Intracranial hypertension in hemorrhagic stroke: a single-center retrospective study

Background. Hemorrhagic stroke (HS) is a polyetiological disease including all forms of non-traumatic intracranial hemorrhage, accompanied by high disability and mortality. More than 67% of spontaneous intracerebral hemorrhage cases are complicated by intracranial hypertension (ICH), and ICH occurs in 71% of patients with aneurysmal subarachnoid hemorrhage. Objective. To evaluate the incidence of ICH, mortality, functional outcomes, and predictors of treatment outcomes in patients with severe HS. Material and methods. A single-center retrospective study was conducted at the regional stroke center in Arkhangelsk. We analyzed the incidence of ICH and outcomes in patients with HS. Predictors of mortality and functional recovery of patients after HS were estimated using logistic and linear regression models. Results. The study enrolled 74 patients with HS and implanted probe for intracranial pressure (ICP) monitoring. ICH developed in 45 (60 %) cases. Mortality rate was 39.2% (n=29). ICH was an independent predictor of mortality in HS (adjusted OR 4.4, 95% CI 1.4—16.4 (p=0.04). Maximum in-hospital ICP was also an independent predictor of mortality (adjusted OR 1.08, 95% CI 1.0—1.1, p=0.002). Incidence of ICH was not associated with modified Rankin Scale score (mRS) at discharge (B=0.3 (β=0.08), 95% CI –0.49 to 1.04 (p=0.48), but maximum ICH was independently associated with higher mRS score (B=0.03 (β=0.36), 95% CI 0.02 to 0.05 (p<0.001). Conclusion. ICH is a common phenomenon in HS patients with high mortality rate. ICH is a predictor of mortality in patients who underwent ICP monitoring. At the same time, functional outcome was determined by maximum in-hospital ICP, but not ICH per se.