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Updated: Sep 20, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Etiology, 3-Month Functional Outcome and Recurrent Events in Non-Traumatic Intracerebral Hemorrhage
Martina B Goeldlin1,2, Achim Mueller3, Bernhard M Siepen1,2
1Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Insights
Hypertension is the most common cause of intracerebral hemorrhage (ICH), but other causes are frequent. While one-third of ICH patients regain independence, specific etiologies like antithrombotic therapy increase mortality risk.
Area of Science:
- Neurology
- Stroke Medicine
- Epidemiology
Background:
- Non-traumatic intracerebral hemorrhage (ICH) encompasses diverse etiologies with limited outcome data.
- Understanding the prevalence and impact of various ICH causes is crucial for clinical management.
Purpose of the Study:
- To determine the prevalence of specific ICH etiologies.
- To analyze the association between ICH etiology and patient outcomes, including functional independence and mortality.
Main Methods:
- Prospective enrollment of consecutive ICH patients in the Swiss Stroke Registry (2014-2019).
- Assessment of pre-specified ICH etiologies and their correlation with 3-month outcomes.
- Statistical analysis using adjusted odds ratios (aOR) and confidence intervals (CI).
Main Results:
- Hypertension was the leading etiology (46.7%), followed by unknown (21.4%) and antithrombotic therapy (8.6%).
- ICH due to hypertension was associated with better functional independence (aOR 1.33) and lower mortality (aOR 0.64).
- Antithrombotic therapy-related ICH showed higher mortality (aOR 1.62), while cerebral amyloid angiopathy (CAA) increased recurrent ICH risk (aOR 3.38).
Conclusions:
- Hypertension is the primary cause of ICH, but other etiologies are significant contributors.
- Approximately one-third of ICH patients achieve functional independence at 3 months.
- Cerebrovascular event risk post-ICH varies by etiology, with ischemic stroke being more common than recurrent ICH, except in CAA cases.
Background And Purpose:
Knowledge about different etiologies of non-traumatic intracerebral hemorrhage (ICH) and their outcomes is scarce.
Methods:
We assessed prevalence of pre-specified ICH etiologies and their association with outcomes in consecutive ICH patients enrolled in the prospective Swiss Stroke Registry (2014 to 2019).
Results:
We included 2,650 patients (mean±standard deviation age 72±14 years, 46.5% female, median National Institutes of Health Stroke Scale 8 [interquartile range, 3 to 15]). Etiology was as follows: hypertension, 1,238 (46.7%); unknown, 566 (21.4%); antithrombotic therapy, 227 (8.6%); cerebral amyloid angiopathy (CAA), 217 (8.2%); macrovascular cause, 128 (4.8%); other determined etiology, 274 patients (10.3%). At 3 months, 880 patients (33.2%) were functionally independent and 664 had died (25.1%). ICH due to hypertension had a higher odds of functional independence (adjusted odds ratio [aOR], 1.33; 95% confidence interval [CI], 1.00 to 1.77; P=0.05) and lower mortality (aOR, 0.64; 95% CI, 0.47 to 0.86; P=0.003). ICH due to antithrombotic therapy had higher mortality (aOR, 1.62; 95% CI, 1.01 to 2.61; P=0.045). Within 3 months, 4.2% of patients had cerebrovascular events. The rate of ischemic stroke was higher than that of recurrent ICH in all etiologies but CAA and unknown etiology. CAA had high odds of recurrent ICH (aOR, 3.38; 95% CI, 1.48 to 7.69; P=0.004) while the odds was lower in ICH due to hypertension (aOR, 0.42; 95% CI, 0.19 to 0.93; P=0.031).
Conclusions:
Although hypertension is the leading etiology of ICH, other etiologies are frequent. One-third of ICH patients are functionally independent at 3 months. Except for patients with presumed CAA, the risk of ischemic stroke within 3 months of ICH was higher than the risk of recurrent hemorrhage.
