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Prognosis

Authoring team

The outcome of ICH is dependent upon the size and location of the haematoma, the level of consciousness on admission, and the progress of neurological signs.

  • size - haematomas > 2 cm diameter are often associated with raised intracranial pressure. Those greater than 4cm are usually fatal unless decompressed.
  • location - pontine, thalamic, and lateral ganglionic sites have the highest fatality rates.
  • level of consciousness on admission - the most important clinical determinant of survival. Stupor or coma suggests direct involvement of the reticular activating system bilaterally in the brainstem tegmentum, or increased intracranial pressure with shifts in brain contents.
  • progress - an increase in focal neurological signs or a decrease in alertness has a poor outcome.

Recurrence of ICH is dependent upon aetiology - amyloid angiopathy and arteriovenous malformations usually recur.

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