CORRELATION BETWEEN HYPERTENSION SEVERITY AND INTRACRANIAL HEMORRHAGE PATTERNS ON EMERGENCY BRAIN CT

Abstract

Background: Hypertension is a major modifiable risk factor for spontaneous intracranial hemorrhage and is associated with significant morbidity and mortality. The severity of hypertension influences cerebrovascular integrity and may determine the pattern, extent, and clinical outcome of intracranial hemorrhage. Emergency non-contrast brain computed tomography (CT) is the primary imaging modality for the rapid diagnosis and assessment of hemorrhagic stroke. However, limited local data are available correlating hypertension severity with intracranial hemorrhage patterns on emergency CT imaging.

Objective: To evaluate the correlation between hypertension severity and intracranial hemorrhage patterns on emergency brain CT and to assess the impact of radiological characteristics on immediate clinical outcomes.

 Methodology: This cross-sectional study was conducted on hypertensive patients presenting with acute neurological symptoms who underwent emergency non-contrast brain CT. A total of 153 patients were included after excluding cases with incomplete clinical or imaging data. Hypertension severity was classified according to American Heart Association guidelines. CT scans were analyzed for hemorrhage type, anatomical location, hematoma volume, laterality, and associated complications. CT-based severity scores, including ICH score, Graeb score, and Modified Fisher score, were calculated. Statistical analysis was performed to assess associations between hypertension severity, imaging findings, and in-hospital outcomes.

Results: Spontaneous intracerebral hemorrhage was the most common hemorrhage type (77.1%). The basal ganglia (45.8%) and thalamus (22.0%) were the most frequently involved sites. Patients presenting with hypertensive crisis demonstrated significantly larger hematoma volumes and higher ICH scores compared to those with stage I or II hypertension (p < 0.05). Severe radiological features such as intraventricular extension, cerebral edema, and midline shift were more common in patients with severe hypertension. In-hospital mortality was 19%, with hematoma volume >60 mL, ICH score ≥3, and hypertensive crisis identified as significant predictors of mortality.