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Traumatic and non-traumatic intracerebral hematomas; differences in demographics, neuroimaging, surgical management, outcome and hospital costs
EANS Academy. Münch J. 09/25/19; 275787; EP05012
Johannes Münch
Johannes Münch

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Abstract
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Background: Patients with large intracerebral hematomas (ICH) most usually require treatment at intensive care units (ICU) and undergo neurosurgical interventions, irrespective of their genesis, i.e whether they occurred after a traumatic brain injury or not. However, traumatic and non-traumatic ICH may represent two separate entities with distinct behavior, since they may demonstrate different demographics and underlying brain and systemic diseases, as well as different radiological courses and distinct outcomes.
Materials and methods: We retrospectively studied135 patients with traumatic (n=90) or spontaneous ICH (n=45) undergoing treatment at a surgical intensive care unit of an urban university hospital between 2015-2018. We compared their demographics, the therapies applied, their radiological (i.e volume and rate of expansion of ICH) and clinical (patients' outcome at 30 days) course, the length of hospital and ICU stay as well as the hospital costs.
Results: 65.1 % of patients were male. Mean age was 67.8 years. Patients with traumatic ICH demonstrated more favorable clinical and radiological characteristics at admission, i.e higher GCS scores (p< 0.001), less frequently dilated pupil (p=0.028), smaller ICH volume (p< 0.001), non eloquent (p< 0.001) or intraventricular (p=0.003) ICH locations (p< 0.001), as well as underwent lesser neurosurgical interventions (p< 0.001) and showed a better outcome (p=0.041), defined as Glasgow Outcome Scale 4&5. Noteworthy, intake of NOAC was associated with a higher rate of ICH expansion (HE) compared to patients on VKA, but only in traumatic ICH (p=0.05). The treatment of patients with non-traumatic ICH was associated with higher hospital costs (p=0.05).
Conclusion: Our data reinforce the notion that traumatic and non-traumatic ICH may represent two different diseases with distinct radiological and clinical behavior. Larger prospective trials are warranted to elucidate the potential individual underlying molecular mechanisms for the development and expansion of ICH in these diseases.
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