Early Hemorrhage Growth in Patients With Intracerebral Hemorrhage

TLDR

Randomized treatment trials are needed to determine whether early natural history of ongoing bleeding and frequent neurological deterioration can be improved. The study prospectively determined the frequency of early intracerebral hemorrhage growth and its relationship to early neurological deterioration. A prospective observational cohort of 103 patients presenting within 3 hours of onset underwent neurological assessment and serial CT scans at baseline, 1 hour, and 20 hours. Substantial hemorrhage growth occurred in 26% of patients within the first hour and an additional 12% between 1 and 20 hours, and early growth was significantly associated with clinical deterioration, yet no baseline predictors were identified.

Abstract

The goal of the present study was to prospectively determine how frequently early growth of intracerebral hemorrhage occurs and whether this early growth is related to early neurological deterioration.We performed a prospective observational study of patients with intracerebral hemorrhage within 3 hours of onset. Patients had a neurological evaluation and CT scan performed at baseline, 1 hour after baseline, and 20 hours after baseline.Substantial growth in the volume of parenchymal hemorrhage occurred in 26% of the 103 study patients between the baseline and 1-hour CT scans. An additional 12% of patients had substantial growth between the 1- and 20-hour CT scans. Hemorrhage growth between the baseline and 1-hour CT scans was significantly associated with clinical deterioration, as measured by the change between the baseline and 1-hour Glasgow Coma Scale and National Institutes of Health Stroke Scale scores. No baseline clinical or CT prediction of hemorrhage growth was identified.Substantial early hemorrhage growth in patients with intracerebral hemorrhage is common and is associated with neurological deterioration. Randomized treatment trials are needed to determine whether this early natural history of ongoing bleeding and frequent neurological deterioration can be improved.