A STUDY OF CLINICAL AND IMAGING PROFILE IN SPONTANEOUS INTRACEREBRALHEMORRHAGE
brief resume of the intended work:
6.1 NEED FOR STUDY. Cerebrovascular diseases rank first in frequency and importance
among all neurologic diseases. Of all the cerebrovascular diseases, intracerebral
haemorrhage is the most dramatic and catastrophic. Various clinical and radiological
parameters have been proved useful as predictors of prognosis in spontaneous
intracerebral hemorrhage . This study is to identify the risk factors, correlate various
clinical and radiological parameters with the prognosis of the patients and to
assess the utility of Intracerebral Hemorrhage(ICH) score in intracerebral
hemorrhage in patients attending KIMS hospital Hubli
6.2 REVIEW OF THE LITERATURE:
Stroke is the second leading cause of death worldwide, and one of the leading causes of disability. With increasing life expectancy the burden of stroke is likely to increase worldwide with middle and low income countries particularly affected. Intracerebral hemorrhage is the second most
common subtype of stroke after ischemic stroke and accounts for approximately 10 % to 20 % of all strokes. Hypertension has been identified as the single most important risk factor causing intracerebral hemorrhage. Other risk factors include alcohol, smoking, diabetes, anticoagulant use1and other genetic risk factors. The incidence of intracerebral hemorrhage increases with age and it is more among men and in Asians 1.
Nag C, Das K, Ghosh M, Khandakar M R3 concluded in their study that in primary intracerebral hemorrhage, from a single non contrast CT scan, clinical outcome can be assessed on admission by using the CT scan parameters like hematoma volume, location of stroke, midline shift , intraventricular extension of bleed and ventricle compression. Mansooreh togha and Khadigeh Bakhtavar4 in their study concluded that factors independently associated with in-hospital mortality were Glasgow Coma Scale (GCS) score (≤ 8), diabetes mellitus disease, volume of hematoma and intraventricular hematoma and that higher rate of mortality were observed during the first two weeks of hospitalization following ICH. Ak. Joy Singh, Kh. Mani Singh Ak. Brogen , W Jatishwor Singh, N Bimol Singh5 concluded in their study that death and functional outcome on 30th day were well correlated with the initial volume of bleed .
Hemphill JC, Bonovich DC ,Besmertis L, Manley GT, Johnston SC6 proved in their study the ICH score is a simple clinical grading scale that allows risk stratification on presentation with ICH. The use of a scale such as the ICH Score could improve standardization of clinical treatment protocols and clinical research studies in ICH. Daniel Agustin Godoy, Gustavo Pinero Mario Di Napoli7 confirmed in their study that, the ICH score is a good predictor of 30-mortality and functional outcome in different socioeconomic population.
6.3 AIMS AND OBJECTIVES OF THE STUDY:
1. To study the clinical profile of spontaneous intracerebral hemorrhage and to identify the risk factors.
2. To study the clinical and radiological parameters that would predict the prognosis of hemorrhagic stroke.
3. To assess the utility of ICH score as a tool to predict outcome of hemorrhagic stroke.
MATERIALS AND METHODS :
7.1 SOURCE OF DATA: All patients admitted in Department of Medicine, Karnataka Institute
of Medical Sciences, Hubli during the period of 1st November 2012 to 31st October 2013 will
be taken for study considering the inclusion and exclusion criteria .
7.2 METHODS OF COLLECTION OF DATA:
Information will be collected through prepared proforma for each patient.
All patients will be interviewed as per the proforma and a complete clinical examination will be done.
Cases of spontaneous intra cerebral hemorrhage diagnosed with clinical history, examination and non-contrast CT.
Patients’ demographic, social, economic and medical details will be
recorded in the proforma sheet.
The following data are to be collected from the patients.
2. Temperature in °F at admission.
3. Mean arterial pressure. This is calculated by:
Mean arterial pressure = Diastolic pressure + 1/3 pulse pressure
4. Glasgow coma score at admission.
CT brain will be done on the day of admission and the following data
will be collected.
5. Volume of Bleed.
6. Location of Bleed.
7. Presence / absence of intraventricular haemorrhage, midline shift,
Results will be analysed with appropriate statistical methods.
As per hospital statistics 33 patients were patients were admitted in Department of Medicine, KIMS, Hubli in the year 2011 with spontaneous intracerebral hemorrhage. All the patients admitted with spontaneous intracerebral hemorrhage in medical wards during the period will be taken for the study.
TYPE OF STUDY: Follow up study(30days), hospital based, time bound study.
SAMPLING: All the patients presenting with spontaneous intracerebral hemorrhage in
Medicine Department, KIMS Hospital during this period will be taken for the study.
Inclusion criteria :
All patients >18yrs admitted with spontaneous intracerebral hemorrhage to