Dorndorf W. Changing pattern of brain hemorrhage during 12 years of computed axial tomography. Stroke

Background and Purpose: We examined whether the pattern of cerebral hemorrhage changed after the introduction of computed tomography. Methods: Using a prospective data base we analyzed the case-fatality ratio, early mortality, and the incidences of hypertension and anticoagulant medication in 488 consecutive cases with supratentorial hemorrhage between 1978 and 1989. Blood pressure at admission of all patients for the years 1978-1979 and 1988-1989 and the Mathew and activities of daily living scores for the years 1978-1979,1982-1983, and 1988-1989 were assessed retrospectively. Results: The case-fatality ratio decreased from 49 % in the period 1978-1981 to 31 % in 1986-1989 (p=0.006); early mortality (day 1-4) decreased from 28 % to 12 % (p=0.0017). The incidence of hypertension decreased from 78 % in the period 1978-1981 to 64 % in 1986-1989 (p=0.01). Systolic and diastolic blood pressure at admission sank (/?=0.09). The decrease of the case-fatality ratio correlated best with a less severe initial disturbance of consciousness (p<0.01) and with a higher Mathew score (p=0.038). The activities of daily living score remained unchanged. Conclusions: The case-fatality ratio and early mortality decreased after the introduction of computed tomography. This was basically due to a decreased incidence of comatose and stuporous patients with severe neurological deficit paralleled by a decrease of mean systolic and diastolic blood pressure values at admission. (Stroke 1992,23:653-656) KEY WORDS • cerebral hemorrhage • hematoma • tomography, x-ray computed The mortality of cerebrovascular disease has beendecreasing for decades.'-4 Reasons proposedhave been lower incidence1-56 or a lower case-fatality ratio7 due to improved diagnostic and therapeu-tic methods during the acute stage.8 The decrease in mortality has been particularly impressive for brain hemorrhage.9-13 More than a decade after the introduc-tion of computed tomography (CT) for routine diagno-sis of stroke, we analyzed changes in the case-fatality ratio, incidence of risk factors, and severity of symptoms in 488 consecutive patients admitted to our department during 12 years