Background: Stroke is a major cause of death and disability. Haemorrhagic strokes constitute 20% of all strokes. Most important risk factor for development of spontaneous intracerebral haemorrhage is systemic hypertension.

Objectives: To study the different clinical and radiologic factors which can be considered as prognostic markers and predictors of survival in patients with spontaneous hypertensive intracerebral hemorrhage.

Materials and Methods: The study is a prospective descriptive study of 100 consecutive patients meeting the inclusion criteria for spontaneous hypertensive intracerebral hemorrhage admitted in the medical wards of a tertiary care centre, Gov. Medical college, Thiruvananthapuram, Kerala. The study was conducted over a period of one year. The patients were clinically assessed and radiologic findings noted.

Results: Older age, presence of headache, vomiting and altered level of consciousness, high systolic BP on admission, long standing hypertension, irregularities in respiration, low GCS on admission, bilateral extensor plantar response, progressive worsening of sensorium , aspiration pneumonia,  larger volume of hematoma, presence of  intraventricular extension,  hydrocephalus,  midline shift and mass effect correlated closely with poor   outcome and higher mortality.

Conclusions: A low Glasgow coma score on admission, respiratory irregularity, anisocoria, large volume hemorrhage, presence of intraventricular extension and hydrocephalus are statistically significant prognostic markers in patients with spontaneous hypertensive intracerebral hemorrhage.

Keywords: Hypertension, Intracerebral hemorrhage, Stroke.

1. The ABCs of measuring intracerebral hemorrhage volumes- Rashmi U. Kothari. Thomas Brott, Joseph P. Broderick, William G.Barsan, Laura R Sauerbeck, Mario Zuccarello, Jane Khoury. Stroke 1996; 27:1304-1305
2. The definition and classification of hydrocephalus: a personal recommendda-tion to stimulate debate: Harold L Lekate Cerebrospinal Fluid Research2008 5:2
3. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage Adnan I. Qureshi, M.D., Yuko Y. Palesch, Ph.D., William G. Barsan, M.D., Daniel F. Hanley, M.D., for the ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network: N Engl J Med 2016; 375:1033-1043
4. Acute Ischemic Stroke H. Bart van der Worp, M.D., Ph.D., and Jan van Gijn, F.R.C.P.NewEngl J Med 2007; 357:572-579August 9, 2007
5. A, AK sharma, V Sardana, A. maru An analysis of 141 cases of intracerebral hemorrhage: A study from north India: Neurosciences today 2000 4:196-199
6. Long-Term Prognosis of Hypertensive Intracerebral Hemorrhage Michael A Douglas MD and Armin F Haerer Stroke,Vol 13, No 4, 1982
7. Caplan LR, Hier DB, D’cruz I, Michael Reese Stroke Stroke Registry: Stroke 1992; 14:530-536
8. The Greater Cincinnati/Northern Kentucky Stroke Study: preliminary first-ever and total incidence rates of stroke. Broderick J¹, Brott T, Kothari R, Miller R, Khoury J, Pancioli A, Gebel J, Mills D, Minneci L, Shukla R.
9. Bougousslavsky J, Dartigues JF et al Death and functional outcome after spontaneous intracerebral hemorrhage: a prospective study of 166 cases using multivariate analysis Stroke: 1995; 22:1-6
10. Silver FL, Norris JW, Lewis AJ et al. early mortality following stroke: a prospective review. Stroke 1988;15:492-496
11. Van Melle, bogouslavsky J, Regli.F The Lausanne Stroke Registry: analysis of 1000 patients with the first stroke. Stroke 1997;19:1083-1092
12. Foulkes MA, Wolf PA, Price TR, Mohr JP, Hier DB. The Stroke Data Bank: design, methods and baseline characteristics. Stroke 1988; 19:547-554
13. Kilpatrick CJ, Davis SM, Tress BM et al. Epileptic Seizures in acute stroke, Arch Neurology 1990;47:157-160
14. Mc Cormick, rosenfield J; Respiratory pattern is a determinant of early mortality in putaminal hemorrhage.
15. Portenoy RK, Lipton RB, Berger AR et al. Intracerebral hemorrhage: a model for the prediction of outcome J Neurology Neurosurgery Psychiatry 1992;50:976-979
16. Stein RW, Caplan LR et al: Outcome of intracranial hemorrhage. Role of blood pressure and location and size of the lesions. Annals of Neurology 1993; 14:132-133.

Dr Sabarisree M

Associate Professor (CAP) in Orthopaedics,

Govt Medical College, Trivandrum