The Prognosis Value Of The Compression Degree Of The Posterior Limb Of Internal Capsule In Basal Ganglia Hemorrhage

Objective:Spontaneous Intracerebral hemorrhage(ICH)is one of the most serious subtype of stroke.The prognosis of patients with cerebral hemorrhage is closely related to hematoma size and bleeding site.The compression of posterior limb of internal capsule may predict the prognosis of ICH patients.Previous studies have suggested that midline migration may have important prognostic significance in patients with intracerebral hemorrhage.But clinical practice,according to midline shift evaluation of the prognosis of patients with unsatisfactory results.Possible reasons are:the hind limb of the internal capsule is located between the thalamus and lentiform nucleus,there are corticospinal tract,thalamocortical bundle,temporal bridge and other nerve fibers from here through.Internal hind limb injury with multiple limb movement disorder,complete injury may be a "three partial syndrome"(hemiplegia,partial deep sensory dysfunction and hemianopia).Compared with the degree of compression of the hind limbs of the internal capsule,the anatomical structures involved in the midline migration are complicated,involving not only the heartbeat,the respiratory center but also the hypothalamic-pituitary axis.Once the most prone to the symptoms of migration is the disturbance of consciousness and endocrine function changes.In order to verify that the extent of compression of the hindlimb of the internal capsule may predict the prognosis of patients with intracerebral hemorrhage,we designed a distance ratio that reflects the degree of hindlimb compression,and in this study,the prognostic indicators used an improved Rankin score,Limb mobility rather than the level of consciousness,so compared to midline shift prediction of cerebral hemorrhage prognosis is more clinical significance.And confimed that it can predict the outcome of patients with basal ganglia hemorrhage.Methods:We retrospectively reviewed our collected database for consecutive patients with cerebral hemorrhage who were admitted between July 2014 and June 2015.According to the initial non-contrast CT scan,we used the distance ratio D,to reflect the compression extent of posterior limb of internal capsule.And we analyzed what factors could affect D',as well as what variants were associated to D'.Results:55 patients were enrolled into this study,with an average age of 57±13 years old and 25 female.Binary logistic regression analysis showed that,D',but not midline shift(OR=1.144,95%CI=0.962-1.361,p=0.128),was independently associated with poor outcome at 3 months after stroke onset(OR=0.002,95%CI=0.001-0.448,p=0.031).Receiver operating characteristic curve analysis showed that,area under the curve for D' predicting 3-months poor outcome was 0.732,with the optimal cutoff point at 0.18 mm(sensitivity 0.87,specificity 0.65,Youden index 0.52).According to the cutoff point of D',patients were divided into obvious compression on the posterior limb of internal capsule group(D' ?0.18 mm)and unobvious compression on the posterior limb of internal capsule group(D'>0.18).Compared with unobvious compression on the posterior limb of internal capsule group,patients with obvious compression on the posterior limb of internal capsule had lower leg muscle strength at admission and discharge.D' was also independently associated with preoperative GCS score(B=10.737,p=0.034)and GCS score at discharge(B=11.611,p=0.046).In addition,stroke history(B=-0.164,p=0.008)and the presence of ventricular hematoma at admission(B=-0.052,p=0.025)were independent factors associating with D'.Conclusions:In patients with basal ganglia hemorrhage,D',which was associated with stroke history and ventricular hematoma at admission,was an independent factor for predicting GCS score at discharge and 3-month poor outcome.Therefore,the compression of posterior limb of internal capsule may predict the prognosis of ICH patients.