[Relapsing non-traumatic intracerebral hemorrhage: study of 28 patients]

Abstract

Background and objective: To characterize the clinical factors and prognosis and identify determinants of hemorrhage recurrence (HCR) in patients with acute non-traumatic intracerebral hemorrhage.

Patients and method: Stroke patterns were studied in 28 consecutive recurrent non-traumatic intracerebral hemorrhage patients admitted to the Department of Neurology of the Sagrat Cor Hospital of Barcelona for a 19 year period. Demographic, risk factors, clinical, neuroimaging and outcome variables were analyzed and compared with patients with first-ever non-traumatic intracerebral hemorrhage (n=380) to identify predictors of hemorrhage recurrence. Significant variables were entered into a multivariate logistic regression analysis.

Results: HCR accounted for 6.8% of all patients with acute consecutive non-traumatic intracerebral hemorrhages. The HCR were mostly lobar (67.9%). Other topographies include: thalamus (10.7%), capsule-ganglionar (7.1%), intraventricular (3.6%) and multiple topographies (10.7%). Although the HCR have poor prognosis, it is not worse compared to the first-ever intracerebral hemorrhages, both at the high hospital mortality (17.9 vs. 28.2%) as the low frequency of absence of limitation at discharge (3.6 vs. 6.1%). The clinical profile significantly associated with HCR was: valvular heart disease (odds ratio [OR] 5.32; 95% confidence interval [95% CI] 1.45-19.47), lobar topography (OR 3.53, 95% IC 1.53-8.13), and the presence of nausea and vomiting (OR 2.43, 95% IC 1.06-5.52).

Conclusions: HCR constitute less than one tenth of non-traumatic intracerebral hemorrhages and are most commonly located in the brain lobes. Although the prognosis is serious, this is no worse during the acute phase, than of the first-ever non-traumatic intracerebral hemorrhages. Clinical profiles were different in recurrent non-traumatic intracerebral hemorrhage patients when compared to first-ever non-traumatic intracerebral hemorrhage patients.