Clinical and neuroradiological predictors of mortality in patients with primary pontine hemorrhage |
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| Institution: | 1. Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA;2. Department of Family Medicine, Universidad San Carlos de Occidente, Quetzaltenando, Guatemala;3. Department of Obstetrics and Gynecology, Hospital Escuela, Tegucigalpa, Honduras;4. Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA;5. Department of Obstetric Medicine, Intensive Care and Obstetric Investigation Group, Sociedad Colombiana de Anestesiologia y Reanimación, Cartagena, Colombia;6. Department of Pediatrics, Wayne State University, Detroit, MI, USA;7. Department of Obstetrics and Gynecology, Centre for Innovative Medical Technology, Department of Clinical Research, Odense University Hospital and University of Southern Denmark, Odense, Denmark;8. American Academy of Family Physicians, Leawood, KS, USA;9. Department of Family and Community Medicine, Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, USA |
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| Abstract: | Background and purposePrimary pontine hemorrhage (PPH) accounts aproximately for about 5–10% of intracranial hemorrhages, and PPHs are known to have a much less uniform prognosis. We aimed to evaluate the clinical and radiological predictors affecting the mortality in 32 patients with PPH.Material and methodsWe retrospectively evaluated the data of 32 patients with PPH admitted to our clinic between 1994 and 2004. We divided the patients into two groups: (1) patients who survived (14 patients), and (2) patients who died (18 patients). The two groups were compared for age, gender, diabetes mellitus, hypertension, initial clinical status, initial GCS, pupillary abnormalities, ophthalmoparesis, volume and localisation of hemorrhage, intraventricular and extrapontine extension, necessity of mechanical ventilation and hydrocephalus. The hematoma volumes were measured with the formulation described by Broderick.ResultsEighteen patients (56%) died and 14 patients (44%) survived. The patients who died (61.3 ± 8.8) were older than the survivors (56.4 ± 11.0), but the difference was not statistically significant. The mean GCS was 4.4 ± 0.2, the mean hematoma volume was 9.9 ± 3.3 ml for patients who died and the mean GCS was 10.1 ± 3.3, the mean hematoma volume was 3.3 ± 1.2 ml for survivors (p < 0.001). Coma on admission (p = 0.001), extrapontine extension (p = 0.001), intraventricular extension (p = 0.019), necessity of mechanical ventilation (p = 0.007), hydrocephalus (p = 0.024), massive and bilateral tegmental localisation (p = 0.006) were found statistically significant predictors for mortality with univariate comparison, and coma on admission (p = 0.038) was the only significant predictor with multivariate regression analysis.ConclusionIn patients with PPH, it is important to know the prognostic factors for mortality for planning the treatment protocol, and coma and bad clinical status on admission was found the only significant prognostic predictor for mortality with multivariate regression analysis. |
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