A Prospective Observational Study of Incidence, Associated Factors, and Impact of Spontaneous Intracranial Hematoma Expansion Admitted at a Teaching Hospital of North Western India

Abstract Background: Intra cranial hematoma (ICH) can be a life-threatening condition in many cases. The outcome depends on various factors, one such being spontaneous ICH expansion. Timely identification of ICH expansion can help us prognosticate the patient and provide individualized care. The present study aimed to determine the incidence of ICH expansion and determine the clinical and radiological variables predicting expansion; along with the prognosis of these patients. Materials and Methods: This prospective and observational study included 94 ICH patients, who presented within 24 h of symptom onset. ICH volume was measured using ABC/2 method, and repeat computed tomography was done within 72 h or when clinically indicated. Clinical and radiological parameters were noted and looked for the prognosis of patient after expansion in the form of average hospital stay, ICH score, and modified Rankin Scale (mRS). Results: Out of 94 patients, 14 (15%) patients showed expansion (10 males [71%], 4 females [29%]). In clinical profile, headache ( P = 0.04) and hemiparesis ( P < 0.001), and radiologically marginal irregularity ( P < 0.001), hypodensities ( P < 0.001), ovoid shape ( P = 0.004), and circular shape ( P = 0.04) showed significant results. While initial volume ( P = 0.16), systolic blood pressure ( P = 0.28), fluid level ( P = 0.15), cerebral edema ( P = 0.18), and Intra ventricular extension (IV) ( P = 0.98) were more in expander group but did not reach to statistically significant level. Prognosis worsened with prolonged stay ( P = 0.05) and deterioration of ICH score ( P = 0.02) as well as mRS. Conclusions: Certain clinical (early presentation and hemiparesis) and radiological (hypodensity within hematoma, marginal irregularity, and ellipsoid shapes) parameters are significantly associated with hematoma expansion. Insight into these predictors can improve the prognosis of hematoma expansion in patients with spontaneous ICH.