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Neurologic Deterioration in Noncomatose Patients with Supratentorial Intracerebral Hemorrhage
Neurol 44:1379-1384, Mayer,S.A.,et al, 1994
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Article Abstract
To determine the frequency,time course and predictors of neurologic deterioration(ND)in noncomatose patients with supratentorial intracerebral hemorrhage(ICH).ND occurred in 15 of 46 patients(33%).The frequency of ND was greatest on the first hospital day(eight of 15 patients)and decreased progressively thereafter.Patients with ND had larger hemorrhages(mean volume 45 ml vs 16 ml,p<0.01)and more frequently demonstrated marked mass effect(60%versus 19%,p<0.01)on initial CT than those with stable deficits, but did not differ with regard to mean GCS score,mean blood pressure,or other clinical variables on admission.Hematoma enlargement was judged to be the cause of worsening in four of 15(27%)patients.Thirty-day case fatality was 47%in those with ND compared with 3%in those with stable deficits(p=0.0012).ND occurs in one-third of noncomatose patients with supratentorial ICH and carries a poor prognosis.Large hematoma volume on CT,rather than clinical predictors,identifies patients at high risk for subsequent worsening.
 
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