Week 2 temporal muscle volume reduction rate and absolute temporal muscle volume loss are independently associated with unfavorable 6-month functional outcome in hypertensive intracerebral hemorrhage patients, whereas admission temporal muscle volume was not.
Key Findings
Results
Temporal muscle volume loss progressed significantly over time during hospitalization in patients with hypertensive intracerebral hemorrhage.
Mean admission TMV was 32.3 ± 13.5 cm³
Temporal muscle volume reduction rate (TMVRR) increased by an average of 4.63 percentage points per week
Absolute temporal muscle volume loss (ATMVL) increased by an average of 1.65 cm³ per week
TMV was measured on admission and on follow-up CT scans during weeks 1–3
Study included 149 patients with HICH involving the thalamus or basal ganglia admitted between January 2022 and December 2023
Results
Surgical treatment and greater baseline TMV were independently associated with higher week 2 TMVRR and ATMVL.
These associations were identified through multivariable analysis
Baseline TMV and surgical treatment were the two independent predictors of the magnitude of temporal muscle loss
The study was single-center and retrospective in design
Patients underwent either surgical or conservative treatment depending on clinical indication
Results
Patients with unfavorable 6-month functional outcomes showed greater temporal muscle volume loss during hospitalization than those with favorable outcomes.
Unfavorable outcome was defined as a modified Rankin Scale score of 3–6 at 6 months
Patients with unfavorable outcomes had greater TMVRR at both weeks 2 and 3
Patients with unfavorable outcomes had greater ATMVL at week 2
Six-month functional outcome was assessed using the modified Rankin Scale
Results
Week 2 TMVRR and ATMVL were independently associated with unfavorable 6-month functional outcome after adjustment for age, sex, and hemorrhage volume.
Week 2 TMVRR: OR = 1.109, p = 0.004
Week 2 ATMVL: OR = 1.282, p = 0.009
Adjustment covariates included age, sex, and hemorrhage volume
Admission TMV was not independently associated with unfavorable outcome after adjustment
Results
Admission temporal muscle volume was not independently associated with 6-month functional outcome in patients with hypertensive intracerebral hemorrhage.
Mean admission TMV was 32.3 ± 13.5 cm³
Despite admission TMV being measurable on routine head CT, it did not predict outcome independently
Longitudinal changes in TMV (TMVRR and ATMVL) rather than baseline TMV were the relevant prognostic markers
This contrasts with findings in some other neurological conditions where baseline TMV has shown prognostic value
Discussion
Week 2 TMVRR and ATMVL were identified as practical CT-based markers that complement established predictors of functional outcome in HICH.
Both metrics are derived from routine head CT scans without requiring additional imaging
TMV was measured on both admission and follow-up CT scans during weeks 1–3
The authors describe these as markers that 'complement established predictors of functional outcome'
The study was retrospective and single-center, which the authors note as a limitation
What This Means
This research suggests that measuring how quickly the temporal muscle (a chewing muscle visible on routine brain CT scans) shrinks during hospitalization can help predict how well patients will recover after a type of stroke caused by high blood pressure bleeding into the brain. The study followed 149 patients and found that the temporal muscle lost volume progressively during the first few weeks after the bleed, with losses averaging about 1.65 cubic centimeters and 4.63 percentage points per week. Patients who had surgery and those who started with larger temporal muscles tended to lose more muscle volume.
The key finding is that patients who went on to have poor functional outcomes six months later — meaning they had significant disability or died — showed greater muscle shrinkage by the second week of hospitalization compared to those who recovered better. Specifically, both the rate of muscle loss and the absolute amount of muscle lost by week 2 were independently linked to worse outcomes, even after accounting for age, sex, and the size of the brain bleed. Interestingly, the size of the temporal muscle at the time of admission did not predict outcomes, suggesting it is the change over time, rather than the starting point, that matters.
This research suggests that doctors could use these muscle measurements from routine follow-up CT scans — which are already performed as standard care — as an additional tool to help identify patients at high risk of poor recovery after this type of stroke. Early identification of patients losing muscle mass rapidly might open opportunities for targeted nutritional support or rehabilitation interventions, though further research would be needed to determine whether intervening on muscle loss actually improves outcomes.
Lv H, Xin Y, Zhang G, Liu W, Ye J, Li Z, et al.. (2026). Predictive value of changes in temporal muscle volume for 6-month functional outcome in patients with hypertensive intracerebral hemorrhage.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1751620