Abstract
There is little information on the characteristics of patients with wake-up intracerebral hemorrhage (WU-ICH). We aimed to evaluate frequency and relevant differences between WU-ICH and while-awake (WA) ICH patients. This is a retrospective study of a prospective database of consecutive patients with spontaneous ICH, who were classified as WU-ICH, WA-ICH or UO-ICH (unclear onset). We collected demographic, clinical and radiological data, prognostic and therapeutic variables, and outcome [(neurological deterioration, mortality, functional outcome (favorable when modified Rankin scale score 0–2)]. From a total of 466 patients, 98 (25.8%) were classified as UO-ICH according to the type of onset and therefore excluded. We studied 368 patients (mean age 73.9 ± 13.8, 51.4% men), and compared 95 (25.8%) WU-ICH with 273 (74.2%) WA-ICH. Patients from the WU-ICH group were significantly older than WA-ICH (76.9 ± 14.3 vs 72.8 ± 13.6, p = 0.01) but the vascular risk factors were similar. Compared to the WA-ICH group, patients from the WU-ICH group had a lower GCS score or a higher NIHSS score and a higher ICH score, and were less often admitted to a stroke unit or intensive care unit. There were no differences between groups in location, volume, rate of hematoma growth, frequency of intraventricular hemorrhage and outcome. One in five patients with spontaneous ICH are WU-ICH patients. Other than age, there are no relevant differences between WU and WA groups. Although WU-ICH is associated with worse prognostic markers vital and functional outcome is similar to WA-ICH patients.
Highlights
There is little information on the characteristics of patients with wake-up intracerebral hemorrhage (WU-ICH)
Our aim was to establish the frequency of WU-ICH and to compare demographic, clinical and radiological features with while-awake ICH (WA-ICH) in a large series of consecutive patients admitted to a tertiary care hospital
We conducted a retrospective study of consecutive patients of 18 years and older with spontaneous ICH included in a prospective registry
Summary
There is little information on the characteristics of patients with wake-up intracerebral hemorrhage (WU-ICH). We aimed to evaluate frequency and relevant differences between WU-ICH and whileawake (WA) ICH patients. Similar to acute myocardial infarction and sudden cardiac death, there is a circadian pattern with an increased risk of acute ischemic and hemorrhagic stroke during the early morning hours[1]. It is known[2,3] that 8–25% of patients with ischemic stroke have symptoms first noted on awakening. Our aim was to establish the frequency of WU-ICH and to compare demographic, clinical and radiological features with WA-ICH in a large series of consecutive patients admitted to a tertiary care hospital. We believe that this information may be useful for the design of future therapeutic studies
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