Work

Predictive modeling of brain herniation risk factors and critical thresholds in spontaneous intracerebral hemorrhage: a pilot study

Year: 2025

Type: article

Abstract: Objective Patients with spontaneous intracerebral hemorrhage (sICH) could benefit from personalized treatment strategies. Developing a rational classification system is therefore essential to guide clinical decision-making. This study aimed to identify independent predictors of brain herniation in sICH patients and establish critical thresholds for these predictors, using clinical and imaging data. Methods We retrospectively analyzed consecutive spontaneous intracerebral hemorrhage patients admitted between June 2020 and December 2023. Demographics, medical history, clinical parameters on admission, and CT findings were collected. Hematoma volume and midline shift were quantified using 3D Slicer software, while intraventricular hemorrhage was graded by the Graeb score. Brain herniation was defined by acute neurological deterioration (e.g., loss of consciousness, anisocoria, or posturing) and CT evidence of critical structural displacement (e.g., obliteration of perimesencephalic cisterns, uncal herniation). Statistical methods included receiver operating characteristic curve analysis and multivariable binary logistic regression to identify independent predictors of herniation. Results Fifty-five patients met inclusion criteria. Among them, 58 CT scans were analyzed. Multivariable analysis identified three independent predictors of cerebral herniation in basal ganglia/thalamic hemorrhages: hematoma volume >64 mL (adjusted OR = 14.67; 95% CI: 1.44–149.82; p = 0.023), midline shift at the interventricular foramen >11 mm (adjusted OR = 10.05; 95% CI: 1.61–62.69; p = 0.014), and Graeb score (per 1-point increase: adjusted OR = 1.47; 95% CI: 1.08–2.00; p = 0.015). Conclusion Among four midline structures analyzed, midline shift at the interventricular foramen was the strongest predictor. Key herniation predictors for basal ganglia/thalamic hemorrhage comprise hematoma volume >64 mL, midline shift at the interventricular foramen >11 mm, and Graeb score.

Source: Frontiers in Neurology

DOI: 10.3389/fneur.2025.1612346

Authors: Jinxiu Peng, Shugang Wang, Jinpeng Wang, Bing Liu, Yimei Yuan, Lishan Yin

Institutions: Weifang Medical University, Weifang People's Hospital, Weifang Chinese Medicine Hospital

Language: English

Topic: Intracerebral and Subarachnoid Hemorrhage Research

Subfield: Neurology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801