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Poor outcome in primary intracerebral haemorrhage: results of a matched comparison

¹ Academic Section of Geriatric Medicine, Royal Infirmary, Glasgow, UK
² Department of Radiology, Royal Infirmary, Glasgow, UK

Correspondence to:
Correspondence to:
Dr Mark Barber
Academic Section of Geriatric Medicine, Third Floor, Centre Block, Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK; M.Barber{at}clinmed.gla.ac.uk

Background: Primary intracerebral haemorrhage (PICH) is associated with a poorer outcome than cerebral infarction. This study aimed to determine whether this is explained by the clinical severity of stroke.

Methods: An observational study of outcome in consecutive admissions with acute PICH and ischaemic stroke was undertaken. A nested case-control analysis, matched on a 1:2 basis for age, pre-stroke disability, early neurological impairment (Scandinavian Stroke Scale; SSS), and Oxfordshire Community Stroke Project classification was then performed. Follow up was at 30 days and at hospital discharge.

Results: Overall, 679 subjects were included in the analysis. Of these, 53 (8%) had PICH; this group had more severe initial neurological impairment (day 3 SSS 28 v 45 points, p<0.001) and a higher prevalence of total anterior circulation strokes (55% v 21%, p<0.001) than did the group admitted with ischaemic strokes. Outcomes were poorer in the PICH group, with 36% inpatient mortality and 68% of survivors having a day 30 modified Rankin Scale (MRS) of at least 3 (compared with 13% and 52%, respectively, in the ischaemic stroke group). Following matching for baseline clinical characteristics, the PICH group had a higher mortality, but this was not statistically significant; the day 30 MRS and institutionalisation rates in survivors were similar in the matched haemorrhage and infarct groups.

Conclusions: Compared with ischaemic stroke, PICH is associated with higher mortality and increased disability in survivors. The severity of clinical stroke is a major contributor to these poor outcomes; baseline characteristics, however, do not fully explain outcome differences.

Keywords: cerebral haemorrhage; cerebrovascular disorders; activities of daily living

Abbreviations: DBP, diastolic blood pressure; LACS, lacunar stroke; MABP, mean arterial blood pressure; MRS, modified Rankin Scale; OCSP, Oxfordshire Community Stroke Project; PACS, partial anterior circulation stroke; PICH, primary intracerebral haemorrhage; POCS, posterior circulation stroke; SBP, systolic blood pressure; SSS, Scandinavian Stroke Scale; TACS, total anterior circulation stroke

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