Prognosis and Outcome of Intracerebral Haemorrhage

Spontaneous intracerebral haemorrhage (ICH) accounts for approximately 15% of all strokes and is a leading cause of disability, with a one-month mortality rate of 40%. Whereas factors predicting short-term mortality are well known, data regarding long-term outcome are scarce and imprecise. The two main underlying vasculopathies responsible for ICH, i.e. deep perforating vasculopathy and cerebral amyloid angiopathy, might have an impact on the overall prognosis of ICH survivors. ICH survivors are at high risk of epileptic seizures, depression and cognitive impairment, which may influence their functional outcome. Lobar location of an ICH, frequently due to cerebral amyloid angiopathy, partly determines the long-term risk of recurrent haemorrhage. Because of common vascular risk factors, patients with ICH are also at considerable risk of serious ischaemic events. Risks of future ischaemic events may be as high as that of recurrent ICH, raising the relevance of antithrombotic treatment in ICH survivors. Future studies of long-term follow-up after ICH are needed to determine predictors of outcome, including biomarkers of the underlying vasculopathies, to tailor preventive strategies to survivors.