Similarly J.P. Broderick et.alhad reported that for Intra-cerebral Haemorrhage with volume of more than 60 cm3 the 30 day mortality for Deep Haemorrhage was 93% and for Lobar haemorrhage was 71% [4].

In the same study it was seen that for volume of less than 30 cm³, the 30 day mortality was 23%, for deep haemorrhage, 7% for lobar Haemorrhage and 57% for cerebellar Haemorrhage. The intra-cerebral Haemorrhage thus remains an area where different confuting views on size of hematoma and its effects are prevalent. This work has been undertaken to resolve some of the confusion and try to reach a better insight into the complex problem. We observed the effect of different sizes of hematoma and utilizing them, if feasible as a marker of prognostic significance.

Study design: It was a cross sectional study.

Study place and duration: Patients admitted in various wards of Department of Medicine RIMS, Ranchi Jharkhand with hypertensive intra-cerebral haemorrhage, during the period of 2008-2009 were evaluated for observation of clinical outcome by various parameters.

Sample size: In this study we observed 60 patients from the time of admission till 30^th day. The various parameters for observation were Age, Sex, Haemorrhagic side (Right or left), Haemorrhagic location, Haemorrhagic volume, B.P. at time of admission, Intra-ventricular extension of blood, Midline shift in CT scan and Glasgow come scale. All the patients who are admitted for the first time with hypertensive intracerebral haemorrhage are included. Patients with intracranial haemorrhage due to Trauma, Aneurysm, Coagulopathy, and recurrent ICH are excluded.

Procedure: All patients were evaluated on admission through emergency or medical OPD. All patients were assessed within hours of their presentation then follow up done in wards and after discharge at 30th day in OPD.

Maximum parameters were derived fromCT scan viz. Volume of haematoma, Side of haemorrhage, Location of haemorrhage, Midline shift, Intraventricular spread of the haemorrhage. A simple method of measuring the volume of haematorna (in cc) on the CT scan is by using the following formula:

Intraventricular extension (Present/Absent), Midline shift (<3 mm, 3-5 mm, >5mm), GCS(≤8,≥9).

Statistical analysis: Statistical analysis was performed to correlate the patient’s outcome and each prognostic factor using the X²test (Chi square test).

Probability values of 0.05 or less were consideredstatistically significant.

Total 60 patient were taken into study out of which 33(55%) were alive, and 27(45%) were dead in 30 days follow up. In my study 38 were male and 22 were female out of 38 male 22(66.66%) were alive and 16 (59.2%) dead and in 22 female 11(33.33%) were alive and 11 (40.7%) were dead (table.1).

HTN, DM, smoking, obesity, prior cardiovascular dis.are risk factor A history of HTN was found in 50% of patients. In some patients no risk factors found (table.2).

Weakness of limbs or focal neurological deficit in 80% of cases, loss of consciousness in 68.33%, vomiting 30%, Headache 28.33%, seizure / convulsion in 11.66%, Aphasia / slurring of speech in 8%, Ataxia in 1.66% others like cranial nerve palsy in 6.66% (table.3).

CT parameters or findings that could predict prognosis.

In our study, out of total 60 patients 38 (63.33%) were male and 22 (36.66%) were female. Age ranged between < 60 yrs. to > 70 yrs. Mean age was 63.83 years, 24 patients had right sided haemorrhage, 33 patients had left sided hemorrhage, 3 patients had midline hemorrhage. 44 patients had DH, 11 patients had LH, 2 patients had cerebellar hemorrhage, 3 patients had pontine/Mid brain haemorrhage. Hemorrhagic volume was kept under 3 categories :-< 30 c.m³, 30-60 c.m³ and > 61 c.m³. Mean volume of haemorrhage was 35.21 cm³.

In our study, 44 patients had DH, 11 patients had LH, 2 patients had cerebellar haemorrhage and 3 patients had pontine/ Midbrain haemorrhage. No significant correlation found according tosite of haemorrhage (p> 0.50). 24 patients had right sided haemorrhage, 33 patients had left sided haemorrhage, 3 patients had bleed in midline. Nosignificant correlation found based on side of haemorrhage (p> 0.50).

In our study, three age groups were taken. Age ranged between 42 yrs. to 84 yrs. Mean age of patients was 63.83 correlation found according to age of presentation (p> 0.50). 38 patients were Male and 22 patients were female. No significant correlation found in mortality according to sex of patients (p> 0.50).

B.P, at the time of admission was recorded 3 categories were divided :<180/104, 180-230 / 104-140 and >230/140. 11 patients had B.P.> 230 / 140, all died. So statistically significant correlation was found (p<0.005) with the B.P. at the time of admission and ICH. Similar reports were found by A.R. Massero [3].

In our study, 27 patients had intraventricular extension and 33 patients had not, 66.66% patients died who had intraventricular extension. Statistically significant correlation found (p<0.01) with theintra-ventricular extension and ICH. J kirn et al found almost similar results (60% mortality) Goldstein JN etal inshows significant mortality(p<.01) [9].

In our study, 3 groups were kept according to midline Shift in CT scan: <3mm, 3-5mm and >5mm, statistically significant correlation found (p < 0.01) with midline shift and ICH. So in our study Haemorrhagic volume, B.P. at the time of admission, Intraventricular extension of blood, Midline shift in CT scan and, GCS at the time of admission correlate significantly with the outcome of spontaneous ICH.

As cerebrovascular disease is very serious group of disorder predominant mainly in the middle and late years of life and are one of the leading causes of mortality and morbidity in our society.

Our study shows HTN, size of hematoma, intra-ventricular extension as independent indicator of prognosis. HTN which has direct with outcome everyone should educated about the early symptoms and long-term adverse effect of this disease.