Visual clue to ICH outcomes

Sep 19 2012

By Eleanor McDermid, Senior medwireNews Reporter

Persistent conjugate eye deviation (CED) predicts poor outcomes in patients with intracerebral hemorrhage (ICH), say researchers.

Patients' risk for death or dependency rose more than fivefold if CED was present at admission and persisted for 72 hours, report Shoichiro Sato (National Cerebral and Cardiovascular Center, Suita, Japan) and colleagues.

"Bedside assessment of CED twice is easy, not time-consuming, and appears to provide valuable information related to chronic outcomes," the team writes in Stroke.

Sato et al defined CED as a National Institutes of Health Stroke Scale "best gaze" subscore of at least 1. The 221 patients in the analysis were drawn from the Stroke Acute Management With Urgent Risk-Factor Assessment and Improvement-ICH (SAMURAI-ICH) study. Thus, all patients were assessed within 2.5 hours of symptom onset, at which point 45% had CED.

Any CED did not predict death or dependency at 3 months after accounting for gender, age, intraventricular extension of the hematoma, baseline Glasgow Coma Scale (GCS) score, and hematoma volume.

However, when reassessed 72 hours after stroke, 25% of all patients still had CED. These patients had a 5.77-fold increased risk for death or dependency after accounting for confounders.

CED was more than twice as likely to occur in patients with right-sided than left-sided lesions, and its prevalence increased in line with GCS and hematoma volume.

Notably, the minimum hematoma volume that caused CED differed according to hematoma location. For hematomas in the putamen, a volume of 13.5 mL or more was 76% sensitive and 72% specific for CED, where for those in the thalamus, the optimal cutoff was just 7.7 mL, giving a sensitivity of 82% and a specificity of 83%.

The researchers suggest that "this may be due to the dense neurological structures of the thalamus." They say that the healthy human thalamus is usually smaller than 6.5 mm³, meaning that a hematoma volume of 7.7 mL would "impair the anterior and posterior limbs of the internal capsule surrounding the thalamus; these are critical structures responsible for CED."

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