Predicting motor outcome in acute intracerebral hemorrhage

J. Puig, G. Blasco, M. Terceño, P. Daunis-I-Estadella, G. Schlaug, M. Hernandez-Perez, V. Cuba, G. Carbó, J. Serena, M. Essig, C. R. Figley, Kambiz Nael, C. Leiva-Salinas, S. Pedraza, Y. Silva

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE: Predicting motor outcome following intracerebral hemorrhage is challenging. We tested whether the combination of clinical scores and DTI-based assessment of corticospinal tract damage within the first 12 hours of symptom onset after intracerebral hemorrhage predicts motor outcome at 3 months. MATERIALS AND METHODS: We prospectively studied patients with motor deficits secondary to primary intracerebral hemorrhage within the first 12 hours of symptom onset. Patients underwent multimodal MR imaging including DTI. We assessed intracerebral hemorrhage and perihematomal edema location and volume, and corticospinal tract involvement. The corticospinal tract was considered affected when the tractogram passed through the intracerebral hemorrhage or/and the perihematomal edema. We also calculated affected corticospinal tract-to-unaffected corticospinal tract ratios for fractional anisotropy, mean diffusivity, and axial and radial diffusivities. Motor impairment was graded by the motor subindex scores of the modified NIHSS. Motor outcome at 3 months was classified as good (modified NIHSS 0-3) or poor (modified NIHSS 4-8). RESULTS: Of 62 patients, 43 were included. At admission, the median NIHSS score was 13 (interquartile range = 8-17), and the median modified NIHSS score was 5 (interquartile range = 2- 8). At 3 months, 13 (30.23%) had poor motor outcome. Significant independent predictors of motor outcome were NIHSS and modified NIHSS at admission, posterior limb of the internal capsule involvement by intracerebral hemorrhage at admission, intracerebral hemorrhage volume at admission, 72-hour NIHSS, and 72-hour modified NIHSS. The sensitivity, specificity, and positive and negative predictive values for poor motor outcome at 3 months by a combined modified NIHSS of >6 and posterior limb of the internal capsule involvement in the first 12 hours from symptom onset were 84%, 79%, 65%, and 92%, respectively (area under the curve = 0.89; 95% CI, 0.78 -1). CONCLUSIONS: Combined assessment of motor function and posterior limb of the internal capsule damage during acute intracerebral hemorrhage accurately predicts motor outcome.

Original languageEnglish (US)
Pages (from-to)769-775
Number of pages7
JournalAmerican Journal of Neuroradiology
Volume40
Issue number5
DOIs
StatePublished - Jan 1 2019
Externally publishedYes

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Cerebral Hemorrhage
Pyramidal Tracts
Internal Capsule
Extremities
Edema
Multimodal Imaging
Anisotropy
Area Under Curve
Sensitivity and Specificity

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

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Puig, J., Blasco, G., Terceño, M., Daunis-I-Estadella, P., Schlaug, G., Hernandez-Perez, M., ... Silva, Y. (2019). Predicting motor outcome in acute intracerebral hemorrhage. American Journal of Neuroradiology, 40(5), 769-775. https://doi.org/10.3174/ajnr.A6038

Predicting motor outcome in acute intracerebral hemorrhage. / Puig, J.; Blasco, G.; Terceño, M.; Daunis-I-Estadella, P.; Schlaug, G.; Hernandez-Perez, M.; Cuba, V.; Carbó, G.; Serena, J.; Essig, M.; Figley, C. R.; Nael, Kambiz; Leiva-Salinas, C.; Pedraza, S.; Silva, Y.

In: American Journal of Neuroradiology, Vol. 40, No. 5, 01.01.2019, p. 769-775.

Research output: Contribution to journalArticle

Puig, J, Blasco, G, Terceño, M, Daunis-I-Estadella, P, Schlaug, G, Hernandez-Perez, M, Cuba, V, Carbó, G, Serena, J, Essig, M, Figley, CR, Nael, K, Leiva-Salinas, C, Pedraza, S & Silva, Y 2019, 'Predicting motor outcome in acute intracerebral hemorrhage', American Journal of Neuroradiology, vol. 40, no. 5, pp. 769-775. https://doi.org/10.3174/ajnr.A6038
Puig J, Blasco G, Terceño M, Daunis-I-Estadella P, Schlaug G, Hernandez-Perez M et al. Predicting motor outcome in acute intracerebral hemorrhage. American Journal of Neuroradiology. 2019 Jan 1;40(5):769-775. https://doi.org/10.3174/ajnr.A6038
Puig, J. ; Blasco, G. ; Terceño, M. ; Daunis-I-Estadella, P. ; Schlaug, G. ; Hernandez-Perez, M. ; Cuba, V. ; Carbó, G. ; Serena, J. ; Essig, M. ; Figley, C. R. ; Nael, Kambiz ; Leiva-Salinas, C. ; Pedraza, S. ; Silva, Y. / Predicting motor outcome in acute intracerebral hemorrhage. In: American Journal of Neuroradiology. 2019 ; Vol. 40, No. 5. pp. 769-775.
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AU - Terceño, M.

AU - Daunis-I-Estadella, P.

AU - Schlaug, G.

AU - Hernandez-Perez, M.

AU - Cuba, V.

AU - Carbó, G.

AU - Serena, J.

AU - Essig, M.

AU - Figley, C. R.

AU - Nael, Kambiz

AU - Leiva-Salinas, C.

AU - Pedraza, S.

AU - Silva, Y.

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N2 - BACKGROUND AND PURPOSE: Predicting motor outcome following intracerebral hemorrhage is challenging. We tested whether the combination of clinical scores and DTI-based assessment of corticospinal tract damage within the first 12 hours of symptom onset after intracerebral hemorrhage predicts motor outcome at 3 months. MATERIALS AND METHODS: We prospectively studied patients with motor deficits secondary to primary intracerebral hemorrhage within the first 12 hours of symptom onset. Patients underwent multimodal MR imaging including DTI. We assessed intracerebral hemorrhage and perihematomal edema location and volume, and corticospinal tract involvement. The corticospinal tract was considered affected when the tractogram passed through the intracerebral hemorrhage or/and the perihematomal edema. We also calculated affected corticospinal tract-to-unaffected corticospinal tract ratios for fractional anisotropy, mean diffusivity, and axial and radial diffusivities. Motor impairment was graded by the motor subindex scores of the modified NIHSS. Motor outcome at 3 months was classified as good (modified NIHSS 0-3) or poor (modified NIHSS 4-8). RESULTS: Of 62 patients, 43 were included. At admission, the median NIHSS score was 13 (interquartile range = 8-17), and the median modified NIHSS score was 5 (interquartile range = 2- 8). At 3 months, 13 (30.23%) had poor motor outcome. Significant independent predictors of motor outcome were NIHSS and modified NIHSS at admission, posterior limb of the internal capsule involvement by intracerebral hemorrhage at admission, intracerebral hemorrhage volume at admission, 72-hour NIHSS, and 72-hour modified NIHSS. The sensitivity, specificity, and positive and negative predictive values for poor motor outcome at 3 months by a combined modified NIHSS of >6 and posterior limb of the internal capsule involvement in the first 12 hours from symptom onset were 84%, 79%, 65%, and 92%, respectively (area under the curve = 0.89; 95% CI, 0.78 -1). CONCLUSIONS: Combined assessment of motor function and posterior limb of the internal capsule damage during acute intracerebral hemorrhage accurately predicts motor outcome.

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