INTRODUCTION: Stroke is the third leading cause of death worldwide. Intracranial hemorrhage (ICH) is the third most common type of stroke following ischemic and subarachnoid hemorrhage. Spontaneous intracerebral hemorrhage (SICH) causes 10-15% of first-ever stroke, with a 30-day mortality rate of 35-52%, half of the deaths occurring in the first two (2) days.3 It is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage (SAH) with only 38% of the patients surviving after one (1) year. The sudden occurrence of an intracranial hemorrhage destroys and displaces brain tissue and can induce an increase in intracranial pressure (ICP). The progression of mass effect after ICH occurred at two (2) distinct points: within two (2) days, related to hematoma enlargement and in the 2nd - 3rd weeks, associated with increased edema. Increased ICP and decreased cerebral perfusion pressure (CPP) gave rise to typical changes in the doppler waveforms obtained by transcranial insonation (i.e. a decrease in diastolic flow velocity and an increase in the PI). Results showed that TCD-PI has the potential to assess mass effect and track ICP changes. In the local setting where many of the hospitals do not have an available intracranial pressure monitoring device, the use of a transcranial doppler will be an economical and practical alternative to detect elevations in ICP, aggressive measures can be instituted immediately and progression of symptoms will be prevented.

OBJECTIVE: The study aimed to utilize TCD-pulsatility index (TCD-PI) as a predictor of the neurological outcome among patients who had spontaneous intracerebral hemorrhage in a tertiary hospital.

METHODS: The study included patients 18-70 years old who sustained acute, supratentorial, non-traumatic, spontaneous intracerebral hemorrhage (Appendix 1) involving the middle cerebral artery as evidenced by neuroimaging. The volume of hematoma should be more than 30 ml or less than 70 ml using the Kothari method. RESULTS: A total of six (6) patients were included in the study. The ages of patients ranged from 39 - 68 years old with a mean age of 53.3 years. Fifty percent (50%) of the patients were males; 100% of the patients are hypertensive; 50% were diabetic; 83.3% of the patients were dyslipidemic, majority (66.6%) are are smokers and alcoholic beverage drinkers; majority of the patients (83.3%) had hematoma on the left basal ganglia, the volumes of hematoma of the study population ranged from 30ml to 65ml, majority of which (83.3%) are between 30-40m by Kothari formula. Results showed that individuals with elevated pulsatility indexes have 13 times greater odds of neurological deterioration compared to patients with normal pulsatility index and this is statistically significant (p = 0.0027).

CONCLUSION: Having shown that elevated TCD-PI created a trend toward deteriorating neurological outcome, its usefulness in the Neuro-ICU and in particular, for patients who have sustained intracerebral hemorrhage, TCD sonography holds a lot of promise. Being non-invasive, portable and cost-effective, it could give the intensivist an idea of an impending elevation of intracranial pressure, aggressive measures could be instituted and possible deterioration of neurological function would be prevented.