Functional Long-Term Outcome after Left- versus Right-Sided Intracerebral Hemorrhage

Abstract

Background and Purpose: Hemispheric location might influence outcome after intracerebral hemorrhage (ICH). INTERACT suggested higher short-term mortality in right hemispheric ICH, yet statistical imbalances were not addressed. This study aimed at determining the differences in long-term functional outcome in patients with right- vs. left-sided ICH with a priori-defined sub-analysis of lobar vs. deep bleedings. Methods: Data from a prospective hospital registry were analyzed including patients with ICH admitted between January 2006 and August 2014. Data were retrieved from institutional databases. Outcome was assessed using the modified Rankin Scale (mRS) score. Outcome measures (long-term mortality and functional outcome at 12 months) were correlated with ICH location and hemisphere, and the imbalances of baseline characteristics were addressed by propensity score matching. Results: A total of 831 patients with supratentorial ICH (429 left and 402 right) were analyzed. Regarding clinical baseline characteristics in the unadjusted overall cohort, there were differences in disfavor of right-sided ICH (antiplatelets: 25.2% in left ICH vs. 34.3% in right ICH; p < 0.01; previous ischemic stroke: 14.7% in left ICH vs. 19.7% in right ICH; p = 0.057; and presence/extent of intraventricular hemorrhage: 45.0% in left ICH vs. 53.0% in right ICH; p = 0.021; Graeb-score: 0 [0-4] in left ICH vs. 1 [0-5] in right ICH; p = 0.017). While there were no differences in mortality and in the proportion of patients with favorable vs. unfavorable outcome (mRS 0-3: 142/375 [37.9%] in left ICH vs. 117/362 [32.3%] in right ICH; p = 0.115), patients with left-sided ICH showed excellent outcome more frequently (mRS 0-1: 64/375 [17.1%] in left ICH vs. 43/362 [11.9%] in right ICH; p = 0.046) in the unadjusted analysis. After adjusting for confounding variables, a well-balanced group of patients (n = 360/hemisphere) was compared showing no differences in long-term functional outcome (mRS 0-3: 36.4% in left ICH vs. 33.9% in right ICH; p = 0.51). Sub-analyses of patients with deep vs. lobar ICH revealed also no differences in outcome measures (mRS 0-3: 53/151 [35.1%] in left deep ICH vs. 53/165 [32.1%] in right deep ICH; p = 0.58). Conclusion: Previously described differences in clinical end points among patients with left- vs. right-hemispheric ICH may be driven by different baseline characteristics rather than by functional deficits emerging from different hemispheric functions affected. After statistical corrections for confounding variables, there was no impact of hemispheric location on functional outcome after ICH.

Presence of Concomitant Systemic Cancer is Not Associated with Worse Functional Long-Term Outcome in Patients with Intracerebral Hemorrhage

“…Yet accounting for sepsis would rather benefit the cancer patient group and this therefore supports the conclusion of our study. A possible reason why an additional cancer diagnosis does not impact long-term prognosis after ICH relates to the severity of the bleeding itself, as demonstrated previously [3,24,32,33,34]. Therefore, the intuitive prognostication that ICH patients with cancer show worse outcomes needs a strong counterbalance to avoid early treatment restrictions and thus self-fulfilling prophecies [12,35].…”

Does a combination treatment of repetitive transcranial magnetic stimulation and occupational therapy improve upper limb muscle paralysis equally in patients with chronic stroke caused by cerebral hemorrhage and infarction?

“…1 ). The factors influencing recovery after muscle paralysis, [ 30 ] such as age, sex, [ 31 , 32 ] time from stroke onset, [ 1 ] affected area of the cerebral hemisphere, [ 33 , 34 ] and handedness were used as covariates for confounder-adjustment estimates. Adjustment for multiplicity was performed using the Bonferroni correction.…”

The ENIGMA Stroke Recovery Working Group: Big data neuroimaging to study brain-behavior relationships after stroke

“…First, the data can be used to test whether brain-behavior relationships identified in smaller, more homogeneous samples also exist in larger, more diverse samples. A specific example might be examining whether individuals with left hemisphere stroke show better or worse outcomes than those with right hemisphere stroke, as reports from the literature on this topic are inconsistent (Beuscher et al, 2017;Macciocchi, Diamond, Alves, & Mertz, 1998;Ween, Alexander, D'Esposito, & Roberts, 1996;Wu et al, 2015). Second, these data can be used to identify characteristics, such as specific lesion locations, that affect stroke outcomes of interest.…”