ROLE OF REPEAT COMPUTED TOMOGRAPHY SCAN ON INTRACEREBRAL HEMORRHAGE IN HYPERTENSIVE PATIENTS OF 30–50 YEARS OF AGE
Keywords:
Intracerebral hemorrhage (ICH), Hypertension, Non-contrast computed tomography (NCCT), Hematoma expansion, Repeat CT scan, ABC/2 method, Blood pressure, Clinical management.Abstract
Background: Spontaneous intracerebral hemorrhage (ICH) is a serious neurological emergency and a condition which causes morbidity and mortality. Hypertension is one of the most important modifiable risk factors and hematoma expansion without apparent neurological deterioration may be more frequent in the early stages and affect prognosis.
Aim: To determine the rate of hematoma expansion in spontaneous ICH patients with hypertension (aged 30-50) on repeat non-contrast computed tomography (NCCT) and its correlation with admission blood pressure, baseline NCCT predictors and subsequent management.
Methodology: This was a prospective observational cohort study that included 81 hypertensive patients aged 30–50 years presenting within 6 hours of symptom onset to tertiary-care hospitals in Lahore. Baseline NCCT confirmed ICH, and repeat NCCT was performed at 24 ± 6 hours. Hematoma volume was estimated using the ABC/2 method. Data were analyzed using SPSS, with p < 0.05 considered significant.
Results: The mean age was 40.5 ± 6.3 years and 54.3% were male. 40 patients (49.4%) had hematoma expansion. Expansion was not significantly associated with either the admission systolic or diastolic blood pressure (p = 0.065 and p = 0.456). Baseline NCCT predictors had a sensitivity of 70.0% and a specificity of 73.2%, with a statistically significant association with hematoma expansion (p < 0.001). Of expansion cases, 42.5% were asymptomatic. Patients with expansion had more management changes than those without expansion (72.5% vs. 24.4%; p < 0.001). The moderate or high clinical utility for repeat NCCT was seen in 59.3% of patients.
Conclusion: An increased risk of hematoma expansion was noted and was often asymptomatic. Baseline NCCT markers had moderate predictive value while admission blood pressure did not. Repeat NCCT at ~24 hours was informative about progression and led to management decisions in some patients with hypertensive ICH.
