Hematoma Expansion in Intracerebral Hemorrhage With Unclear Onset

Andrea Morotti, Gregoire Boulouis, Andreas Charidimou, Qi Li, Loris Poli, Paolo Costa, Valeria De Giuli, Eleonora Leuci, Federico Mazzacane, Giorgio Busto, Francesco Arba, Laura Brancaleoni, Sebastiano Giacomozzi, Luigi Simonetti, Michele Laudisi, Giuseppe Micieli, Anna Cavallini, Elisa Candeloro, Massimo Gamba, Mauro MagoniAndrew D Warren, Christopher D Anderson, M Edip Gurol, Alessandro Biffi, Anand Viswanathan, Ilaria Casetta, Enrico Fainardi, Andrea Zini, Alessandro Pezzini, Alessandro Padovani, Steven M Greenberg, Jonathan Rosand, Joshua N Goldstein

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: To investigatethe prevalence, predictors and prognostic impact of hematoma expansion (HE) inintracerebral hemorrhage (ICH) patients with unclear symptom onset (USO).

METHODS: Retrospective analysis of patients with primary spontaneous ICH admitted at 5 academic medical centers in USA and Italy.HE (volume increase >6 mL and/or >33% from baseline to follow-up non-contrast CT [NCCT]) and mortality at 30 days were the outcomes of interest. Baseline NCCT was also analyzed for presence of hypodensities (any hypodense region within the hematoma margins). Predictors of HE and mortality were explored with multivariable logistic regression.

RESULTS: We enrolled 2,165 subjects, 1,022 in the development cohort and 1,143 in the replication cohort, of whom 352 (34.4%) and 407 (35.6%) had ICH with USO respectively. When compared with subjects having a clear symptom onset, USO patients had a similar frequency of HE (25.0% vs 21.9%, p = 0.269 and 29.9% vs 31.5%, p = 0.423). Among USO patients, HE was independently associated with mortality after adjustment for confounders (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.43-4.89, p = 0.002). This finding wassimilar in the replication cohort (OR 3.46, 95% CI 1.86-6.44, p < 0.001). The presence of NCCT hypodensities in USO subjects was an independent predictor of HE in the development (OR 2.59, 95% CI 1.27-5.28, p = 0.009) and replication (OR 2.43, 95% CI 1.42-4.17, p = 0.001) population.

CONCLUSION: HE is common in USO patients and independently associated with worse outcome. These findings suggest that USO patients may be enrolled in clinical trials on medical treatments targeting HE.

Original languageEnglish
Pages (from-to) e2363-e237
Issue number19
Publication statusPublished - Apr 1 2021


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