Formulation of a radiological scoring system to prognosticate patients with primary intracerebral haemorrhage


  • Krishna Kumar Department of Neurosurgery, Government Thirumala Devaswom Medical College, Vandanam, Alappuzha, Kerala, India
  • Harison Gopalan Government Thirumala Devaswom Medical College, Vandanam, Alappuzha, Kerala, India
  • Jayalakshmi Jayaprakash Department of Internal Medicine, Government Thirumala Devaswom Medical College, Vandanam, Alappuzha, Kerala, India



radiological score, MIVL score, primary intracerebral haemorrhage


Background. Primary intracerebral haemorrhage is a neurological condition associated with high morbidity and mortality. Outcome prediction is necessary to allocate the available resources in such cases judicially. Our study aims to identify the radiological predictors of in-hospital mortality based on a plain CT study of the brain at admission and to develop a prognostic scoring system based on them.

Material and methods. We collected the clinical and radiological data from 182 consecutive patients who presented with primary spontaneous ICH. Bivariate analysis of radiological predictors of in-hospital mortality was undertaken using unadjusted logistic regression. Those variables found to have significance were put into a multivariate logistic regression model. The Results of multivariate logistic regression were treated as a foundation for developing the scoring system.  

Results. The mortality rate in our series was 23.6% (N = 43). After multivariate analysis, Midline shift (MLS), presence or absence of intraventricular haemorrhage (IVH), Volume of ICH and Location of haematoma were significant predictors of mortality. Based on the identified radiological variables, a five-score prognostic scoring system (AUROC = 0.925, 95% CI 0.887–0.964)) was developed, with higher scores indicating higher mortality.

Conclusions. The established scoring system, MIVL, may help physicians to do better patient counselling regarding outcomes.


Download data is not yet available.


Dennis MS. Outcome after brain hemorrhage. Cerebrovasc Dis. 2003; 16 (suppl 1): 9–13. DOI:

Daniel Agustin Godoy, Gustavo Piñero, Mario Di Napoli. Predicting Mortality in Spontaneous intracerebral hematoma. Can Modification to Original Score Improve the Prediction? Stroke. 2006; 37:1038-1044 DOI:

Flaherty ML1, Haverbusch M, Sekar P, Kissela B, Kleindorfer D, Moomaw CJ, Sauerbeck L, Schneider A, Broderick JP, Woo D. Long‑term mortality after intracerebral hemorrhage. Neurology. 2006 Apr 25; 66(8):1182-6. DOI:

Bilbao G, Garibi J, Pomposo I, Pijoan JI, Carrasco A, Catalán G, González S. A prospective study of a series of 356 patients with supratentorial spontaneous intracerebral hematomas treated in a Neurosurgical Department. Acta Neurochir (Wien). 2005 Aug;147(8):823-9. DOI:

Rohit Bhatia, Hariom Singh, Shaily Singh, Madakasira V Padma, Kameshwar Prasad, Manjari Tripathi, Guresh Kumar, Mamta Bhushan Singh.A prospective study of in‑hospital mortality and discharge outcome in spontaneous intracerebral hemorrhage. Neurol India 2013; 61:244-8. DOI:

Fogelholm R, Murros K, and Rissanen A, Avikainen S. Long term survival after primary intracerebral haemorrhage: a retrospective population based study.J Neurol Neurosurg Psychiatry. 2005 Nov;76(11):1534-8.

McKissock W, Richardson A, Taylor J. Primary intracerebral hemorrhage: A controlled trial of surgical and conservative treatment in 180 unselected cases. Lancet. 1961; 2:221–6. DOI:

Batjer HH, Reisch JS, Allen BC, Plaizier LJ, Su CJ. Failure of surgery to improve outcome in hypertensive putaminal hemorrhage. A prospective randomized trial. Arch Neurol. 1990; 47:1103–6 DOI:

Witsch J, Siegerink B, Nolte CH, Sprügel M, Steiner T, Endres M, Huttner HB. Prognostication after intracerebral hemorrhage: a review. Neurol Res Pract. 2021 May 3;3(1):22. doi: 10.1186/s42466-021-00120-5. PMID: 33934715; PMCID: PMC8091769. DOI:

Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, and Zuccarello M, Khoury J: The ABCs of measuring intracerebral hemorrhage volumes. Stroke 1996; 27:1304-1305. DOI:

Hemphill JC, 3rd, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage editorial comment: a simple, reliable grading scale for intracerebral hemorrhage. Stroke.2001;32(4):891-897. DOI:

McCracken DJ, Lovasik BP, McCracken CE, Frerich JM, McDougal ME, Ratcliff JJ, Barrow DL, Pradilla G. The Intracerebral Hemorrhage Score: A Self‑Fulfilling Prophecy? Neurosurgery. 2019 Mar 1;84(3):741-748. doi: 10.1093/neuros/nyy193. PMID: 29762777. DOI:

Gregorio T, Pipa S, Cavaleiro P, Atanasio G, Albuquerque I, Chaves PC, Azevedo L. Prognostic models for intracerebral hemorrhage: Systematic review and meta‑analysis. BMC Med Res Methodol. 2018; 18, 145. DOI:

Rost NS, Smith EE, Chang Y, Snider RW, Chanderraj R, Schwab K, Rosand J. Prediction of functional outcome in patients with primary intracerebral hemorrhage: the FUNC score. Stroke. 2008;39(8):2304–2309 DOI:

