Research Article - (2020) Volume 8, Issue 5
Received: 12-Mar-2020
Published:
31-Aug-2020
, DOI: 10.37421/2329-6895.2020.8.430
Citation: Ahmed Sandra M, Hanan A Amer, Hadeer M Hassan
and Dalia M Labib. “Role of Ultrasound in Diagnosis and Prediction of Outcome
in Patients with Spontaneous Intracerebral Hemorrhage.” J Neurol Disord 8
(2020): 430. doi: 10.37421/jnd.2020.8.430.
Copyright: © 2020 Ahmed SM, et al. This is an open-access article distributed under the
terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author
and source are credited.
Background Intracerebral hemorrhage, despite being less frequent than ischemic stroke, has a worst early outcome and poorer prognosis. Intracerebral hematoma (ICH) size is one of the important predictors of outcome. CT scan is the gold standard for diagnosis and follows up of ICH yet needs the patient to be moved to radiology department which can be difficult for some ICU patients. Bedside ultrasound can be a potential reliable tool for assessing ICH size. Aim Assessing the utility of ultrasound in diagnosing and predicting outcome of ICH Subjects and method Thirty patients with spontaneous ICH has been selected and diagnosed by CT scan of the brain. Brain transcranial sonography (TCS) was done just after the CT. Multiple clinical scales were done and correlated to hematoma size detected by TCS. Results The results showed excellent reliability for hematoma volume assessment using CT and TCS, intra-class correlation coefficient (ICC) 95% CI 0.963 (0.923-0.983). Hematoma size by TCS showed a very good correlation to most of the clinical scales. Conclusion Bedside TCS can be a reliable tools for diagnosis and prediction of outcome of patients with ICH specially those who are difficult to be transported.
Intracerebral haemorrhage • Ultrasound
Despite being less frequent than ischemic stroke, the global burden of disability in hemorrhagic strokes remains higher [1] The high rate of early neurological deterioration after ICH is related in part to active bleeding that may progress for hours after symptom onset and increases risk of poor functional outcome and death [2] Computed tomography (CT) and magnetic resonance imaging (MRI) remains the gold standard imaging for intracerebral hemorrhage [3] Yet, CT and MRI can be a problem if the patient can’t be transported to radiology department, be exposed to radiation or patients with cardiac pacemakers [4]. Bedside transcranial ultrasound offers a good alternative to follow intracerebral hemorrhage (ICH) in critically ill patients when all conditions are favorable (good transcranial window, visualized site by ultrasound) [4].
The aim of the study is to evaluate the role of transcranial ultrasound in imaging of intracerebral hemorrhage. Also, to evaluate its possible role in follow up and outcome prediction of these patients.
This is a prospective study conducted in kasralainy stroke unit, Neurology Department, Cairo University between July 2018 and January 2019. The study included 30 patients diagnosed with non-traumatic spontaneous intracerebral hemorrhage. Patients from both sexes were included, age ranged from 18 to 70 years.
Clinical examination included; National institutes of Health Stroke Scale (NIHSS) [5] at admission and follow up at 7 days, Glasgow coma scale (GCS) [6], Intracerebral hemorrhage (ICH) score [7] and FUNC score for prediction of outcome [8].
All patients at admission underwent a CT scan at radiology department, Cairo University. CT slices thickness was 0.5 cm. Hematoma volume (V) was measured according to the following formula:
V=Longitudinal measure × Sagittal measure × Coronal measure ÷2 [9].
Major longitudinal and sagittal diameter represents the largest perpendicular diameters through the hyperdense area in axial plane. Coronal diameter represents the thickness of the hematoma.
Transcranial ultrasound was performed at bedside as soon as the patient was admitted to the Stroke Unit, Cairo University using ultrasound machine (GE Healthcare Ultrasound LOGIQTM V2/ LOGIQ V1, CHNA) equipped with a 3 MHZ phased array transducer. The examination was performed contralateral to the side of bleeding. The depth was increased until the contralateral skull bone was visualized. The axial plane used was the thalamic plane to measure the maximal longitudinal and sagittal measures. Then Coronal plane was used to assess the maximal coronal measure by tilting the probe 90˚ to the axial plane. Brain hematoma appears as an echodense parenchymal lesion in the acute phase with progressive decrease in the central echogeneicity as the time passes. The three measures were multiplied to obtain the hematoma volume as done with CT measures (Figure 1).
Figure 1. Longitudinal distance in CT and Ultrasound 1.4 cm and 1.24 cm respectively. Sagittal distance in CT and Ultrasound 2.77 cm and 2.41 cm respectively.
Data was entered on the computer using "Microsoft Office Excel Software" program (2010) for windows. Data was then transferred to the Statistical Package of Social Science Software program, version 23 (IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp) to be statistically analyzed.
Data presented using range, mean, standard deviation, median and interquartile range for quantitative variables and frequency and percentage for qualitative ones. Comparison between groups was conducted using Chi square test for qualitative variables and Mann Whitney test or Kruskal Wallis test (due to data skewness) for quantitative ones. Spearman correlation coefficients were calculated to estimate the association between different quantitative variables. Paired measures were assessed through Wilcoxon test. Two-way mixed model with consistency type was performed to explore the reliability (concordance) of Duplex measures against that of CT findings. P values less than 0.05 were considered statistically significant. Figures were used to illustrate some information.
In conclusion, ultrasound can be used in diagnosis of intracerebral hemorrhage, prediction of outcome and potentially follow up of the hematoma size. Yet, its role will be limited to large supratentorial hematoma. Its utility is to be saved for unstable ICU patients who are difficult to be transported to radiology department.
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