PAPER

The risk of recurrent stroke after intracerebral haemorrhage

H C Hanger¹, T J Wilkinson², N Fayez-Iskander², R Sainsbury²

¹ Older Persons Health, The Princess Margaret Hospital, Christchurch, New Zealand
² Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand

Correspondence to:
Dr H C Hanger
Older Persons Health, The Princess Margaret Hospital, PO Box 800, Christchurch, New Zealand; carl.hanger{at}cdhb.govt.nz

Background and aim: The risks of recurrent intracerebral haemorrhage (ICH) vary widely (0–24%). Patients with ICH also have risk factors for ischaemic stroke (IS) and a proportion of ICH survivors re-present with an IS. This dilemma has implications for prophylactic treatment. This study aims to determine the risk of recurrent stroke events (both ICH and IS) following an index bleed and whether ICH recurrence risk varies according to location of index bleed.

Patients and methods: All patients diagnosed with an acute ICH presenting over an 8.5 year period were identified. Each ICH was confirmed by reviewing all of the radiology results and, where necessary, the clinical case notes or post-mortem data. Recurrent stroke events (ICH and IS) were identified by reappearance of these patients in our stroke database. Coronial post-mortem results for the same period were also reviewed. Each recurrent event was reviewed to confirm the diagnosis and location of the stroke.

Results: Of the 7686 stroke events recorded, 768 (10%) were ICH. In the follow-up period, there were 19 recurrent ICH and 17 new IS in the 464 patients who survived beyond the index hospital stay. Recurrence rate for ICH was 2.1/100 in the first year but 1.2/100/year overall. This compares with 1.3/100/year overall for IS. Most recurrences were "lobar–lobar" type.

Conclusion: The cumulative risk of recurrent ICH in this population is similar to that of IS after the first year.

Abbreviations: CAA, cerebral amyloid angiopathy; ICD, International Classification of Diseases; ICH, intracerebral haemorrhage; IS, ischaemic stroke; NHI, national health identifier

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• Zia, E., Engstrom, G., Svensson, P. J., Norrving, B., Pessah-Rasmussen, H. (2009). Three-Year Survival and Stroke Recurrence Rates in Patients With Primary Intracerebral Hemorrhage. Stroke 40: 3567-3573 [Abstract] [Full Text]