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25.03.2020 | Original Article

Acute hematoma expansion after spontaneous intracerebral hemorrhage: risk factors and impact on long-term prognosis

Zeitschrift:
Neurological Sciences
Autoren:
Agnese Sembolini, Michele Romoli, Umberto Pannacci, Giulio Gambaracci, Piero Floridi, Monica Acciarresi, Giancarlo Agnelli, Andrea Alberti, Michele Venti, Maurizio Paciaroni, Valeria Caso
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s10072-020-04356-y) contains supplementary material, which is available to authorized users.
Agnese Sembolini and Michele Romoli contributed equally to this work.

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Abstract

Introduction

Hematoma expansion (HE) after intracerebral hemorrhage (ICH) is associated with short-term mortality, but its impact on long-term prognosis is still unclear. The aim of this study was to evaluate the impact of HE on long-term survival and functional status after spontaneous ICH.

Methods

Consecutive patients admitted with spontaneous ICH were prospectively enrolled and followed up for a minimum of 2 years. We compared short-term (< 30 days) and long-term survival and functional status between ICH patients with HE (HE+) and those without (HE-). Main outcomes were mortality and poor outcome, defined as modified Rankin Scale ≥ 3. Secondary outcomes included recurrent ICH, admission to institutionalized care, and ischemic events (stroke, myocardial infarction, and systemic embolism).

Results

Overall, 140 patients were included (mean age 74.9 years, male 59.3%) and followed up for a mean of 2.25 years. HE+ patients (25.7%) had larger hematoma volume at admission (23.8 ml vs 15.3 ml, p < 0.05), higher NIHSS score (14.6 vs 10.5, p < 0.05) and higher cumulative mortality (59.3% vs 39.2%, p < 0.05) compared to HE- patients. Survival analysis showed that HE+ confers higher mortality and worse functional status at all time points. HE did not associate with secondary outcomes.

Discussion

HE translates into higher mortality and functional dependence over long-term follow-up. Strategies limiting HE might benefit long-term functional status.

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