Primary Intracerebral Haemorrhage in the Oxfordshire Community Stroke Project

Abstract

Sixty-six patients with primary intracerebral haemorrhage were identified in a prospective, community-based register of 675 consecutive patients with first-ever in a lifetime stroke. No patient was lost to follow-up (up to 6 years). The 30-day case fatality rate was 52%. For patients surviving 30 days the average annual mortality rate was 8% per year for the next 5 years. The main cause of early death (≤30 days) was the neurological sequelae of the original stroke (73%, whilst late deaths (> 30 days) were due to either complications of immobility (45%) or vascular disease (55%). Twenty one percent of all patients were independent at 6 months (52% of survivors). The main predictors for death within 30 days were age, reduced conscious level, abnormal proprioception and rupture of blood into the ventricles or subarachnoid space. In addition, the size of the initial haemorrhage was predictive for death at any stage of follow-up, and the degree of limb weakness was predictive of death or dependency at 6 months. Nine patients had 14 recurrent strokes (including 4 definite haemorrhages and 4 definite cerebral infarctions). Five of the recurrences were fatal. The actuarial risk of recurrence in 30-day survivors was 7% per year (14 per 100 patient-years) and the actuarial risk of death or recurrence in 30-day survivors was 11% per year. Seven patients (11%) had at least one seizure during follow-up, the risk of first seizure being 8 per 100 patient-years overall. Patients with primary intracerebral haemorrhage have a high early case fatality but survivors have a similar outcome to patients with cerebral infarction.

What is the best imaging strategy for acute stroke?

“…The mRS is widely used in research to assess outcome after stroke. 10,312,[340][341][342] One concern with using this instrument in the present analysis was whether it would be sufficiently sensitive to detect changes in outcome. However, there appeared to be little alternative, as the mRS is widely used, and it was the outcome measure that was available for many of the primary data that were available for the model.…”

“…The hydrocephalus will not be drained and therefore patients will die as a result of lack of acute treatment • PICH patients in a non-life-threatening condition have an increased risk of recurrent haemorrhagic stroke and an increased risk of death. Longer term actuarial risk of recurrent PICH in survivors of PICH to 30 days was 7% per year in those not given aspirin 340 (OCSP). A 40% (30% to 50%) relative increase at 1 year in recurrent PICH was estimated if these patients were given aspirin a 20% relative increase in death and a 20-30% increase in dependency.…”

Recommendations for Stroke Management: Update 2003

“…The risk of recurrent hemorrhage is as low as 2% per year when blood pressure is well controlled 189 . The 30-day mortality correlates with location and size of initial bleeding, and is found to be 35%-52% [190][191][192][193] . Only 20% of patients regain functional independence by 6 months 192,193 .…”

“…The 30-day mortality correlates with location and size of initial bleeding, and is found to be 35%-52% [190][191][192][193] . Only 20% of patients regain functional independence by 6 months 192,193 . Deep basal ganglial bleeding is often found in patients with hypertension, whereas lobar bleeding is more commonly seen in elderly patients with cerebral amyloid angiopathy 194 .…”

Hemodynamic effects of mannitol infusion in patients with acute intracerebral hemorrhage

“…Intracerebral hemorrhage (ICH) accounts for approximately 10% to 15% of first-ever strokes, with a 30-day mortality rate of 35% to 52% [1][2] . Mannitol is effective in reversing acute brain swelling.…”