Role of the radiological variables, clinical picture and values of C-reactive protein (CRP) and leukocytes in the brain edema development and eary intrahospital mortality in patients with hemorrhagic cerebrovascular insult

Abstract

Introduction: The development of brain edema is one of the key factors that cause early neurological deterioration in patients with hemorrhagic cerebrovascular insult (H-CVI). In this study we analyzed the impact of: radiological variables (initial volume and volume of the 5th day of the intracerebral hematoma (IH), clinical state at admission (scored on appropriate scale), as well as nonspecific inflammatory markers (leukocyte count and C-reactive protein - CRP). on the development of brain edema and early in-hospital mortality, in patients with H-CVI. Material and methods: 26 conservatively treated patients with acute spontaneous intracerebral haemorrhage treated at the University Clinics of Neurosurgery and Neurology in Skopje. Computed tomography (CT) was used to evaluate radiological variables, the Canadian Stroke Scale (CSS) for neurological status scoring, as well as biochemical analysis of blood taken in the first 24 hours, to measure leukocyte counts and CRP level. Results: 8 of 26 patients (30.8%) were with lethal outcome. Initial volume of IH had the strongest effect on the development of perifocal edema, with less impact but statistically significant were: clinical status on admission and age of the patients. The strongest effect on early in-hospital mortality had all radiological variables (hematoma volume at admission and after 5 days, as well as volume of perifocal edema measured after 5 days).