Background and Purpose—A clinical grading scale for intracerebral hemorrhage (ICH), formally ICH score, was recently developed showing to predict 30-day mortality in a simple and reliable manner. The aim of the present study was to validate the original ICH (oICH) score in an independent cohort of patients from a developing country assessing 30-day mortality and 6-month functional outcome and whether its modifications can improve prediction.Methods—Consecutive patients admitted with acute ICH between January 1, 2003, and July 31, 2004, were prospectively included. oICH score was applied and 2 modified ICH (mICH) scores were created with the same variables, except localization, of the oICH score but with different cutoff values. Outcome was assessed as 30-day mortality and 6-month good outcome (Glasgow Outcome Scale [GOS] 4 to 5).Results—A total of 153 patients were included during study period. Thirty-day mortality rate was 34.6% (n=53), and 59 patients (38.6%) had good functional outcome (GOS 4 to 5) at 6 months. The oICH and mICH scores predicted mortality equally well. According to Youden’s index (J), the oICH score was a reliable predictor for mortality (J=0.59) but less reliable for predicting good outcome (J=0.54). The mICH scores were equal in predicting mortality but better for predicting good outcome than the oICH score (J=0.60).Conclusions—oICH score also confirms its validity in a socially and culturally different population. Modifications of oICH do not improve its 30-day mortality prediction but improve its ability to predict good functional outcome at 6 months.

During traumatic brain injury, intracranial hypertension can become a life-threatening condition if it is not managed quickly and adequately. Physicians use therapeutic hyperventilation to reduce elevated intracranial pressure (ICP) by manipulating autoregulatory functions connected to cerebrovascular CO2 reactivity. Inducing hypocapnia via hyperventilation reduces the partial pressure of arterial carbon dioxide (PaCO2), which incites vasoconstriction in the cerebral resistance arterioles. This constriction decrease cerebral blood flow (CBF), which reduces cerebral blood volume (CBV) and, ultimately, decreases the patient’s ICP. The effects of therapeutic hyperventilation are transient, but the risks accompanying these changes in cerebral and systemic physiology must be carefully considered before the treatment can be deemed advisable. The most prominent criticism against this approach is the cited possibility of developing cerebral ischemia and tissue hypoxia. While it is true that certain measures, such as cerebral oxygenation monitoring, are needed to mitigate these dangerous conditions, using available evidence of potential poor outcomes associated with hyperventilation as justification to dismiss the implementation of therapeutic hyperventilation is debatable and remains a controversial subject among physicians. This review highlights various issues surrounding the use of hyperventilation as a means of controlling posttraumatic intracranial hypertension, including indications for treatment, potential risks and benefits, and a discussion of what techniques can be implement to avoid adverse complications.

The epidemiological analysis of brain death (BD) can assist physicians in their development of relevant guidelines regarding training and action protocols. This study aims to find the incidence of BD in the United States. This is a cross-sectional study between 2012 and 2016 in the United States. BD data were extracted from the Healthcare Cost and Utilization Project (HCUP) and compared with those of all in-hospital Cardio-Pulmonary Deaths (ih-CPD). There were 69,735 BD (0.039%) and 3,309,955 ih-CPD (1.85%) with one BD for every fifty ih-CPD. The number of BD increased from 12,575 in 2012 to 15,405 in 2016 (p < 0.0001), with an average of 39 BD per 100,000 discharges and a mean age of 47.83 ± 20.93 years old. Both groups were mainly male and ethnically white; however blacks had the highest rate of BD per capita (p < 0.0001). The most frequently reported cause for BD was the Central Nervous System diseases (50.17%). In recent years, the incidence of BD has increased in the United States. Knowing the incidence of BD and the establishment of long-term programs that raise awareness about BD may increase the number of potential organ donors in the future.