Clinical features and functional outcome of intracerebral hemorrhage in patients aged 85 and older.

Abstract

The importance of studies of older stroke victims is growing because of the changes in the age structure of Western populations. We determined demographic characteristics, clinical features, neuroimaging data, and outcome of acute spontaneous intracerebral hemorrhage occurring in people aged 85 and older. Prospective collection of data from a hospital-based registry. Sagrat Cor Hospital of Barcelona (an acute care, 350-bed teaching hospital serving a population of approximately 250,000). Between January 1986 and December 1995, data were collected on 2,000 stroke patients admitted consecutively to the department of neurology (25 beds and an acute stroke unit). For the purpose of this study, all cases of intracerebral hemorrhage were selected (n = 229). Demographic data, clinical features, neuroimaging findings, and outcome variables (in-hospital mortality and medical complications developed during hospitalization)in patients aged 85 and older (n = 28) were compared with patients who were younger than age 85 (n = 201). Distinctive clinical features of intracerebral hemorrhage in very old people were assessed by multivariate analysis. Intracerebral hemorrhage was diagnosed in 11% of subjects aged 85 and older included in the stroke registry and accounted for 12% of all cases of intracerebral hemorrhage. Very old people with intracerebral hemorrhage showed a significantly higher frequency of female gender (75% vs 32%, P < .005), altered consciousness (64% vs 43%, P < .05), multiple topographic involvement (29% vs 13%, P < .03), undetermined etiology of bleeding (50% vs 27%, P < .02), moderate or severe neurological deficit at hospital discharge (89% vs 58%, P < .005), and in-hospital mortality (50% vs 27%, P < .01) than younger people. After multivariate analysis, female sex (odds ratio (OR) = 3.2,95% confidence interval (CI) - 1.27-7.99) and moderate or severe neurological deficit at hospital discharge (OR =4.75, 95% Cl = 1.36-16.55) were independent clinical factors associated with intracerebral hemorrhage in very old people. Patients aged 85 and older with intra-cerebral hemorrhage showed some peculiar clinical features and poorer outcome, including higher in-hospital mortality and moderate or severe neurological deficit at hospital discharge, than younger patients with intracerebral hemorrhage.