Elavarasi Manimegalai, E (2010) Prognostic Predictors of 30 day Outcome in Patients with Non Traumatic Intraparenchymal Haemorrhage. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Cerebrovascular diseases rank first in frequency and important among all neurologic diseases. It is the second cause of mortality in the World. A stroke or cerebrovascular accident is defined by the abrupt onset of a neurologic deficit that is attributable to a focal vascular cause. 80% of stroke is ischaemic and remaining 20% is due to haemorrhage. Intracranial haemorrhage includes: 1. Intraparenchymal haemorrhage, 2. Intraventricular haemorrhage, 3. Subarachnoid haemorrhage. There is 2 – 3 fold increased risk of intraparenchymal haemorrhage in Asians and Blacks. Many controversies surround the management of patients with ICH in large part because of paucity of prospective randomized controlled trial data that might more rationally guide therapy. These controversies include management of hypertension, treatment of raised ICP and appropriate use of surgical techniques. Since there is no sufficiently efficacious therapy for haemorrhage induced cerebral injury, prevention is the mainstay of treatment particularly hypertension. It is appropriate to think in terms of pathophysiology to guide management decisions. It would be useful, therefore, to know something about the time, course and prognosis of ICH. Various factors have been identified as predicting outcome including age, gender, race, initial MAP, temperature, volume of bleed, site of bleed, intraventricular extension, mass effect and initial level of consciousness. This study is done to evaluate and discuss the significances of various factors in predicting 30 day mortality and morbidity of patients with nontraumatic intraparenchymal haemorrhage in hypertension and non-hypertension haemorrhage stroke. AIM OF THE STUDY: 1. To evaluate the prognostic factors in predicting 30 day outcome in patients with non traumatic intraparenchymal haemorrhage admitted to medical wards in the Government General Hospital, Chennai. 2. To find out the prognostic significance of: a. Age, b. Temperature, c. Mean arterial pressure, d. GCS score at admission, e. Volume of Bleed, f. Location of Bleed, g. Intraventricular haemorrhage. in predicting 30 day outcome assessed by NIHSS score in patients with non-traumatic intraparenchymal haemorrhage admitted to the medical wards in the Government General Hospital, Chennai. 3. To compare the results with that one reported in literature. MATERIALS AND METHODS: All patients with acute stroke admitted in the medical ward of Government General Hospital, Chennai from April 2009 to July 2009 were investigated for haemorrhagic stroke by obtaining a CT brain. Inclusion Criteria: Patients with non traumatic intraparenchymal haemorrhage admitted to medical wards. Exclusion Criteria: 1. Patients with history of Trauma 2. Patients with suh arachnoid haemorrhage alone 3. Patients with intraventricular haemorrhage alone 4. Patients with previous history of intraparenchymal haemorrhage The following data were collected from the patients. 1. Age, 2. Temperature in °F at admission, 3. Mean arterial pressure. This is calculated by: a. Mean arterial pressure = Diastolic pressure + 1/3 pulse pressure. 4. Glassgow coma score at admission to assess the severity of the bleed. CT brain was done on the day of admission and the following data were collected. 5. Volume of Bleed, 6. Location of Bleed, 7. Presence / Absence of Intraventricular haemorrhage. CONCLUSION: • Age, Gender, Temperature do not have a significant role in detecting the 30 day mortality rate in patients with IPH. i) Volume of Bleed, ii) GCS at admission, iii) Presence of IVH, iv) Mean Arterial Pressure, have a significant role in detecting the 30 day mortality in IPH patients. • Location of bleed at sites other than Brainstem did not have a difference in mortality in this study. Studies with larger number of patients with different locations of Bleed may throw some light on this aspect • A case of stroke with ICH with MAP < 145mm Hg, GCS > 8, Volume of Bleed < 30ml, in the absence of IVH has 80% chance of survival after 30 days with the best NIHSS score. • Early detection of HT and prompt management can prevent the occurrence of event.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Prognostic Predictors ; 30 day Outcome ; Patients ; Non Traumatic Intraparenchymal Haemorrhage. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 29 Mar 2018 02:16 |
| Last Modified: | 29 Mar 2018 02:16 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6721 |
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