Introduction: Although much effort has been made to study first-ever intracerebral hemorrhage (ICH) patients, recurrent ICH has not been investigated as extensively. We sought to evaluate recent clinical features and prognosis of recurrent ICH in Japan.
Methods: Of 331 consecutive patients admitted to our institute with ICH between December 2008 and May 2014, 30 patients (9.1%) with recurrent ICH were included in this study. Clinical features, changes in hemorrhagic location, mortality, and prognosis were evaluated. Unfavorable functional outcome was defined as a modified Rankin scale score of 3-6.
Results: The patient group consisted of 16 males and 14 females with a mean age of 74.8 years (range, 47-94 years). The mean period until ICH recurrence was 6.7 years [< 1 year, 5 patients (17%), 1-5 years, 12 patients (40%), 6-10 years, 5 patients (17%), ? 11 years, 7 (23%)]. Bleeding occurred second two times in 26 patients (87%), three times in 3 patients (10%), and four times in 1 patient (3%). The most frequent vascular risk factor was hypertension (67%). Six patients (20%) with ischemic stroke were on antithrombotic treatment. First-onset ICH was observed in a deep location in 65% of patients, a lobar location in 20% of patients, and an infratentorial location in 15% of patients. At recurrence, ICH location changed in deep cases (53%), lobar cases (40%), and infratentorial cases (7%). The mortality rate and the rate of unfavorable outcome at discharge were 27% and 87%, respectively.
Conclusions: The rise in the incidence of lobar type recurrent ICH in the elderly may be strongly influenced by cerebral amyloid angiopathy. The prognosis of patients with recurrent ICH remains very poor despite appropriate secondary prevention.
Patient Care: Our research suggests that we must enforce the secondary prevention for intracerebral hemorrhage more in future.
Learning Objectives: By our conclusion, many participants can understand recent clinical features and prognisis of recurrent ICH in Japan.