Recurrent hypertensive intracerebral hemorrhage among Taiwanese

Hypertensive intracerebral hemorrhage (HICH) was once thought to be a one-time event with very rare recurrence, but recent studies have revealed that the recurrent hemorrhage due to hypertension is not unusual. The purpose of this study was to determine the clinical characteristics of HICH among Taiwanese. From June 1988 to December 1999, 1421 HICH patients were admitted to our hospital. Among them, 68 patients (4.8%) had recurrent HICH. We reviewed their medical records and computed tomographic findings. There were 46 males and 22 females (M/F = 2.1) with a mean age of 59.9 +/- 11.9 years at the onset of the second hemorrhage. The median interval between the first two hemorrhages was 22.5 months (range: 1-107 months). Most of the recurrence was within two years of the first hemorrhage (within 1 year in 27.9%, within 1-2 years in 25%). The location of the second hemorrhage was typical for HICH (putamen in 44.1%, thalamus in 33.8%, cerebellum in 5.9%, pons in 4.4%, and caudate nucleus in 1.5%) except for 7 patients (10.3%) who had lobar hematoma. Forty-nine patients (72%) had both hemorrhages located in the supratentorium and in most of them (40 patients) the recurrent HICH occurred contralaterally to the first one. Putaminal-thalamic pattern was the most common (23.5%), followed by the putaminal-putaminal pattern (20.6%). The mortality rate of the second HICH was 17.6%. Seven patients (10.3%) experienced more than 2 episodes of hemorrhages. This report found that the recurrent HICH was not rare among Taiwanese. A substantial proportion (19.1%) of recurrence was after 5 years. The male predominance and risk factor for recurrent HICH require further study.