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Chapter 17. Prognosis in Neurocritical Care

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An 87-year-old man with hypertension, coronary artery disease (prior coronary artery bypass grafting on aspirin), and chronic obstructive pulmonary disease presents to the emergency department (ED) after being found on the ground at home with slurred speech, right gaze deviation, and left-sided weakness. A head computed tomography (CT) was completed (shown below). The volume of hemorrhage was calculated to be approximately 75 mL without any intraventricular extension. His initial examination on arrival to the ED was as follows: eyes opening to voice, oriented to self, severely dysarthric with, right gaze preference, left facial droop, no movement of the left arm or leg, and full strength of the right arm and leg.

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What is his intracerebral hemorrhage (ICH) score?

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A. 1

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B. 2

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C. 3

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D. 4

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E. 5

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B. The patient has a large, lobar hemorrhage. The intracerebral hemorrhage (ICH) score (Table 17-1) is a prognostic grading scale for 30-day mortality following primary ICH. The score uses ALVIS: age (< or > 80 years), location (infratentorial or not), volume of hemorrhage (< or > 30 mL), intraventricular hemorrhage (present or absent), Glasgow coma scale score (15-13, 13-8, or <8). The 30-day mortality rates for patients with ICH scores of 1, 2, 3, and 4 were 13%, 26%, 72%, and 97%, respectively. In this patient’s case, he receives points for age >80 years and volume of hemorrhage >30 mL, resulting in an ICH score of 2 and a 30-day mortality of 26%.

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The prognostic score used to predict the functional outcome of a patient following a primary ICH is the FUNC score (Table 17-2). Same as the ICH score, the FUNC score uses ALVIS: age, location of hemorrhage, volume of hemorrhage, and Glasgow coma scale. However, premorbid cognitive function is used in FUNC but not the ICH score. A higher score is associated with more likelihood of recovery to an independent state. The scores are grouped into 5 categories—<5, 5 to 7, 8, 9 to 10, and 11—which are associated with rates of functional independence at 90 days of 0%, 13%, 42%, 66%, and 82%, respectively.

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Table 17-1. The Intracerebral Hemorrhage (ICH) Score
Component Points Total Points 30-Day Mortality (%)
Glasgow coma scale score
3-4 2 5+ 100
5-12 1
13-15 0 4 97
ICH volume (mL)
30 1 3 72
<30 0
Interventricular hemorrhage
Yes 1 2 26
No 0 1 13
Age (year)
80 1 0 0
<80 0
Infratentorial origin
Yes 1
No 0

(Adapted from Hemphill JC 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: A simple, reliable grading scale for intracerebral hemorrhage. Stroke. 2001;32:891-897.)

Date of download: 01/30/17 from Neurology Collection: www.neurology.mhmedical.com. © McGraw-Hill Education. All rights reserved.

Reproduced with permission from Lee K. The NeuroICU Book. New York, NY: McGraw-Hill, 2012.

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