Factors Impacting Outcomes in Brainstem Hemorrhage: A Single-center Experience Investigating Functional Outcome
Muhammed Gunduz1, Victoria Fleming1, Shravan Sivakumar1, Zakir Shaikh1, Raphael Carandang2
1Department of Neurology, University of Massachusetts Chan Medical School, 2Department of Neurology, Anesthesiology and Surgery, University of Massachusetts Chan Medical School
Objective:
To describe the functional outcomes and determine favorable prognostic factors in patients with brainstem hemorrhage.
Background:
Brainstem hemorrhage comprises 5-10% of intracranial hemorrhages (ICH) and is historically known to be associated with significant disability and high-mortality. Studies investigating functional outcome are limited and this presumption of poor prognosis can lead to premature withdrawal of care and self-fulfilling prophecy.
Design/Methods:
We retrospectively reviewed all ICH patients admitted to our center from 2017-2021 and identified CT-proven brainstem hemorrhage patients. We gathered demographic information, clinical and radiological parameters, outcome measures during and after hospitalization. The Modified Rankin scale (mRS) at 3-6 months was adjudicated by three independent investigators. Univariate analysis was performed to identify possible associations between outcome and potential prognostic factors using Mann-Whitney, Chi-square, and t-tests.
Results:
Among 569 ICH patients admitted, 29 (5%) brainstem hemorrhages were identified. 15 (52%) were male and 14 (48%) were female, with ages ranging from 20-91 (mean 61.9). The mortality rate was 52%, while 10 patients (34.5%) had good recovery (mRS 0-2). Age, gender, race, and hemorrhage location didn’t differ between groups. Our analysis demonstrated that the Glasgow coma scale (GCS) at admission, hemorrhage volume (ABC/2), ICH score, functional outcome in patients with primary ICH (FUNC) score, and early withdrawal of care were all significantly associated with both functional outcome and mortality.
Conclusions:
In our center, the percentage of brainstem hemorrhages and mortality was consistent with previous studies however there was a higher percentage of patients with good outcomes than previously reported in the literature. Despite sample size and study design limitations, our study suggests GCS at admission, lower hemorrhage volume, and favorable ICH severity scales were potential factors associated with good prognosis, while early withdrawal of care was associated with higher mortality. Identification of reliable prognostic factors is important to guide clinical management and prevent premature withdrawal of care.