Prevalence, Characteristics, and Outcomes of Undetermined Intracerebral Hemorrhage: A Systematic Review and Meta-Analysis
Stroke (08/04/21) DOI: 10.1161/STROKEAHA.120.031471
Malhotra, Konark; Zompola, Christina; Theodorou, Aikaterini; et al.
Researchers evaluated the prevalence, radiological characteristics, and clinical outcomes of intracerebral hemorrhage (ICH) of undetermined etiology. The study involved a systematic review and meta-analysis of studies involving patients with spontaneous ICH, as well as an assessment of the rates for ICH secondary to hypertensive arteriopathy and cerebral amyloid angiopathy. Using data from 24 studies including 15,828 spontaneous ICH patients with a mean age of 64.8 years, the researchers calculated the pooled prevalences of hypertensive arteriopathy undetermined ICH, and cerebral amyloid angiopathy at 50%, 18%, and 12%, respectively. The volume of cerebral amyloid angiopathy ICH was 24.7 mL, compared with 16.2 mL for hypertensive arteriopathy ICH and 15.4 mL for undetermined ICH. The rates of short-term mortality and concomitant intraventricular hemorrhage for patients with undetermined ICH were 33% and 38%, respectively. A subgroup analysis showed a higher rate of undetermined ICH in studies that did not employ an etiology-based classification; however, there was no difference seen between studies based on the completion of detailed neuroimaging to measure the rates of undetermined ICH. Based on their findings, the authors conclude, "The etiology of spontaneous ICH remains unknown or cryptogenic among 1 in 7 patients in studies using etiology-oriented classification and among 1 in 4 patients in studies that avoid using etiology-oriented classification."