Nerses Sanossian, MD

Samarasekera N, Fonville A, Lerpiniere C, Farrall AJ, Wardlaw JM, Philip M. White PM, et al. Influence of Intracerebral Hemorrhage Location on Incidence, Characteristics,and Outcome: Population-Based Study. Stroke. 2015

Intracerebral hemorrhage is a complex disease with numerous factors affecting prognosis. Glasgow coma scale, age, volume, intraventricular extension and infratentorial origin are the most commonly used factors to guide prognosis: comprising the ICH score. For supratentorial ICH the location of hemorrhage as a predictor of prognosis has not been as well described.

Primary ICH can originate from the deep perforating arteries off of the large arteries at the base of the brain, most often in the lentiform nucleus and thalamus as well as small vessels within the cerebral hemispheres. Samarasekera et al provide a descriptive analyses comparing origin of first-ever hemorrhage due to lobar and non-lobar location. Their results are support pathophysiological and etiologic differences for ICH in these locations. For example cortical ICH is more likely to occur in the setting of dementia and more likely to extend in size and recur. Survival is worse in non-lobar ICH.

ICH is a deadly disease with a 1-year mortality of >50% and mortality/disability of 86%. Location can help identify prognosis. I wonder if within the non-lobar ICH cases whether lentiform nucleus location vs. thalamic location has differential effect on prognosis when controlling for other factors. I would imagine that the thalamus is a more vital structure for recovery without disability, but I am not sure. There is a lot to learn about ICH and there is a real need to develop better preventative and treatment strategies.