Predictive value of changes in temporal muscle volume for 6-month functional outcome in patients with hypertensive intracerebral hemorrhage.

BACKGROUND AND PURPOSE: Accurate prediction of functional outcome after hypertensive intracerebral hemorrhage (HICH) remains challenging. Temporal muscle volume (TMV), measurable on routine head computed tomography (CT), may reflect skeletal muscle status. This study investigated longitudinal TMV changes, the factors associated with these changes, and their prognostic value in HICH. MATERIALS AND METHODS: This single-center retrospective study included 149 patients with HICH involving the thalamus or basal ganglia admitted between January 2022 and December 2023. TMV was measured on admission and follow-up CT scans during weeks 1-3. Absolute temporal muscle volume loss (ATMVL) and temporal muscle volume reduction rate (TMVRR) were calculated relative to baseline. Six-month functional outcome was assessed using the modified Rankin Scale; scores of 3-6 indicated an unfavorable outcome. RESULTS: Mean admission TMV was 32.3 ± 13.5 cm3. TMVRR and ATMVL increased significantly over time, averaging 4.63 percentage points and 1.65 cm3 per week, respectively. Surgical treatment and greater baseline TMV were independently associated with higher week 2 TMVRR and ATMVL. Patients with unfavorable outcome showed greater TMVRR at weeks 2 and 3 and greater ATMVL at week 2. After adjustment for age, sex, and hemorrhage volume, week 2 TMVRR (OR = 1.109, p = 0.004) and ATMVL (OR = 1.282, p = 0.009) were independently associated with an unfavorable 6-month outcome, whereas admission TMV was not. CONCLUSION: Temporal muscle loss progresses during hospitalization in patients with HICH. Week 2 TMVRR and ATMVL may provide practical CT-based markers that complement established predictors of functional outcome.