Longterm Prognosis

Long-term outcome has been studied less frequently than early mortality for several reasons: (i ) there are relatively fewer survivors overall (though short-term prognosis has improved partly because of the ability to identify relatively mildly affected individuals, with modern imaging techniques); (ii) obtaining information at appropriate intervals postdischarge is more difficult than determining early mortality; and (iii) it is more difficult to measure recovery or functional capacity than the clear endpoint of mortality. Many early long-term stroke outcome studies did not separate ICH from infarction; the results of several of the larger studies that did are summarized below. One study reported on 63 of 100 consecutive patients with spontaneous ICH, who survived the first month. Of these, 34 remained paretic (11 plegic), although only 5 of those were not ambulatory. Thirty-five returned to work, and only 6 remained institutionalized. Functional status was largely independent of hemorrhage location but was related to original hematoma size and GCS (29).

Of the 69 survivors from among 104 nonoperated ICH patients followed for 1 year in another study, 51 made a good to excellent recovery (28). The 18 patients with persistent, severe neurologic deficits who had significantly larger hemorrhages were older (mean age 65 vs. 58), and were twice as likely to have had IVH.

Another group followed 42 survivors from a series of 70 ICH patients for an average of 29 months. Another 7 died during the follow-up period; none died of vascular disease, and 5 patients suffered seizures. Only 5 of the 35 surviving patients returned to work, 19 walked without assistance, and 13 ambulated with assistance. The authors noted that functional status of most patients did not change during the follow-up period. The GCS was used to assess functional status following ICH in a cohort of 166 ICH patients, of whom 95 survived 6 months, and 78% of them functioned independently at 6 months. Limb weakness, language disorders, hemorrhage size, and ventricular hemorrhage were related to outcome. Initial survival was unrelated to age, but age was an important determinant of functional recovery (36).

Tuhrim et al. used factors predictive of 30-day survival (GCS, hemorrhage size, pulse pressure, and ventricular extension) to devise a model for predicting long-term outcome. The model correctly classified 95% of patients as having a good (defined as alive, Barthel's index > 60) or poor (defined as dead or Barthel's index < 60) outcome at 1 year. This study made no attempt to determine if age or premorbid level of function related to long-term outcome (35). Another group did include premorbid Rankin scale in a multivariate analysis of predictors of 6-month outcome and found that it, along with age and GCS, was helpful as a predictor (42 ).

Given the caveat that the data are more limited, the same factors that determine early mortality appear to be predictive of poor long-term functional outcome. Age may play a greater

Table 1 Predictors of Intracerebral Hemorrhage Outcome

Intracerebral Intraventricular Glasgow Coma

Table 1 Predictors of Intracerebral Hemorrhage Outcome

Intracerebral Intraventricular Glasgow Coma

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