PRIMARY INTRACEREBRAL HEMORRHAGE IN THE OXFORDSHIRE COMMUNITY STROKE PROJECT .2. PROGNOSIS

Sixty-six patients with primary intracerebral haemorrhage were identified in a prospective, community-based register of 675 consecutive patients with first-ever in a lifetime stroke. No patient was lost to follow-up (up to 6 years). The 30-day case fatality rate was 52%. For patients surviving 30 days the average annual mortality rate was 8% per year for the next 5 years. The main cause of early death (less than or equal to 30 days) was the neurological sequelae of the original stroke (73%, whilst late deaths (>30 days) were due to either complications of immobility (45%) or vascular disease (55%). Twenty one percent of all patients were independent at 6 months (52% of survivors). The main predictors for death within 30 days were age, reduced conscious level, abnormal proprioception and rupture of blood into the ventricles or subarachnoid space. In addition, the size of the initial haemorrhage was predictive for death at any stage of follow-up, and the degree of limb weakness was predictive of death or dependency at 6 months. Nine patients had 14 recurrent strokes (including 4 definite haemorrhages and 4 definite cerebral infarctions). Five of the recurrences were fatal. The actuarial risk of recurrence in 30-day survivors was 7% per year (14 per 100 patient-years) and the actuarial risk of death or recurrence in 30-day survivors was 11% per year. Seven patients (11%) had at least one seizure during follow-up, the risk of first seizure being 8 per 100 patient-years overall. Patients with primary intracerebral haemorrhage have a high early case fatality but survivors have a similar outcome to patients with cerebral infarction.