Chiranjib Nag, Kamalesh Das, Mrinalkanti Ghosh, M R Khandakar: Prediction of Clinical Outcome in Acute Haemorhagic Stroke from a Single CT scan on Admission. Am J Med Sci.2012;4(10): 463-467. DOI:

Fogelholm R, Murros K, and Rissanen A, Avikainen S. Long term survival after primary intracerebral haemorrhage: a retrospective population‑basedstudy. J Neurol Neurosurg Psychiatry. 2005 Nov;76(11):1534-8. DOI:

Leira R, Davalos A, Silva Y, Gil‑Peralta A, Tejada J, Garcia M, Castillo J: Early neurologic deterioration in intracerebral hemorrhage: predictors and associated factors. Neurology 2004; 63:461-467. DOI:

Diringer MN, Edwards DF, and Zazulia AR: Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage. Stroke 1998; 29:1352-1357. DOI:

Al-Mufti F, Thabet AM, Singh T, El-Ghanem M, Amuluru K, Gandhi CD. Clinical and Radiographic Predictors of Intracerebral Hemorrhage Outcome. Interv Neurol. 2018 Feb;7(1-2):118-136. doi: 10.1159/000484571. Epub 2018 Jan 12. PMID: 29628951; PMCID: PMC5881146. DOI:

Broderick JP, Brott TG, Duldner JE, Tomsick T, Huster G: Volume of intracerebral hemorrhage. A powerful and easy‑to‑use predictor of 30-day mortality. Stroke 1993; 24:987 DOI:

Flemming KD, Wijdicks EF, Li H. Can we predict poor outcome at presentation in patients with lobar hemorrhage? Cerebrovasc Dis. 2001. 11: 183-9. DOI:

Davis SM, Broderick J, Hennerici M, Brun NC, Diringer MN, Mayer SA, Begtrup K, and Steiner T: Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology 2006; 66:1175-1181. DOI:

Ferro J M: Update on Intracerebral Hemorrhage. J Neural 2006; 253(8):985-99. DOI:

Seiji Kazui, Hiroaki Naritomi, Haruko Yamamoto, Tohru Sawada, Takenori Yamaguchi: Enlargement of Spontaneous Intracerebral Hemorhage, Incidence and Time Course. Stroke 1996; 27:1783-1787. DOI:

Menon G. Surgery for spontaneous intracerebral hemorrhage: Emerging trends. Arch Med Health Sci [serial online]2017 [cited 2021 Dec 20]; 5:65-70. Available from:

Lee JH, Chang CH, Jung YJ, Kim JH: The Relationship between the Direction of Putaminal Intracerebral Hemorrhage and Anterior Cerebral artery Predominance. Lee JH, ChangCH, JungYJ, Kim JH. World Neurosurg. 2017 Nov; 107:211-215. DOI:

Becker KJ, Baxter AB, Bybee HM, Tirschwell DL, AbouelsaadT.CohenWA.Extravasation of radiographic contrast is an independent is an independent predictor of death in primary intracerebral hemorrhage. Stroke 1999; 30(10):2025-32. DOI:

Delgado Almandoz JE, Yoo AJ, Stone MJ, Schaefer PW, Goldstein JN,Rosand J, Oleinik A, Lev MH, Gonzalez RG, Romero JM. Systematic characterization of the computed tomography angiography spot sign in primary intracerebral hemorrhage identifies patients at highest risk for hematoma expansion. The spot sign score. Stroke. 2009; 40:2994 –3000. DOI:

EufrozinaSelariu, Elisabet Zia, Marco Brizzi, and Kasim Abul‑Kasim: Swirl sign in intracerebral hemorrhage: definition, prevalence, reliability and prognostic value. BMC Neurol.2012; 12: 109. DOI:

Li Q, ZhangG, Huang Y J, DongMX, LvFJ, WeiX, ChenJJ, Zhang L J, QinXY, XieP: Blend sign on ComputerisedTomography: Novel and Reliable Predictor for Early Hematoma Growth in Patients with Intracerebral Hemorrhage. Stroke 2015; 46(8):2119-23. DOI:

QiLi, Gang Zhang, Xin Xiong, Xing‑Chen Wang, Wen‑Song Yang, Ke‑Wei Li, Xiao Wei, Peng Xie. Black Hole Sign. Novel Imaging Marker That Predicts Hematoma Growth in Patients with Intracerebral Hemorrhage. Stroke. 2016;47:1777-1781. DOI:

Sporns PB, Schwake M, Kemmling A, et al. Comparison of Spot Sign, Blend Sign and Black Hole Sign for Outcome Prediction in Patients with Intracerebral Hemorrhage. J Stroke. 2017; 19(3):333-339. DOI:

Barras CD, Tress BM, Christensen S, MacGregor L, Collins M, Desmond PM, Skolnick BE, Mayer SA, Broderick JP, Diringer MN, Steiner T, Davis SM. Density and shape as CT predictors of intracerebral hemorrhage growth. Stroke 2009;40(4):1325-31. DOI:

How to Cite

Kumar K, Gopalan H, Jayaprakash J. Formulation of a radiological scoring system to prognosticate patients with primary intracerebral haemorrhage. JMS [Internet]. 2023 Mar. 30 [cited 2023 Jun. 1];92(1):e724. Available from:



Original Papers
Received 2022-08-23
Accepted 2023-01-21
Published 2023-03-30