Primary intracerebral and aneurysmal subarachnoid hemorrhage in Izumo City, Japan. Part II: management and surgical outcome.

The purpose of this community-based study was first to estimate the incidence rates of primary intracerebral hemorrhage (ICH) and aneurysmal subarachnoid hemorrhage (SAH) in Izumo City, Japan, and second to investigate whether there were seasonal and diurnal periodicities in their onset. During 1991 through 1996, 267 patients with primary ICH and 123 with aneurysmal SAH were treated in Izumo City. The crude and the age- and sex-adjusted annual incidence rates per 100,000 population for all ages were 52 and 48 for ICH and 24 and 23 for SAH, respectively. These incidence rates were higher than those previously published for any other geographical region. The incidence rates of both ICH and SAH increased almost linearly with age. For ICH, a significant seasonal pattern was observed in men and in patients younger than 65 years, with a peak in winter and a trough in summer. However, no significant seasonal fluctuation was found in women or in individuals aged 65 years or older. There was no significant seasonal periodicity for SAH, even when patients were analyzed according to sex and age. Diurnal variations in the onset of both ICH and SAH were significant (except in men with SAH), with a nadir between midnight and 6:00 a.m. The actual incidence rates of both primary ICH and aneurysmal SAH seem to be much higher than have been reported so far. In addition, the data indicate the existence of seasonal periodicity for men and younger patients with ICH, and that the risk of both ICH and SAH is lower during nighttime.

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Prognostic Value and Determinants of Ultraearly Angiographic Vasospasm after Aneurysmal Subarachnoid Hemorrhage

The aim of this community-based study was to investigate the incidence rates and outcome of primary intracerebral hemorrhage (ICH) in relation to the site of hemorrhage. The subjects were 350 patients with primary first-ever ICH who were treated during the 8-year period 1991 to 1998 in Izumo City, Japan. The crude and age- and sex-adjusted incidence rates for all types of ICH were 52 and 47 per 100,000 population, respectively, for all ages. The most common site of ICH was the putamen (120 patients, 34%), followed by the thalamus (115, 33%), lobar areas (53, 15%), brainstem (30, 9%), cerebellum (25, 7%), and caudate nucleus (7, 2%). The crude and age- and sex-adjusted annual incidence rates per 100,000 population were 18 and 16 for putaminal, 17 and 15 for thalamic, 8 and 7 for lobar, 4 and 3 for cerebellar, 4 and 4 for brainstem, and 1 and 1 for caudate hemorrhages, respectively. The Glasgow Coma Scale scores on admission were best in patients with cerebellar hemorrhage and worst in those with brainstem hemorrhage. Surgery was performed for 34% of putaminal, 9% of thalamic, 14% of caudate, 21% of lobar, and 32% of cerebellar hemorrhages but not for brainstem hemorrhages. The 30-day case fatality rate was 11% for putaminal, 9% for thalamic, 14% for caudate, 11% for lobar, 0% for cerebellar, and 53% for brainstem hemorrhages. When patients with ICH were analyzed as a whole, the overall survival rates at 30 days, 3 months, and 3 years were 87, 83, and 73%, respectively. Both the short-term and long-term outcomes after ICH were directly related to the site of hemorrhage and the severity of bleeding, which was assessed by the hematoma volume and Glasgow Coma Scale score. Overall, 190 (54%) of 350 patients had a favorable outcome, and 55 (16%) had died at discharge. Marked differences were observed in the incidence rates and outcome of primary ICH in relation to the site of hemorrhage. The differences in outcome were primarily a result of differences in the severity of bleeding for each ICH subtype.

