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Predictors of Poor Outcome in Patients with a Spontaneous Cerebellar Hematoma

Published online by Cambridge University Press:  04 August 2016

Erik K. Louis ,
Eelco F. M. Wijdicks ,
Hongzhe Li  and
John D. Atkinson
Erik K. Louis*
Affiliation:
From the Department of Neurology and Department of Neurologic Surgery, Neurological and Neurosurgical Intensive Care Unit, Saint Mary's Hospital, Mayo Clinic and Foundation, Rochester, MN,USA
Eelco F. M. Wijdicks
Affiliation:
Section of Biostatistics, Mayo Clinic and Foundation, Rochester, MN,USA
Hongzhe Li
Affiliation:
Section of Biostatistics, Mayo Clinic and Foundation, Rochester, MN,USA
John D. Atkinson
Affiliation:
Section of Biostatistics, Mayo Clinic and Foundation, Rochester, MN,USA
*
Department of Neurology, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905
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Abstract:

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Background and purpose:

The authors studied the clinical and neuroimaging features of cerebellar hematomas to predict poor outcome using comprehensive statistical models.

Methods:

We retrospectively reviewed clinical and neuroimaging features in 94 patients with spontaneous cerebellar hematomas to identify predictive features for a poor neurologic outcome, defined as death or dismissal to long-term care facility. Data were analyzed using chi square and Fisher's exact test with calculation of odd's ratios together with 95% confidence intervals.

Results:

Clinical and neuroradiologic predictors for a poor outcome at p < 0.05 were admission systolic blood pressure > 200 mm Hg, hematoma size >3cm, visible brain stem distortion, and acute hydrocephalus. Presenting findings predicting subsequent death at p < 0.05 were abnormal corneal and oculocephalic responses, Glasgow coma sum score less than 8, motor response less than localization to pain, acute hydrocephalus and intraventricular hemorrhage.

Conclusion:

A tree-based analysis model using binary recursive partitioning showed that cornea reflex, hydrocephalus, doll's eyes, age, and size were the most important discriminating factors. Absent corneal reflexes on admission highly predicts poor outcome (86 percent, confidence limits 67-96 percent). When a cornea reflex is present, acute hydrocephalus predicts poor outcome but only when doll's eyes are additionally absent.

Résumé:

RÉSUMÉ:Introduction et Objectif:

Les auteurs ont étudié les caractéristiques cliniques et neuroradiologiques d'hématomes cérébelleux afin de prédire au moyen de modèles statistiques ceux qui comportent un mauvais pronostic.

Méthodes:

Nous avons revu de façon rétrospective les caractéristiques cliniques et neuroradiologiques de 94 patients porteurs d'hématomes cérébelleux spontanés pour identifier les signes prédictifs de séquelles neurologiques importantes définies comme le décès ou le placement dans une institution de soins prolongés. Les données ont été analysées au moyen du chi carré, de la méthode exacte de Fisher ainsi que du calcul du risque relatif et de l'intervalle de confiance (IC) à 95%.

Résultats:

Les prédicteurs cliniques et neuroradiologiques d'un mauvais pronostic (p <0.05) étaient une pression systolique >200 mm Hg à l'admission, un hématome de plus de 3 cm, une distorsion visible du tronc cérébral et une hydrocéphalie aiguë. Les observations au moment de l'examen initial qui prédisent un décès subséquent (p >0.05) étaient une réponse cornéenne et oculocéphalogyre anormales, un score de moins de 8 à l'échelle de Glasgow, un score moindre pour la réponse motrice que pour la localisation à la douleur, une hydrocéphalie aiguë et une hémorragie intraventriculaire.

Interprétation:

Un algorythme d'analyse utilisant un cloisonnement récursif binaire a montré que le réflexe cornéen, l'hydrocéphalie, le phénomène des yeux de poupée, l'âge et la taille de l'hématome étaient les facteurs discriminants les plus importants. Des réflexes cornéens absents à l'admission étaient un signe important d'un mauvais pronostic (86%, intervalle de confiance 67 à 96%). Quand le réflexe cornéen est présent, une hydrocéphalie aiguë indique un mauvais pronostic, mais seulement quand le phénomène des yeux de poupée est également absent.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 27 , Issue 1 , February 2000 , pp. 32 - 36
Copyright
Copyright © The Canadian Journal of Neurological 2000

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