J Stroke.  2022 May;24(2):266-277. 10.5853/jos.2021.01823.

Etiology, 3-Month Functional Outcome and Recurrent Events in Non-Traumatic Intracerebral Hemorrhage

• Goeldlin MB
• Mueller A
• Siepen BM
• Mueller M
• Strambo D
• Michel P
• Schaerer M
• Cereda CW
• Bianco G
• Lindheimer F
• Berger C
• Medlin F
• Backhaus R
• Peters N
• Renaud S
• Fisch L
• Niederhaeuser J
• Carrera E
• Dirren E
• Bonvin C
• Sturzenegger R
• Kahles T
• Nedeltchev K
• Kaegi G
• Vehoff J
• Rodic B
• Bolognese M
• Schelosky L
• Salmen S
• Mono ML
• Polymeris AA
• Engelter ST
• Lyrer P
• Wegener S
• Luft AR
• Z’Graggen W
• Bervini D
• Volbers B
• Dobrocky T
• Kaesmacher J
• Mordasini P
• Meinel TR
• Arnold M
• Fandino J
• Bonati LH
• Fischer U
• Seiffge DJ
• on Behalf of the SSR Investigators

• KMID: 2530529
• DOI: http://doi.org/10.5853/jos.2021.01823

Abstract

Background and Purpose
Knowledge about different etiologies of non-traumatic intracerebral hemorrhage (ICH) and their outcomes is scarce.
Methods
We assessed prevalence of pre-specified ICH etiologies and their association with outcomes in consecutive ICH patients enrolled in the prospective Swiss Stroke Registry (2014 to 2019). Results We included 2,650 patients (mean±standard deviation age 72±14 years, 46.5% female, median National Institutes of Health Stroke Scale 8 [interquartile range, 3 to 15]). Etiology was as follows: hypertension, 1,238 (46.7%); unknown, 566 (21.4%); antithrombotic therapy, 227 (8.6%); cerebral amyloid angiopathy (CAA), 217 (8.2%); macrovascular cause, 128 (4.8%); other determined etiology, 274 patients (10.3%). At 3 months, 880 patients (33.2%) were functionally independent and 664 had died (25.1%). ICH due to hypertension had a higher odds of functional independence (adjusted odds ratio [aOR], 1.33; 95% confidence interval [CI], 1.00 to 1.77; P=0.05) and lower mortality (aOR, 0.64; 95% CI, 0.47 to 0.86; P=0.003). ICH due to antithrombotic therapy had higher mortality (aOR, 1.62; 95% CI, 1.01 to 2.61; P=0.045). Within 3 months, 4.2% of patients had cerebrovascular events. The rate of ischemic stroke was higher than that of recurrent ICH in all etiologies but CAA and unknown etiology. CAA had high odds of recurrent ICH (aOR, 3.38; 95% CI, 1.48 to 7.69; P=0.004) while the odds was lower in ICH due to hypertension (aOR, 0.42; 95% CI, 0.19 to 0.93; P=0.031).
Conclusions
Although hypertension is the leading etiology of ICH, other etiologies are frequent. One-third of ICH patients are functionally independent at 3 months. Except for patients with presumed CAA, the risk of ischemic stroke within 3 months of ICH was higher than the risk of recurrent hemorrhage.

Keyword

Cerebral hemorrhage; Etiology; Ischemic stroke; Outcome

Figure

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  Figure 1. Mechanistic classification of intracerebral hemorrhage (ICH) etiology: comparison of the original and adapted SMASH-U (structural lesion > systemic disease > medication > amyloid angiopathy > hypertension > unknown) classifications. CAA, cerebral amyloid angiopathy; INR, international normalized ratio.

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  Figure 2. Frequency of intracerebral hemorrhage etiologies. CAA, cerebral amyloid angiopathy.

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  Figure 3. Distribution of (A) age, (B) National Institutes of Health Stroke Scale (NIHSS), (C) systolic blood pressure, and (D) time from onset to admission among different intracerebral hemorrhage etiologies. CAA, cerebral amyloid angiopathy. *Clinical findings differed according to the underlying etiology.

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  Figure 4. Functional outcomes at 3 months according to intracerebral hemorrhage (ICH) etiology. CAA, cerebral amyloid angiopathy; mRS, modified Rankin Scale.

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  Figure 5. All cerebrovascular events, Ischemic stroke and recurrent intracerebral hemorrhage (ICH) at 3 months according to ICH etiology. CAA, cerebral amyloid angiopathy.

Reference

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