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Predictors of good outcome in medium to large spontaneous supratentorial intracerebral haemorrhages
  1. M Castellanos1,
  2. R Leira2,
  3. J Tejada3,
  4. A Gil-Peralta4,
  5. A Dávalos1,
  6. J Castillo2,
  7. for the Stroke Project, Cerebrovascular Diseases Group of the Spanish Neurological Society
  1. 1Department of Neurology, Hospital Doctor Josep Trueta, Girona, Spain
  2. 2Department of Neurology, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
  3. 3Department of Neurology, Hospital Virgen Blanca, León, Spain
  4. 4Department of Neurology, Hospital Virgen del Rocio, Seville, Spain
  1. Correspondence to:
 Dr José Castillo
 Department of Neurology, Hospital Clínico Universitario Santiago de Compostela, Travesa da Choupana s/n, Santiago de Compostela 15706, Spain;


Objective: To determine potential predictors of good outcome in primary medium to large intracerebral haemorrhages (ICH) which could be useful for selecting patients for surgical procedures.

Methods: Subjects were 138 patients with spontaneous hemispheric ICH >20 ml. They were non-surgically treated and were admitted consecutively to 15 hospitals within the first 12 hours of symptom onset (mean (SD), 5.8 (3.1) hours). Haematoma volume was measured on computed tomography (CT) at admission. Stroke severity was assessed by the Canadian stroke scale (CSS). Good outcome was defined as modified Rankin score ⩽2 at three months.

Results: At the end of the follow up period, 45 patients (32.6%) had good outcome. Baseline stroke severity, systolic and diastolic blood pressure, body temperature, and acute phase reaction biochemical markers (ESR, C-reactive protein, fibrinogen, neutrophil count) were significantly associated with good outcome in bivariate analyses. Of the initial CT scan variables, intraventricular contamination, deep location, mass effect, and greater ICH volume were related to poor outcome. On multiple logistic regression analysis, cortical location of bleeding (odds ratio 3.79 (95% confidence interval 1.2 to 12.01); p = 0.023), high CSS score (OR 2.3 (1.6 to 3.1); p<0.0001), and low fibrinogen concentrations (OR 0.92 (0.87 to 0.97); p = 0.001) were independent predictors of good outcome. These three factors correctly classified 85% of patients.

Conclusions: Good outcome in medium to large ICH can be predicted on admission by three readily assessable factors (CSS score, ICH location, and fibrinogen levels). These predictors may be helpful in selecting patients for surgical treatment.

  • CSS, Canadian stroke scale
  • ICH, intracerebral haemorrhage
  • mRS, modified Rankin score
  • intracerebral haemorrhage
  • outcome
  • stroke

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  • Competing interests: none declared