# A simple CT score predicts early neurological disability and survival in supratentorial intracerebral hemorrhage - The intracerebral mass and brain edema score (IMBES)

## TL;DR

A new CT-based score called IMBES helps predict neurological disability and survival in patients with brain hemorrhage.

## Contribution

IMBES, a simple CT score based on sulcal effacement, outperforms ICH volume in predicting outcomes in supratentorial intracerebral hemorrhage.

## Key findings

- IMBES was a significant predictor of neurological outcome and mortality in 762 patients.
- High IMBES scores were associated with decreased neurological recovery and increased mortality.
- IMBES outperformed ICH volume in predicting neurological outcomes.

## Abstract

Treatment of spontaneous intracerebral hemorrhage (ICH) remains challenging, and intracerebral mass and brain edema (IMBE) are accused of being the main factors influencing patient course.

CT scan assessment of the space-occupying effect after initial ICH was evaluated using an IMBE-score to detect the sulcal effacement of the subarachnoid space.

Supratentorial ICH-patients within a 10 years observation period were identified. Two independent reviewers screened each CT scan in three defined axial planes. Where the combined mass effect of hemorrhage and edema showed sulcal effacement of more than half of the hemisphere, one point was assigned, resulting in an IMBES between 0 and 6. The primary endpoint was neurological outcome measured by the modified Rankin Scale (mRS) and mortality.

We identified 762 patients, median age was 75.4 years (IQR: 64.3–81.1) and mean ICH volume was 46.1 cc. Multiple regression for mRS at discharge (mean: 12.5 days, IQR: 7.1–22.3) identified age, presence of intraventricular hemorrhage, ICH volume, renal insufficiency, intake of anticoagulants and IMBES as statistically significant variables. This was confirmed during follow-up examination, although ICH volume was not significantly associated with neurological outcome.

We observed a decreased neurological recovery and an increased mortality for patients with high IMBES during acute care and at early follow-up, indicating that IMBES had the strongest association in all regression analysis. We conclude that the fast and simple IMBES may be a useful tool to estimate patient risk for impaired neurological outcome and death.

•This retrospective study identified 762 patients with spontaneous intracerebral hemorrhage.•The cumulative space-occupying effect of ICH and edema is assessed by IMBES on three axial CT scans.•This simple radiological assessment can be quickly performed using routine non-contrast CT scans.•The IMBES was a significant predictor of neurological outcome and mortality.•Based on sulcal effacement the IMBES outperforms ICH volume in predicting neurological outcome.

This retrospective study identified 762 patients with spontaneous intracerebral hemorrhage.

The cumulative space-occupying effect of ICH and edema is assessed by IMBES on three axial CT scans.

This simple radiological assessment can be quickly performed using routine non-contrast CT scans.

The IMBES was a significant predictor of neurological outcome and mortality.

Based on sulcal effacement the IMBES outperforms ICH volume in predicting neurological outcome.