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Related Experiment Video

Updated: Mar 7, 2026

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Simultaneous Multiple Intracerebral Hemorrhages (SMICH).

Teddy Y Wu1,2,3, Nawaf Yassi1,2,3, Darshan G Shah1,2,3

  • 1From the Department of Medicine and Neurology, Melbourne Brain Centre (T.Y.W., N.Y., D.G.S., M.M., B.C.V.C., B.Y., S.M.D., A.M.) and Department of Radiology (G.S., P.M.D.), the Royal Melbourne Hospital, University of Melbourne, Australia; Department of Neurology, Helsinki University Hospital, Finland (J.P., D.S., T.T., A.M.); Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, People's Republic of China (M.M.); Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sweden (T.T.); and Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden (T.T.).

Stroke
|February 25, 2017
PubMed

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Summary

Simultaneous multiple intracerebral hemorrhages (SMICH) occur in approximately 1 in 20 patients and are often lobar. Despite varied causes, SMICH outcomes are similar to single intracerebral hemorrhages, necessitating targeted management.

Area of Science:

  • Neurology
  • Neurosurgery
  • Stroke Medicine

Background:

  • Simultaneous multiple intracerebral hemorrhages (SMICH) are rare, with limited single-center data available.
  • This study investigates the clinical characteristics and outcomes of SMICH patients across two major stroke centers.

Purpose of the Study:

  • To analyze the clinical and radiological characteristics of SMICH.
  • To compare the outcomes of SMICH patients with those of single intracerebral hemorrhage (ICH) patients.
  • To identify factors associated with SMICH and its impact on 90-day mortality.

Main Methods:

  • Screened 1552 consecutive ICH patients for SMICH.
  • Classified ICH pathogenesis using the SMASH-U system.
  • Compared baseline characteristics and 90-day mortality between SMICH and single ICH groups.
Keywords:
cerebral hemorrhagemortalitymultiplepathogenesis

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  • Utilized multivariable logistic regression and propensity score matching to assess mortality association.

    • Main Results:

    • SMICH accounted for 5.9% of ICH cases (85/1452).
    • SMICH patients were more often female, had lower Glasgow Coma Scale scores, and more frequent lobar locations.
    • SMICH pathogenesis showed less hypertension (20%) and more systemic coagulopathy (12%) compared to single ICH.
    • No significant association was found between SMICH and 90-day mortality in univariate, multivariable, or propensity score-matched analyses.

    Conclusions:

    • SMICH occurs in about 1 in 20 ICH cases, typically with lobar hematomas and systemic coagulopathy.
    • The mortality rate for SMICH is comparable to that of single ICH.
    • Management strategies for SMICH should focus on addressing the diverse underlying etiologies.