Predictive value of CT signs for disorders of consciousness in patients with primary brainstem hemorrhage

Objective To analyze the value of CT signs in the prediction of disorders of consciousness (DOC) in patients with primary brainstem hemorrhage (PBH). Methods A total of 377 patients with brainstem hemorrhage admitted to the Second Affiliated Hospital of Army Medical University from August 2011 to October 2020 were recruited, and 107 patients with PBH were screened out. According to the level of their consciousness, they were divided into 4 levels, that is, consciousness, somnolence, sopor and coma. Mann-Whitney U and Spearman rank correlation tests were used to perform univariate analysis on the factors that may affect DOC (gender, age, CT signs, bleeding stage), and ordinal multinomial logistic regression analysis was carried out for those with significance (P < 0.05) to explore the correlation of these indicators with consciousness level in order to explore the CT signs that can predict the level of DOC. Results Mann-Whitney U test showed that gender had no significant correlation with DOC, while whether being broken into the ventricle or involved in the midbrain were significantly correlated. Spearman rank correlation analysis indicated that age was not significantly related with DOC, while bleeding stages and average CT values were weakly correlated with DOC, differences of shape and heterogeneity of density were moderately correlated with DOC, and bleeding volume and greatest hemorrhage diameter were highly correlated with DOC. Ordinal multinomial logistic regression analysis showed that: ① The greater bleeding volume or the greatest hemorrhage diameters of the hematoma are, the more serious DOC in PBH patients is. ② The probability of aggravating the DOC level in patients with >5~10 mL brainstem bleeding was 8.05 times higher than that in patients with ≤2 mL bleeding volume. The patients with greatest hemorrhage diameters of >3~4 cm in hematoma had the possibility of aggravating the DOC level at least 1 grade, which was 16.66 times higher than those with ≤2 cm. ③ There were no significant correlations among DOC and the differences of shape, heterogeneity of density, whether the hemorrhage being involved in the midbrain and broken into the brain ventricle or not. Conclusion In PBH patients, bleeding volume and greatest hemorrhage diameters of hematoma are positively correlated with DOC level. Bleeding volume of brainstem bleeding of >5~10 mL or greatest hemorrhage diameter of >3~4 cm indicates the changes of DOC level.