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Published on: February 8, 2022
The frequency and predictors of hematoma expansion in wake-up intracerebral hemorrhage
Han Wang1, Zijie Wang1, Rui Cheng1
1Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
Background:
Hematoma expansion (HE) is a key determinant of poor outcomes in intracerebral hemorrhage (ICH), but its frequency and predictors in wake-up ICH remain insufficiently characterized. This study aimed to compare HE between wake-up and clear-onset ICH and to identify predictors of HE in wake-up ICH.
Methods:
We analyzed patients with spontaneous ICH from a prospective cohort between August 2022 and September 2025. The primary outcome was HE defined as an absolute increase in volume > 6 mL or > 33% from baseline on follow-up computed tomography (CT). Poor outcome was defined as a modified Rankin Scale (mRS) score of 3-6 at 3 months. Baseline characteristics, HE rates, and outcomes were compared between wake-up ICH and clear-onset ICH groups. Logistic regression analyses were performed to identify predictors of HE and poor outcome in wake-up ICH.
Results:
Among 415 patients, 66 (15.9%) had wake-up ICH. The frequency of HE was comparable between wake-up and clear-onset ICH (35.2% vs. 24.7%; p = 0.115), as were 3-month functional outcomes and mortality (all p > 0.05). HE was independently associated with poor 3-month outcome among wake-up ICH. Hypodensities (OR = 3.96, 95% CI: 1.08-15.77, p = 0.044) and irregular shape (OR = 3.95, 95% CI: 1.09-15.49, p = 0.040) were independently associated with HE among wake-up ICH.
Conclusion:
HE is common and associated with poor outcomes in wake-up ICH. Noncontrast CT markers, including hypodensities and irregular shape, may serve as imaging markers for risk stratification of HE in wake-up ICH.
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