Epidemiological and clinical characteristics of 266 cases of intracerebral hemorrhage in Hangzhou, China

Abstract

Ethnicity and socioeconomic factors can influence disease susceptibility, clinical presentation, and outcome. We investigated the clinical characteristics (age, sex, seasonal variation, lesion site, symptoms, complications, prognosis, and sequelae) and risk factors for intracerebral hemorrhage (ICH) in 266 cases treated at our hospital in Hangzhou City, China, from January 2011 to December 2011. Risk of ICH increased dramatically with age; only 4.3% of cases were <30 years old, while 44.4% were >60 years of age. Men outnumbered women by 2:1 (67.3% vs. 32.7%). Single hemorrhage was most often located in the cerebral lobes (37.2% of cases), basal ganglia (34.2%), thalamus (8.3%), cerebellum (6.8%), ventricle (1.5%), and brainstem (1.1%), while 10.9% of cases exhibited hemorrhages at multiple sites. Hypertension was also a major risk factor for ICH, as 47% of all patients were hypertensive and the percentage increased with age. In hypertensive patients, the most common hemorrhage site was the basal ganglia and ICH was often associated with thrombopenia. In patients with leukemia (all forms), most hemorrhages were lobar. Warfarin- and encephalic operation-associated ICHs were all lobar. Headache was the major symptom of occipital, temporal, and frontal lobe hemorrhage. Dizziness, nausea, and vomiting were the major symptoms of cerebellum hemorrhage. Limb dysfunction was the major symptom of thalamic and basal ganglia hemorrhage. Disturbed level of consciousness was the major symptom in multisite, ventricular, parietal lobe, and brainstem hemorrhage. Hyperspasmia occurred most often in lobar hemorrhage and blurred vision in occipital lobe hemorrhage. Hospital mortality was 24.4% (n=65) with a mean delay from presentation to death of (10.5±18.5) d. The majority of fatalities were cerebral hernia cases (58.5%) and these patients also had the shortest time to death [(2.9±3.5) d]. Mortality was 100% in brainstem ICH and hemorrhagic conversion of cerebral infarct. Thrombopenia-associated ICH also had a high mortality rate (81.0%), while patients with cerebrovascular malformations and cerebral aneurysms demonstrated a much better prognosis (46.2% recovery).

Endoscopic-assisted keyhole technique for hypertensive cerebral hemorrhage in elderly patients: a randomized controlled study in 184 patients

“…as shown in an epidemiological study of 266 cases of intracerebral hemorrhage from Hangzhou (China) (9), pulmonary infection accounts for the most frequent complication in these patients. Deaths in the first month, but beyond the first few days following HCH onset, is usually the result of complications such as pulmonary infection, intracranial infection, respiratory failure, and multiple organ failure (9). In elderly patients with HCH, it is essential to select a minimally invasive treatment leading to less brain retraction and brain tissue injury, with shorter anesthesia time and less blood loss.…”

Gender Differences in Neurologic Emergencies Part I: A Consensus Summary and Research Agenda on Cerebrovascular Disease

“…One large metaanalysis showed no significant difference in ICH incidence between men and women, 28 although other data conflict. 29 However, risk factors differ between women and men, with hypertension and heavy alcohol use increasing ICH risk in men more than women. 30 Differing study populations and unrecognized confounders result in this conflicting data on the relationship between sex and outcomes in ICH.…”

Influence of Intracerebral Hemorrhage Location on Incidence, Characteristics, and Outcome

“…21 Determining whether risk factors and outcome differ according to ICH location has been further complicated by studies' varied definitions of ICH location. Of 41 observational studies comparing lobar and nonlobar ICH, 20 did not define lobar location, 18,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] and 21 used different definitions of lobar location (including ICH which was cortical, subcortical, or cortical and subcortical, [41][42][43][44][45][46] cerebellar, 47 predominantly cortical and involving underlying white matter, [48][49][50] subcortical or in a hemisphere excluding the basal ganglia or thalamus, [51][52][53] or in any lobe(s) of the brain). [54][55][56][57][58][59][60][61] Of 28 studies that defined nonlobar ICH, 20 defined nonlobar as involving the basal ganglia or infratentorial regions, 18,25,27,<...>…”