Functional Outcomes In Patients With Non- Lesional Spontaneous Intracerebral Haemorrhage Seen In Kenyatta National Hospital

Abstract

Background: Spontaneous intracerebral haemorrhage (SICH) accounts for about 15% of all strokes but has a higher morbidity as well as mortality rate compared with other types of strokes. Functional outcomes of patients with ICH depend on several factors, such as age, blood pressure, location and volume of haematoma, and treatment modality. The objective of this study was to determine the functional outcomes of patients with nonlesional spontaneous ICH treated in Kenyatta National Hospital (KNH), the biggest referral hospital in Kenya. Methods: This study was a prospective cross-sectional study encompassing patients aged 18 years and above with SICH admitted within 72 hours of symptom onset. Patients with early death, de-escalation of care, or lesion-related ICH were excluded. Data on demographic, clinical, radiological, treatment and outcome variables were collected using a structured questionnaire at admission and at three months post-ictus. Outcome measures included the modified Rankin score (mRS) and the Barthel index (BI), which assessed the level of disability and independence of patients, respectively. Descriptive statistics were utilised to recapitulate the demographic, clinical, and outcome data for patients diagnosed with nonlesional spontaneous ICH. Inferential statistics were used to determine the risk elements linked with the development of nonlesional spontaneous ICH and to evaluate the functional outcome measures for patients with this condition. The data was analysed using SPSS software, with a significance level set at 95%. Results: Data were collected from 75 patients aged 18 years, with the mean age of patients being 61.41 years and a nearly equal gender distribution. The majority had moderate to severe impairment based on Glasgow Coma Scale (GCS) scores and elevated blood pressure. Comorbidities included hypertension (98.7%), diabetes mellitus (13.3%), and hyperlipidaemia (4.0%). Alcohol use was reported by 30.7% of patients, and smoking by 6.7%. Functional outcomes significantly improved at three months compared to one month. At one month, most patients had moderate to severe disability according to mRS scores, but by three months, a substantial proportion showed mild disability. Similar trends were observed with BI scores. Hematoma location and intraventricular hemorrhage (IVH) significantly influenced functional outcomes. Age, GCS, diastolic blood pressure, and hematoma volume were associated with BI scores at one month. Conclusion: The study highlights the potential for significant recovery in functional outcomes for patients with nonlesional spontaneous ICH, emphasizing the importance of early and tailored medical intervention. The associations found between various clinical factors and functional outcomes can guide clinicians in optimizing treatment strategies to improve patient recovery trajectories