Abstract
Background: Most descriptive studies of intracerebral hemorrhage (ICH) use cases from hospital registries or large stroke databases. The clinical, imaging, and outcome characteristics for patients presenting acutely after symptom onset, and found to have primary ICH on imaging in the emergency department (ED) is not well described. Methods: Cases presenting to the ED via ambulance in the first 2 hours after symptom onset with intracerebral hemorrhage on initial imaging were identified from the Field Administration of Stroke Therapy-Magnesium (FAST-MAG) phase 3 clinical trial of intravenous magnesium vs. placebo. All subjects provided consent in the field and were transported to their usual care hospital, and no guidance was provided on treatment. Results: Of 1700 stroke cases presenting <2 hours from onset, there were 369 (22%) cases with primary ICH. Primary ICH cases had a mean [SD] age of 65 [13] years, 34% women, 79% White race, 34% Hispanic ethnicity, 80% pre-exisitng hypertension, 20% diabetes, 18% smokers; they were assessed in the field by paramedics a median [IQR] of 23 [15-40] and arrived in the ED 58 [46-77] minutes after onset. Median Glasgow Coma Scale was 15 [15-15] in the field and 15 [10-15] in the ED. Initial CT demonstrated ICH on the right in 61%, left in 39% and bilateral in 1. There was concurrent intraventricular hemorrhage in 41%, subarachnoid hemorrhage in 11%, and subdural hemorrhage in <1%. Mean [SD] hematoma volume was 29.2 [38.6] cc. At three months 30% had a good outcome [MRS 0-2] and 44% were dead or bedridden [MRS 5-6]. Younger age, absence of diabetes, smaller volume of hemorrhage, absence of intraventriuclar hemorrhage, and less severe clinical deficit in the field and in the ED was associated with good outcome. Conclusions: We describe the characteristics of hyper-acute primary ICH presenting to the ED, the population most likely to respond to acute treatments aimed at improving outcomes.
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