Neurorehabilitation, Functional Outcomes and Prognostic Factors in Traumatic Intracerebral Hematomas | International Journal of Medical Sciences And Clinical Research

Authors

Begaliev S.M.

Karakalpak Branch of the Republican Scientific Centre of Emergency Medical Care, Nukus, Republic of Uzbekistan
Mambetkarimov G.A.

Medical Institute of Karakalpakstan, Nukus, Republic of Uzbekistan

DOI:

https://doi.org/10.37547/ijmscr/Volume06Issue06-03

Keywords:

Traumatic intracerebral haematoma neurorehabilitation Glasgow Outcome Scale (GOSE)

Abstract

Background. Traumatic intracerebral haematomas (TICH) are characterised by high mortality (35–72%) and significant disability in survivors (> 60%). Functional outcomes and quality of life are determined not only by the severity of the primary injury but also by the effectiveness of neurorehabilitation. Comprehensive assessment of prognostic factors and development of optimal rehabilitation programmes remain priority challenges in contemporary neurosurgery.

Objective. To evaluate functional treatment outcomes, identify independent prognostic factors, and investigate the effectiveness of neurorehabilitation in patients with TICH based on analysis of two clinical cohorts.

Materials and methods. This retrospective-prospective cohort study included 154 patients with TICH: a primary cohort of 82 patients (RNSC, Tashkent, 1994–1999) and an additional cohort of 72 patients (neurosurgical unit of MIK, Nukus, 2020–2024). Functional outcomes were assessed using the Glasgow Outcome Scale Extended (GOSE) at discharge and at 12 months. Cognitive status was evaluated through neuropsychological assessment of 38 surviving patients at 3–6 months post-injury. Social reintegration was analysed by return-to-work rates and quality of life (SF-36) at 12 months in 75 survivors.

Results and discussion. Overall mortality was 8.5%: 14.0% in the surgical group and 2.6% in the conservative group. Good functional recovery (GOSE 7–8) was achieved in 40.2% of patients; moderate disability (GOSE 5–6) in 31.7%. Independent predictors of unfavourable outcome were: GCS ≤ 6 on admission (OR 8.4), midline shift > 10 mm (OR 6.2), haematoma volume > 60 mL (OR 5.7), intraventricular haemorrhage (OR 4.9), and age > 60 years (OR 3.8). Cognitive impairment at 3–6 months was identified in 71.1% of survivors, with memory impairment in 68.4% and reduced attention in 63.2%. Return to full employment at 12 months was achieved by only 37.3% of patients. Early neurorehabilitation (from days 1–3) and a multidisciplinary approach resulted in significant improvement of cognitive functions in 61.5% of patients.

Conclusion. Functional outcomes in TICH are determined by a complex of clinical, neuroimaging, and laboratory factors. Early staged neurorehabilitation within a multidisciplinary framework is an essential condition for improving functional recovery, social reintegration, and quality of life. Long-term follow-up is necessary given the high frequency of cognitive, emotional, and social sequelae in the late period.

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