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Prognostic significance of ventricular blood in supratentorial hemorrhage

A volumetric study

Departments of Neurology (W.B. Young, K.P. Lee, M.S. Pessin, and L.R. Caplan), Radiology (E.S. Kwan), and Community Health (W.M. Rand), Tufts University School of Medicine and the New England Medical Center, Boston, MA.

We reviewed CTs from 47 patients with 48 spontaneous, supratentorial brain hemorrhages to determine the effect of ventricular blood on outcome. We correlated volumetric analysis of the parenchymal (P) and ventricular (V) blood, as well as other clinical and CT features, with clinical outcome in a statistical analysis. Hemorrhages were located in putamen 20/48 (42%), thalamus 13/48 (27%), lobar 9/48 (19%), caudate 3/48 (6%), and miscellaneous locations 3/48 (6%). Outcome in putaminal hemorrhages was highly correlated with the total (P+V) and P blood volumes, whereas the V blood was less important. For thalamic hemorrhages, outcome correlated more highly with the V and P+V volumes than with the P portion. Outcome for ail hemorrhages was significantly correlated, in descending order of importance, with the severity of the initial neurologic deficit, P+V blood, hydrocephalus, the number of ventricles containing blood, P, V, and blood in the 4th ventricle. In general patients with more than 20 cc of V blood did poorly. Although hydrocephalus was associated with poor outcome, ventricular drainage did not benefit 8 of 9 patients.

Address correspondence and reprint requests to Dr. Michael S. Pessin, New England Medical Center, 750 Washington Street, Boston, MA 02111.

Presented in part at the 41st annual meeting of the American Academy of Neurology, Chicago, IL, April 1989.

Received August 14, 1989. Accepted for publication in final form September 29, 1989.

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