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Intracerebral Hemorrhage Prognosis

  • Craig A. Williamson
  • Venkatakrishna Rajajee
Chapter

Abstract

Predicting outcome and communicating prognosis to patients and families are a core aspect of caring for patients with intracerebral hemorrhage. In the absence of a definitive treatment, the mortality rate from ICH remains high, with conflicting evidence regarding whether it is decreasing over time. The majority of ICH patients die following withdrawal of life-sustaining treatment, suggesting that provider and patient perceptions about prognosis can profoundly affect survival and neurological outcome. This phenomenon also creates the potential for a “self-fulfilling prophecy,” whereby perceived poor prognosis results in withdrawal of care and may then influence future predictions and prognostic models. Several clinical and patient factors – such as age, hematoma volume, and GCS – have consistently been found to predict prognosis. Additionally, numerous models have been developed to predict survival and neurological outcome in ICH. The ICH score remains the most widely utilized of these scores. While prognostic scores are extremely valuable for standardizing communication between providers and risk-stratifying individuals for research purposes, caution should be exercised in extending population-based outcome predictors to individual patients. Overall, accurate prognostication remains a challenging task for clinicians that is best facilitated by integrating information from prognostic models with individual clinical judgment.

Keywords

Cerebral hemorrhage Stroke Cerebral hemorrhage mortality Stroke mortality Prognosis Glasgow coma scale ICH score Cerebral hemorrhage outcome Outcome prediction Cerebral hemorrhage rehabilitation 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Departments of Neurosurgery and NeurologyUniversity of MichiganAnn ArborUSA

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