IP Indian Journal of Neurosciences 2019;5(4):181–188 Content available at: iponlinejournal.com IP Indian Journal of Neurosciences Journal homepage: www.innovativepublication.com Original Research Article Factors associated with enlargement of hematoma in patients with primary intracranial hemorrhage Alok Verma 1 , Saurabh Agarwal 2 , Manish Singh 3, * 1 Dept.of Neurology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India 2 Dept. of Medicine, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India 3 Dept. of Neurosurgery, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India ARTICLE INFO Article history: Received 31-10-2019 Accepted 16-11-2019 Available online 14-12-2019 Keywords: ute Health SHematoma enlargement National Instittroke Scale score Glasgow Coma Scale ABSTRACT Introduction: This study is done to evaluate the role of different clinical factors in hematoma enlargement, especially severe hypertension during the early phase of spontaneous ICH. Materials and Methods: All patients with spontaneous intracranial hematoma who were of > 18 years in age, presented within 24 hour of onset, were enrolled for this study. Repeat CT scan was done within 24 - 48 hours after 1st scan. Results: 88 patients were enrolled and among them, 11 (12.5%) had >20% enlargement in the size of the hematoma on the second CT. The Mean increase in the size of hematoma was 19.8 ± 11.4 ml (47.3 ± 27.2 %). Progression of symptom after onset and after admission, lower GCS (< 8) at admission, time from onset to CT < 6 hrs, higher NIHSS at admission and midline shift were significantly associated with the enlargement of the hematoma. Mean systolic BP at admission > 200 mm Hg was present in a higher proportion of patients with hematoma enlargement. Conclusion: The present study showed that patients of spontaneous ICH presenting within 6 hours with higher NIHSS, low GCS (GCS <8), larger hematoma volume and midline shift, had increased risk of hematoma enlargement. SBP >200 mm of Hg at admission may be a potential risk factor. ( Hematoma enlargement, NIHSS =National Institute Health Stroke Scale score, GCS =Glasgow Coma Scale, MAP=mean arterial pressure) © 2019 Published by Innovative Publication. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by/4.0/) 1. Introduction Stroke is a major cause of morbidity and mortality, especially among the elderly population. Stroke is 4th leading cause of death in India and 3rd in the USA. 1,2 among all kinds of stroke intracranial hemorrhage contributes to 15 -30% case. 3 ICH is more common in Asian and black populations than the western popul ation. 3 The case fatality of ICH ranges from 17-58%. 1,2,4 Till now supportive medical care is the only mainstay of treatment. 5,6 Historically, ICH bleeding was considered to be a monophasic event that stopped quickly as a result of clotting and by surrounding brain tissue. Now in recent years, * Corresponding author. E-mail address: manishsinghneurosurgery@gmail.com (M. Singh). few studies have shown that an increase in the size of spontaneous hematoma may occur even after few hours of onset, can lead to clinical deterioration, increased morbidity and mortality. 7–10 In cases of spontaneous ICH, early deterioration occurs within few hours or a day of onset, usually because of hematoma enlargement while delayed deterioration occurs because of edema associated with hematoma. 11 More recently, prospective and retrospective CT-based studies have demonstrated that hematoma growth occurs in up to 35% of patients initially scanned within 3 hours of onset, even in the absence of coagulopathy. In a prospective study, substantial growth (>33%) in the volume of parenchymal hemorrhage occurred in 26% of the 103 study patients between the baseline CT (within 3 hours of onset) and 1-hour CT scans. An additional 12% of patients https://doi.org/10.18231/j.ijn.2019.029 2581-8236/© 2019 Innovative Publication, All rights reserved. 181