to hypertension and the reported mortality rate within 6 months can reach 50%, and more than 60% of surviving patients had moderate or severe disability [6–8]. The prognostic risk factors of outcome in patients with SCH including hyperglycemia and platelet count at admission, a larger hematoma volumes or diameter, a lower Glasgow Coma Scale (GCS) at admission, and imaging findings that reveal the initial presence of hydrocephalus, intraventricular hemorrhage (IVH), the appearance of the fourth ventricle, or basal cistern obliteration have been reported in several studies [2, 6, 8–12].…”

Section: Introductionmentioning

confidence: 99%

Predictive factors of neurologic deterioration in patients with spontaneous cerebellar hemorrhage: a retrospective analysis

Hsu

Lin

et al. 2019

BMC Neurol

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Background Cerebellar hemorrhage is a potentially life-threatening condition and neurologic deterioration during hospitalization could lead to severe disability and poor outcome. Finds out the factors influencing neurologic deterioration during hospitalization is essential for clinical decision-making. Methods One hundred fifty-five consecutive patients who suffered a first spontaneous cerebellar hemorrhage (SCH) were evaluated in this 10-year retrospective study. This study aimed to identify potential clinical, radiological and clinical scales risk factors for neurologic deterioration during hospitalization and outcome at discharge. Results Neurologic deterioration during hospitalization developed in 17.4% (27/155) of the patient cohort. Obliteration of basal cistern (p≦0.001) and hydrocephalus (p≦0.001) on initial brain computed tomography (CT), median Glasgow Coma Scale (GCS) score at presentation (p≦0.001) and median intracerebral hemorrhage (ICH) score (P≦0.001) on admission were significant factors associated with neurologic deterioration. Stepwise logistic regression analysis showed that patients with obliteration of basal cistern on initial brain CT scan had an odds ratio (OR) of 9.17 ( p = 0.002; 95% confidence interval (CI): 0.026 to 0.455) adjusted risk of neurologic deterioration compared with those without obliteration of basal cistern. An increase of 1 point in the ICH score on admission would increase the neurologic deterioration rate by 83.2% ( p = 0.010; 95% CI: 1.153 to 2.912). The ROC curves showed that the AUC for ICH score on presentation was 0.719 ( p = 0.000; 95% CI: 0.613–0.826) and the cutoff value was 2.5 (sensitivity 80.5% and specificity 73.7%). Conclusion Patients had obliteration of basal cistern on initial brain CT and ICH score greater or equal to 3 at admission implies a greater danger of neurologic deterioration during hospitalization. Cautious clinical assessments and repeated brain images study are mandatory for those high-risk patients to prevent neurologic deterioration during hospitalization.

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Section: Introductionmentioning

confidence: 99%

Predictive factors of neurologic deterioration in patients with spontaneous cerebellar hemorrhage: a retrospective analysis

Hsu

Lin

et al. 2019

BMC Neurol

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“…Of these 121 articles, 41 (34%) articles fulfilled the predefined inclusion criteria and were therefore included in this systematic review (figure 1). 4 12–51 The 41 eligible studies described 2062 patients (40% female) of which 1171 (57%) underwent haematoma evacuation and 891 (43%) did not. Thirty-seven (90%) studies had a retrospective design.…”

Section: Resultsmentioning

confidence: 99%

“…Based on the available literature and its limitations as described previously, there is currently insufficient published evidence to guide treatment decisions on when and for whom haematoma evacuation for spontaneous cerebellar ICH should be performed 13–51. Ultimately, randomised clinical trials may well be needed to assess the role of haematoma evacuation in patients with spontaneous cerebellar ICH.…”

