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 MB1,2
- Mueller A3
- Siepen BM1,2
- Mueller M1
- Strambo D4
- Michel P4
- Schaerer M5
- Cereda CW6
- Bianco G6
- Lindheimer F7
- Berger C7
- Medlin F8
- Backhaus R9
- Peters N9
- Renaud S10
- Fisch L11
- Niederhaeuser J11
- Carrera E12
- Dirren E12
- Bonvin C13
- Sturzenegger R14
- Kahles T15
- Nedeltchev K15
- Kaegi G16
- Vehoff J16
- Rodic B17
- Bolognese M18
- Schelosky L19
- Salmen S1,20
- Mono ML21
- Polymeris AA22
- Engelter ST22,23
- Lyrer P22
- Wegener S3
- Luft AR3,24
- Z’Graggen W1,25
- Bervini D25
- Volbers B1,26
- Dobrocky T27
- Kaesmacher J2,27,28
- Mordasini P27
- Meinel TR1,2
- Arnold M1
- Fandino J29
- Bonati LH22
- Fischer U
22 - Seiffge DJ1
- on Behalf of the SSR Investigators 1
- Affiliations
-
- 1Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- 2Graduate School of Health Sciences, University of Bern, Bern, Switzerland
- 3Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- 4Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- 5Department of Neurology, Buergerspital Solothurn, Solothurn, Switzerland
- 6Stroke Center EOC, Neurocenter of Southern Switzerland, Lugano, Switzerland
- 7Stroke Unit, Department of Internal Medicine, Hospital of Grabs, Grabs, Switzerland
- 8Stroke Unit and Division of Neurology, Department of Internal Medicine, HFR Fribourg–Cantonal Hospital, Villars-sur-Glâne, Switzerland
- 9Stroke Center Hirslanden, Klinik Hirslanden Zurich, Zurich, Switzerland
- 10Division of Neurology, Pourtalès Hospital, Neuchatel, Switzerland
- 11Stroke Unit, GHOL, Hospital Nyon, Nyon, Switzerland
- 12Stroke Research Group, Department of Clinical Neurosciences, Geneva University Hospital, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- 13Service of Neurology, Valais Hospital, Sion, Switzerland
- 14Department of Internal Medicine, Hospital Graubünden, Chur, Switzerland
- 15Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
- 16Department of Neurology, Cantonal Hospital, St. Gallen, Switzerland
- 17Stroke Unit, Department of Neurology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
- 18Neurology Department, Lucerne Cantonal Hospital (LUKS), Luzern, Switzerland
- 19Division of Neurology, Kantonsspital Münsterlingen, Munsterlingen, Switzerland
- 20Stroke Unit, Department of Neurology, Hospital Biel, Biel, Switzerland
- 21Stadtspitäler Triemli und Waid, Zurich, Switzerland
- 22Department of Neurology and Stroke Center, University Hospital Basel, University of Basel, Basel, Switzerland
- 23Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
- 24Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
- 25Department of Neurosurgery, Inselspital, Bern University Hospital, Bern, Switzerland
- 26Department of Neurology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
- 27University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- 28University Institute of Diagnostic, Interventional and Paediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- 29Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland
- 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.
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