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Assessing etiological classification systems and their relationship with neurological deterioration in patients with

Daniel Vázquez-Justes1,2, Gerard Mauri-Capdevila1,2, Yhovany Gallego1,2

  • 1Stroke Unit. Neurology Department. Hospital Universitari Arnau Vilanova, IRBLleida. Universitat de Lleida, Av, Rovira Roure 80, Lleida, Spain.

Scientific Reports
|July 2, 2025
PubMed

Insights

Intracerebral hemorrhage (ICH) etiology impacts neurological deterioration (ND). Anticoagulation-related ICH, especially with hypertension, significantly increases ND risk. Understanding these links aids patient care.

Area of Science:

  • Neurology
  • Clinical Medicine
  • Stroke Research

Background:

  • Intracerebral hemorrhage (ICH) lacks a standardized etiological classification, unlike ischemic stroke.
  • The relationship between ICH etiological classifications and neurological deterioration (ND) is not well understood.

Purpose of the Study:

  • To investigate the association between etiological classifications (SMASH-U, H-ATOMIC) and ND in intracerebral hemorrhage patients.
  • To identify specific etiological subtypes linked to increased risk of neurological deterioration during hospitalization.

Main Methods:

  • Prospective cohort study of 301 consecutive ICH patients (2015-2022).
  • Systematic recording of demographic, radiological, and clinical data.
  • Multivariate logistic regression analysis to identify variables and etiological groups associated with ND.

Main Results:

  • 41.2% of patients experienced neurological deterioration (ND).
  • Anticoagulation (AC)-related ICH was associated with a higher risk of ND.
  • SMASH-U: medication-related ICH (OR 6.02) linked to ND. H-ATOMIC: HT+AC combination (OR 9.91) and combined groups (OR 17.49) related to ND.

Conclusions:

  • ICH etiology is associated with the risk of neurological deterioration.
  • Anticoagulation-related ICH, particularly when combined with hypertension, presents the highest risk for ND.
  • Factors like intraventricular extension and initial hematoma volume also correlate with ND.

Keywords:
EtiologyH-ATOMICIntracerebral hemorrhageNeurological deteriorationOutcomeSMASH-U

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