The burden and risks factors for intracerebral hemorrhage in a Southeast Asian population

The characteristics of intracerebral hemorrhage in Southeast Asian countries are insufficiently represented in the literature despite a large proportion of new stroke cases and deaths. This study aims to report the epidemiological and clinical presentation of intracerebral hemorrhage in Brunei Darussalam and investigate its incidence according to sex and age, as well as in relation to clinical presentation, radiological findings, and prognostic factors.

This retrospective study of intracerebral hemorrhage admissions was conducted from 1 January 2016-31 December 2019. Crude incidence rates were calculated by age and sex. Patient characteristics/demographics, mortality and functional outcomes were analyzed. Multivariate Cox regression models were used for investigating predictors of mortality.

The study cohort consisted of 255 patients (median age, 52 years); most were men (64.3% [164/255]) and had hypertension (76.9% [196/255]). The annual incidence rate was 14.6 per 100,000 (95% confidence interval, 12.9-16.5), and incidence rates were higher in men than in women for all age groups. A 7-day and 30-day mortality rate of 22.7% and 31.4%, respectively, was reported. Increased 30-day mortality was associated with patients on dialysis, diabetes mellitus, Glasgow Coma Scale score ≤ 8, bilateral dilated pupils, higher international normalized ratio, hematoma in the cerebellum or brainstem, hematoma volume, and presence of intraventricular hematoma.

This study provided insight into several aspects of the burden of intracerebral hemorrhage in Brunei Darussalam where an increasing incidence trend in men was observed. Intracerebral hemorrhage is associated with significant mortality and severe disability, and hypertension remains a significant risk factor.