Imaging and Clinical Prognostic Features in Lobar Versus Deep Intracerebral Hemorrhage in an Unselected Swedish...

Hematoma location may influence hematoma volume and risk of expansion, the strongest prognostic predictors in patients with intracerebral hemorrhage (ICH). This study aims to determine differences in imaging and clinical factors affecting survival in patients with lobar vs. deep ICH.

Patients with spontaneous supratentorial ICH residing in Skåne county registered in the Swedish Stroke Register 2016-2020 were included. Baseline non-contrast CT scans were evaluated for hematoma location and volume, subarachnoid or intraventricular extension, hydrocephalus, and midline shift. Multivariable Cox- and logistic regression analyses were used to determine imaging and clinical factors associated with increased 90-day mortality rate and functional dependency (mRS 3-5).

Of 1398 patients, 666 (48%) had lobar, and 732 (52%) had deep ICH. Lobar ICH volumes were larger (median 27 vs. 13 mL, p < 0.001) compared to deep ICH. At 90 days, the unadjusted mortality rate (34% vs. 32%; p = 0.33) and functional dependency (mRS 3-5: 60.4% vs. 62.4%; p = 0.52) were non-significant between deep and lobar ICH patients. In multivariable analysis adjusted for confounders, hematoma volume (≥ 80 mL (HR = 5.90; 95% CI: 3.40-10.23), 30-79 mL (HR = 4.24; 95% CI: 2.81-6.42), and 10-29 mL (HR = 2.21; 95% CI: 1.49-3.27)), deep ICH location (HR = 1.78, 95% CI: 1.39-2.29), hydrocephalus (HR = 1.69, 95% CI: 1.21-2.37), pre-stroke dependency (HR = 1.51, 95% CI: 1.18-1.94), antiplatelets at onset (HR = 1.47, 95% CI: 1.14-1.90), and age (HR =1.03, 95% CI: 1.02-1.04) were significantly associated with an increased 90-day mortality rate.

Despite larger hematoma volumes and older age in lobar ICH patients, lobar hemorrhages were associated with a lower mortality rate compared to deep hemorrhages. Our findings highlight the need to consider lobar and deep ICH separately in therapeutic and prognostic studies.