Long-Term Temporal Profile of Motor Recovery After Intracerebral Hemorrhage

Abstract

Objective: Limited data is available to describe the temporal profile of long-term recovery over 1 year after the stroke in patients with spontaneous intracerebral hemorrhage (ICH).

Methods: A registered multicentral cohort was conducted to consecutively include non-herniated supratentorial ICH patients from November 2013 to January 2023. Eligible patients received follow-ups at the time of 3 months, 6 months, 1 year, and each year after the enrollments until death or the study termination. The outcome of motor recovery was assessed with the dichotomy of independent standing ability. Analyses were performed to investigate the associated factors, recovery rates, and temporal profile.

Results: Of 1624 eligible responses, 105 (6.5%) regained motor recovery beyond 1 year after the stroke. The motor recovery course decreased with time and continued until 44 months, with 1-year and long-term cumulative recovery rates of 71.3% (95% CI: 69.0%-73.5%) and 80.2% (95% CI: 78.0%-82.5%), respectively. Moreover, the onset age, ICH location, larger ICH, and peripheral hematomal edema (PHE), intraventricular extension, GCS score, and admission hospital tier were independent factors on the motor outcome (all p < 0.05). However, the older age (aHR = 0.97/year, 95% CI: 0.95-0.98, p < 0.001) was identified as the only hazard factor for future recovery in patients who were incapable of recovery within 1 year.

Interpretation: The poststroke recovery was ongoing beyond 1 year until about 3 years after the onset, and those with delayed motor recovery accounted for about 10% of ultimately recovered patients.

Keywords: intracerebral hemorrhage; long‐term; motor recovery; temporal profile.

FIGURE 1

Flow diagram depicting study population. CT, computed tomography; IVH, intraventricular hemorrhage; mRS, modified Rankin scale.

FIGURE 2

Incident of post‐hemorrhagic motor recovery and Kaplan–Meier curves.

FIGURE 3

Percentages of patients with different motor recovery times. ICH, intracerebral hemorrhage; PHE, perihematomal edema. *The p value was calculated by the chi‐square test for trend.

FIGURE 4

Kaplan–Meier curves for motor recovery in subgroups by (A) ICH location, (B) ICH volume categories, and (C) PHE volume categories. ICH, intracerebral hemorrhage; PHE, perihematomal edema. *Adjusted p value < 0.05 compared with small ICH/PHE group (< 20 mL), by BH method. **Adjusted p value < 0.05 compared with both small and median ICH/PHE groups (< 20 mL and 20–40 mL), by BH method.