Primary ICH has been reported to be the most lethal form of stroke and to account for approximately 15% of all strokes worldwide. The rate of mortality and disability after ICH, highlighting the pressing, needs to improve current therapy [11, 12].
The median case fatality at 30 days after primary ICH was found to be 40.4%; ranging from 13 to 61%, with most deaths occurring within the first 48 h . In our study, the overall 30-day mortality was 33 out of 120 patients (28.4%) of which 13.8% was during the first week of onset and 14.6% during the subsequent 3 weeks. The remaining 71.6% had variable degrees of motor (67.2%), speech (13.8%), cognitive (8.6%), visual field (6.9%), and sensory (6.9%) disabilities. The range of the recorded mRS was 1–6 points with no patients scored 0/6 or 5/6. Patients scored 1–2 were 18.9%, those with score 3–4 were 52.6%, and those patients who died had a score of 6/6. The outcome of our patients as regards the mortality and disability was almost like that of EL-Tallawy and colleagues , who reported that 32.3% of their patients died within the first month. Similarly, Zis and colleagues , found that 30-day case fatality rate in their ICH patients was 31.9%, as 61 patients died within 30 days after the ICH out of 191 patients included in their study. Also, Stein and colleagues  observed that 30-day mortality was 28.6%, but in contrast to our results regarding disability, they found only 17.4% of their patients showed a favorable functional outcome (mRS ≤ 3) vs 56.8% in our patients. In 2013, Hu and colleagues  reported that overall hospital mortality was 24.4% and mean time from admission to death was 10.5 ± 18.5 days, of them, 36 patients died in the first 72 h due to neurological complications. Of their total sample, 21.8% recovered fully with no lasting squealed, while 50.4% improved after therapy but with lasting squealed, that discrepancy between their results and ours may be due to their larger sample size (266 vs 120), and also, not all their patients were of primary type of ICH. In our results, the absence of patients that had an independent life activity after 1 month of ICH may be due to the relatively short time of follow-up, small sample size as compared to multicenter studies, and also due to the lower quality of complementary as nutritional, rehabilitation, and psychological treatment strategies.
The NIHSS score had originally validated for evaluation of ischemic stroke severity, and then, it has been tried to predict outcome of ICH . In our study, the NIHSS range was 3–38 with median of 16 points. There were 43.1% of patients who have NIHSS 5–15, 31% with NIHSS 21–42, and 24.1% with 16–20 points. The hematoma volume was highly correlated to admission NIHSS (p < 0.001). This is in disagreement with the results of Christensen and colleagues , who found that hematoma volume on admission is not correlated to NIHSS (p = 0.494). This can be due to their much larger sample size 821 patients with primary ICH from 122 centers in 22 countries.
It is reported that ICH mortality is better predicted by the NIHSS than the GCS. An increased NIHSS score on admission impacts ICH outcomes unfavorably . In our study, we found a highly statistically significant relation (p = 0.001) between the 30-day mortality and NIHSS. A matched result was reached by Cheung and Zou , and a retrospective study of cases was admitted to the regional in Hong Kong and found that in 142 patients with ICH, was a statistically significant relation of the 30-day mortality to NIHSS (p = 0.000). Our results were also similar to the results of Finocchi and colleagues , who concluded that the NIHSS is a reliable tool of clinical monitoring and correlates with 30-day and 3-month mortality and functional outcome in subjects with ICH with a sensitivity of 93.5 and 92.2%, specificity of 82.3 and 69.6%, and GA of 87.8 and 80.8%, respectively, at 1 and 3 months. In Essa and colleagues , a study included patients admitted to Alexandria Main University Hospital, with acute cerebrovascular stroke, during 6 months interval for November 2008 till April 2009; there were similar results regarding the significant relation between mortality following ICH and admission NIHSS (p = 0.001). This in agreement with the findings of Christensen and colleagues , in Factor Seven for Acute Hemorrhagic Stroke (FAST) trial which included 821 patients with sICH from 122 sites in 22 countries, that neurological deterioration and mortality were significantly related to NIHSS (p < 0.001). Similar results to ours were obtained by Bakhshayesh and colleagues  in their prospective study conducted at Poursina Teaching-Hospital in Rasht, Iran, from January 2010 to the end of January 2011, where they found that in 98 cases with primary ICH, the deceased patients have significantly higher NIHSS score (p < 0.001).
Different scoring systems have been tested and devised in order to improve the prediction of the outcome of primary ICH, but they are not used routinely in clinical practice . In our present study, a significant correlation was found between each of the four scores that have been used in patients’ evaluation. mRS was positively correlated with ICH score, GCS, and NIHSS, and there is an inverse correlation found between ICH score and GCS.
In view of our results, we can conclude that in patients with primary ICH initial assessment on admission, using both the NIHSS and ICH scores (hematoma volume and GCS are included in ICH score) is much informative and predictive for the outcome than using any one of them alone and that NIHSS score has an independent predictive value of a 30-day outcome regarding mortality and disability.