Clinical features and predictors of in hospital mortality in patients with intra cerebral haemorrhage

Rajat K. Agarwal, Dinkar Kulshreshtha, Pradeep K. Maurya, Ajai K. Singh, Anup K. Thacker


Background: Intracerebral haemorrhage (ICH) accounts for 15-20% of all strokes and is associated with significant morbidity and mortality. The present study was done to assess the risk factors for ICH and determine the factors responsible for poor outcome in ICH.

Methods: Consecutive patients of ICH were assessed for modifiable and non-modifiable risk factors, followed by detailed examination with emphasis on ICH score and CT scan findings.

Results: There were 200 patients with ICH; 108 males and 92 females. The prevalence of ICH was maximum in the age group of 61-70 years (34%). Hypertension was present in 68% of the patients and was the single most important modifiable risk factor. The most common presenting symptom was altered sensorium present in 58% patients. The mean hematoma volume in our study was 44+/-45 cm3. 45 patients with a GCS <5 and both the patients with ICH score 5 expired. On multivariate analysis, there was a significant correlation of mortality with GCS and hematoma volume.

Conclusions: Hypertension is the commonest risk factor for ICH. Patients with a low GCS score, large hematoma volume and a higher ICH score have a poor prognosis and higher probability of mortality.



Intracerebral haemorrhage, Hypertension, ICH score, GCS, Hematoma volume

Full Text:



Sims NR, Murderman H. Mitochondria, oxidative metabolism and cell death in stroke. Biochimica et biophysica Acta. 2009;1802(1):80-91.

Donnan GA, Fischer M, MacLeod M, Davis SM. Stroke. Lancet. 371(9624):1612-23.

Caceres JA, Goldstein JN. Intracranial haemorrhage. Emerg Med Clin North Am. 2012;30(3):771-94.

Magistris F, Bazak S, Martin J. Clinical review. Intracerebral haemorrhage: pathophysiology, diagnosis and management. MUMJ. 2013;10(1):15-22.

Tshikwela ML, Longo Mbenza M. Spontaneous intra cerebral hemorrage: Clinical and computed tomography findings in predicting in-hospital mortality in central Africans. J Neurosci Rural Pract. 2012;3:115-20.

Hemphill JC, Bonovich DC, Besmertis L, Manley GT, Johnston SC. The ICH score: a simple, reliable grading scale for intracerebral haemorrhage. Stroke. 2001;32(4):891-7.

Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, Khoury J. The ABCs of measuring intracerebral haemorrhage volumes. Stroke. 1996;27(8):1304-5.

Kojic B, Burina A, Hodzic R, Pasic Z, Sinanovic O. Risk factors impact on the long-term survival after haemorrhagic stroke. Med Arh. 2009;63(4):203-6.

Feldmann E, Broderick JP, Kernan WN, Viscoli CM, Brass LM, Brott T et al. Major risk factors for intracerebral haemorrhage in the young are modifiable. Stroke. 2005;36:1881-5.

Ojemann RG, Heros RC. Spontaneous brain haemorrhage. Stroke. 1983;14:468-75.

Thrift AG, Donnan GA, McNeil JJ. Heavy drinking, but not moderate or intermediate drinking, increases the risk of intracerebral haemorrhage. Epidemiology. 1999;10(3):307-12.

Iso H, Baba S, Mannami T, Sasaki S, Okada K, Konishi M, for the JPHC Study Group. Alcohol consumption and risk of stroke among middle-aged men: the JPHC study cohort I. Stroke. 2004;35:1124-9.

O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P et al, on behalf of the interstroke investigators. Risk factors for Ischaemic and intracerebral hemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010:376;112-23

Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP et al. The Harvard cooperative stroke registry: a prospective registry. Neurology (NY). 1978;28:754.

Chiewvit P, Danchaivijitr N, Nilanont Y, Poungvarin N. Computed tomographic findings in non-traumatic haemorrhagic stroke. J Med Assoc Thai. 2009;92(1):73-8.

Smith EE, Koroshetz WJ. Epidemiology of stroke. In: Furie KL, Kelly PJ, editors. Current clinical neurology. Handbook of stroke prevention in clinical practice. Totawa (NJ): Humana press;2004:1-17.

Aguilar MI, Brott TG. Update in intracerebral haemorrhage. Neurohospitalist. 2011;1(3):148-59.

Brott T, Thalinger K, Hertzberg V. Hypertension as a risk factor for spontaneous intracerebral haemorrhage. Stroke. 1986;17:1078-83.

Albright KC, Gupta SR, Azat KB. Primary intraventricular haemorrhage in adults: clinical features, risk factors and outcome. Surg Neurol. 1995;44(5):433-6.

Fernandes H, Brott T, Broderick J. Early haemorrhagic growth in patients with intra cerebral haemorrhage. Stroke. 1997;28:1-5.

Ahmad R, Shakir AH. Predictors for in hospital mortality for intracerebral haemorrhage. J Stroke Cerebrovasc dis. 2001;10(3):122-7.

Bhatia R, Singh H, Padma MV, Prasad K, Tripathi M, Kumar G et al. A prospective study of in-hospital mortality and discharge outcome in spontaneous intracerenbral haemorrhage. Neurol India. 2013;61:244-8.

Teri S, Juvela S, Saloheimo P, Pyhtinen J, Hillbom M. Hypertension and diabetes as predictors of early death after spontaneous intracerebral haemorrhage. J Neurosurg. 2009;110:411-7.