Deans' stroke musings: Outcome Prediction by Combining Initial Clinical Severity With Corticospinal Tract Lesion Load in Patients With Intracerebral Hemorrhage

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, April 17, 2025

Outcome Prediction by Combining Initial Clinical Severity With Corticospinal Tract Lesion Load in Patients With Intracerebral Hemorrhage

Predicting failure to recover is TOTALLY FUCKING USELESS! You're fired!

Outcome Prediction by Combining Initial Clinical Severity With Corticospinal Tract Lesion Load in Patients With Intracerebral Hemorrhage

Toshiki Yasukawa • Yuki Uchiyama • Tetsuo Koyama • Kazuhisa Domen

Published: April 17, 2025 DOI: 10.7759/cureus.82430 Peer-Reviewed Cite this article as: Yasukawa T, Uchiyama Y, Koyama T, et al. (April 17, 2025) Outcome Prediction by Combining Initial Clinical Severity With Corticospinal Tract Lesion Load in Patients With Intracerebral Hemorrhage. Cureus 17(4): e82430. doi:10.7759/cureus.82430

Abstract

Objective:

This study aimed to assess the predictive accuracy of motor outcomes in patients with intracerebral hemorrhage by integrating the initial severity of hemiparesis and the corticospinal tract lesion load (CST-LL).

Materials and methods:

A retrospective analysis was conducted on patients diagnosed with putaminal and/or thalamic hemorrhage who underwent computed tomography (CT) shortly after stroke onset. The CT images were aligned with a standardized brain template to calculate CST-LL. The initial severity of hemiparesis was evaluated using the summed Brunnstrom Recovery Stage (BRS total; range: 3-18). Motor outcomes at the time of discharge from a rehabilitation facility were assessed using the motor component total score of the Stroke Impairment Assessment Set (SIAS-motor total; range: 0-25). A multivariate regression analysis was performed with BRS total and CST-LL as independent variables and SIAS-motor total as the dependent variable.

Results:

A total of 61 patients were included in the analysis. The median CST-LL was 1.974 mL (interquartile range (IQR): 1.113-3.311 mL), the median BRS total was 8 (IQR: 4-13), and the median SIAS-motor total was 20 (IQR: 9.5-24.5). Both BRS total and CST-LL were found to be significant predictors of motor outcomes. The estimated t-values were 4.79 for BRS total and −3.29 for CST-LL, indicating comparable contributions of both factors. The developed regression model explained 60.4% of the variance in SIAS-motor outcomes.

Conclusions:

The combination of initial clinical severity and CST-LL enhances the predictive accuracy of motor recovery in patients with intracerebral hemorrhage.

Introduction

Predicting patient outcomes is crucial(NO, it's not you blithering idiots! Try thinking like a patient for once in your life. They don't want to hear they aren't going to recover!) for planning effective rehabilitation strategies for individuals who have experienced a stroke [1]. Among the various factors influencing recovery, the severity of clinical symptoms in the early stages is particularly important, as it provides critical insights into stroke impact and guides therapeutic and rehabilitative interventions [2]. Therefore, assessing(Assessments do ABSOLUTELY NOTHING FOR RECOVERY! If you think so; GET THE HELL OUT OF STROKE!) clinical manifestations during the acute phase is essential for predicting outcomes and determining appropriate management strategies in stroke rehabilitation.

Beyond initial clinical seserity, the integrity of the corticospinal tract (CST) has been identified as a key factor in predicting functional outcomes, particularly motor recovery in the extremities [3,4]. Studies utilizing magnetic resonance imaging (MRI) have demonstrated that the overlap between the stroke lesion and the CST, known as CST lesion load (CST-LL), correlates with motor function outcomes [5,6]. In addition, computed tomography (CT), which is commonly used in stroke management, especially for hemorrhagic stroke, has been investigated as a potential tool for estimating CST-LL. Some reports suggest that CST-LL derived from CT imaging may aid in outcome prediction, particularly in cases involving putaminal or thalamic hemorrhage [7,8].

Various predictive models incorporating techniques such as machine learning and functional MRI have been developed to estimate stroke outcomes [9-11]. However, these methods often require significant computational resources and prolonged processing times, limiting their feasibility for routine clinical use. In contrast, integrating initial clinical severity assessment with CST-LL derived from standard CT scans offers a practical approach that can be readily implemented in daily clinical practice [8,12]. This study aims to evaluate the clinical utility of combining early clinical severity and CST-LL in predicting outcomes for patients with intracerebral hemorrhage.