Section: Discussionmentioning

confidence: 99%

Haematoma evacuation in cerebellar intracerebral haemorrhage: systematic review

Singh

Brouwers

Senff

et al. 2019

J Neurol Neurosurg Psychiatry

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BackgroundGuidelines regarding recommendations for surgical treatment of spontaneous cerebellar intracerebral haemorrhage (ICH) differ. We aimed to systematically review the literature to assess treatment strategies and outcomes.MethodsWe searched PubMed and Embase between 1970 and 2019 for randomised or otherwise controlled studies and observational cohort studies. We included studies according to predefined selection criteria and assessed their quality according to the Newcastle-Ottawa Scale (NOS) and risk of bias according to a predefined scale. We assessed case fatality and functional outcome in patients treated conservatively or with haematoma evacuation. Favourable functional outcome was defined as a modified Rankin Scale score of 0–2 or a Glasgow Outcome Scale score of 4–5.ResultsWe included 41 observational cohort studies describing 2062 patients (40% female) with spontaneous cerebellar ICH. A total of 1171 patients (57%) underwent haematoma evacuation. Ten studies described a cohort of surgically treated patients (n=533) and 31 cohorts with both surgically and conservatively treated patients (n=638 and n=891, respectively). There were no randomised clinical trials nor studies comparing outcome between the groups after adjustment for differences in baseline characteristics. The median NOS score (IQR) was 5 (4–6) out of 8 points and the bias score was 2 (1–3) out of 8, indicative of high risk of bias. Case fatality at discharge was 21% (95% CI 17% to 25%) after conservative treatment and 24% (95% CI 19% to 29%) after haematoma evacuation. At ≥6 months after conservative treatment, case fatality was 30% (95% CI 25% to 30%) and favourable functional outcome was 45% (95% CI 40% to 50%) and after haematoma evacuation, case fatality was 34% (95% CI 30% to 38%) and 42% (95% CI 37% to 47%).ConclusionsControlled studies on the effect of neurosurgical treatment in patients with spontaneous cerebellar ICH are lacking, and the risk of bias in published series is high. Due to substantial differences in patient characteristics between conservatively and surgically treated patients, and high variability in treatment indications, a meaningful comparison in outcomes could not be made. There is no good published evidence to support treatment recommendations and controlled, preferably randomised studies are warranted in order to formulate evidence-based treatment guidelines for patients with cerebellar ICH.

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“…Al Safatli D showed that a GCS score <10 on admission was associated with increased 30-day mortality and poorer short-term outcomes of patients with SCH. 34 Other researchers have demonstrated that GCS scores ≤ 8 on arrival are a strong predictive factor for first-week mortality and shortand long-term poor prognoses of patients with SCH. [35][36][37][38] Hydrocephalus was observed in 22.6% of all patients, similar to the previously reported 23%.…”

Section: Discussionmentioning

confidence: 97%

Risk Factors for Postoperative Rebleeding and Short-Term Prognosis of Spontaneous Cerebellar Hemorrhage

Shen

Shao

et al. 2021

RMHP

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Postoperative rebleeding (PRB) is one of the most severe complications after hematoma evacuation of spontaneous intracerebral hemorrhage (ICH). PRB has been proven to be an independent risk factor for poor prognosis. Previous studies have shown that spot sign and blend sign are independent risk factors for PRB of spontaneous ICH. However, the risk factors for PRB of spontaneous cerebellar hemorrhage (SCH) have not been elucidated. The aim of the present study was to investigate the possible risk factors for PRB and shortterm prognosis of patients with SCH. Patients and Methods: This study identified 62 patients with SCH who underwent hematoma evacuation in our department. Risk factors for PRB and short-term prognosis were identified by a univariable logistic regression model, and predictors with a P value of less than 0.05 were included in the multivariable logistic regression model to identify independent predictors. A receiver operating characteristic (ROC) curve was created to test the sensitivity and specificity of independent risk factors. Results: Hematoma volume was the only independent predictor of PRB (OR=15.14, 95% CI=1.08-213.1, P=0.044). The sensitivity and specificity of hematoma volume to PRB were 63.6% and 89.7%, respectively, and the cutoff value of hematoma volume was >29.3 mL. GCS score ≤8 (OR=5.131, 95% CI=1.030-25.554, P=0.046) and PRB (OR=13.17, 95% CI=1.316-131.798, P=0.028) were independent risk factors for poor prognosis of patients with SCH. The sensitivity and specificity of the GCS score to poor prognosis were 66.7% and 86.2%, respectively. The sensitivity and specificity of the PRB to poor prognosis were 36.4% and 96.6%, respectively. Conclusion: Hematoma volume is likely to be a strong predictor of PRB among patients with SCH. GCS scores ≤8 on arrival and PRB were significant predictors of short-term poor outcome.

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Prediction of 30-day mortality in spontaneous cerebellar hemorrhage

Cited by 12 publications

References 39 publications

Predictive factors of neurologic deterioration in patients with spontaneous cerebellar hemorrhage: a retrospective analysis

Predictive factors of neurologic deterioration in patients with spontaneous cerebellar hemorrhage: a retrospective analysis

Haematoma evacuation in cerebellar intracerebral haemorrhage: systematic review

Risk Factors for Postoperative Rebleeding and Short-Term Prognosis of Spontaneous Cerebellar Hemorrhage

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