The serum S100 protein has been known to reflect the severity of neuronal damage. The purpose of this study was to assess the prognostic value of the serum S100 protein by Elecsys S100 immunoassay in patients with subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) and to establish reference value for this new method. Serum S100 protein value was measured at admission, day 3 and 7 after bleeding in 42 consecutive patients (SAH : 20, ICH : 22) and 74 healthy controls, prospectively. Admission Glasgow coma scale (GCS) score, Hunt & Hess grade and Fisher grade for SAH, presence of intraventricular hemorrhage, ICH volume, and outcome at discharge were evaluated. Degrees of serum S100 elevation and their effect on outcomes were compared between two groups. Median S100 levels in SAH and ICH groups were elevated at admission (0.092 versus 0.283 microg/L) and at day 3 (0.110 versus 0.099 microg/L) compared to healthy controls (0.05 microg/L; p<0001). At day 7, however, these levels were normalized in both groups. Time course of S100 level in SAH patient was relatively steady at least during the first 3 days, whereas in ICH patient it showed abrupt S100 surge on admission and then decreased rapidly during the next 7 days, suggesting severe brain damage at the time of bleeding. In ICH patient, S100 level on admission correlated well with GCS score (r=-0.859; p=0.0001) and ICH volume (r=0.663; p=0.001). A baseline S100 level more than 0.199 microg/L predicted poor outcome with 92% sensitivity and 90% specificity. Logistic regression analyses showed Ln (S100) on admission as the only independent predictor of poor outcome (odd ratio 36.1; 95% CI, 1.98 to 656.3). Brain damage in ICH patient seems to develop immediately after bleeding, whereas in SAH patients it seems to be sustained for few days. Degree of brain damage is more severe in ICH compared to SAH group based on the S100 level. S100 level is considered an independent predictor of poor outcome in patient with spontaneous ICH, but not in SAH. Further study with large population is required to confirm this result.

Background: Many patients with acute intracerebral hemorrhage (ICH) clinically deteriorate between the time of paramedic assessment in the field and Emergency Department (ED) arrival. Cohort studies have used decline in the Glasgow Coma Scale (GCS) score from prehospital assessment to ED assessment to identify patients with early clinical deterioration (ECD), but the degree of GCS decline that best correlates with poor final functional outcome has not been delineated. Methods: Consecutive cases with primary ICH 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 underwent GCS evaluation in the field by paramedics within 2 hours from symptom onset, and again in the ED by study research coordinators. Poor outcome was defined as a modified Rankin Scale of 4 to 6 at 3-months. Deteriorations in GCS from one point through 10 points were evaluated in relation to poor final functional outcome through receiver operating characteristic (ROC) and area under curve (AUC). Results: Among the 369 (22%) patients with primary ICH, mean [SD] age was 65 [13] years, 34% were women, 79% White race, 34% Hispanic ethnicity, 80% had pre-existing hypertension, 20% diabetes, 18% smokers. Paramedic on scene time was a median [IQR] of 23 [15-40] minutes from last known well and time of GCS assessment in the ED was a median of 140 [119-175] minutes after last known well. Glasgow Coma Scale scores were mean 14.4 (SD 1.5) and median 15 [15-15] in the field and mean 12.1 (SD 4.5) and median 15 [10-15] in the ED, and 59% had a poor outcome at 3 months. Frequency of deteriorations on the GCS included: ≥1 point - 38%, ≥2points - 31%, ≥3 points - 27%, ≥5 points - 21%, and ≥10 points - 13%. The best performing cutpoints on the the ROC for predicting poor final outcome were ECD definitions of GCS decline of &gt;=1: sensitivity 54% and specificity 85%; and GCS decline of &gt;=2: sensitivity 46% and specificity 91%. The c statistic for ECD defined as a 1 point GCS decline as a predictor of poor final outcome was 0.71 (95%CI 0.66, 0.76). Conclusions: Early clinical deterioration of GCS is common and its presence may be helpful in predicting poor outcome.

The authors of this study aimed to identify predictors of in-hospital mortality in patients with primary supratentorial intracerebral hemorrhage (ICH) at emergency department admission and 6 hours thereafter. Additionally, they evaluated the predictive accuracy of a modified ICH (mICH) Score incorporating midline shift (MLS), compared to that of the original ICH Score. This retrospective analysis included adult patients with primary supratentorial ICH who had been admitted to a Comprehensive Stroke Center between July 2017 and December 2023. Data extracted from the electronic medical records included demographics, clinical history, blood pressure, ICH characteristics on CT scans (i.e., location, hematoma volume, intraventricular hemorrhage, MLS), Glasgow Coma Scale (GCS) score, ICH Score, laboratory tests (i.e., white blood cell [WBC] count and hemoglobin, hematocrit, platelet, and glucose levels), antithrombotic use, neurological interventions, and discharge status. The primary outcome was in-hospital mortality. The mICH Score was calculated by substituting ICH volume in the original risk stratification scale with MLS (≥ 5 mm = 1 point). Statistical analyses included descriptive statistics, chi-square test, t-test, logistic regression, and receiver operating characteristic curve analysis. The in-hospital mortality rate among 518 patients with primary supratentorial ICH was 23%. Compared with survivors, deceased patients were older, had lower BMIs, more frequently presented with loss of consciousness, and had lower GCS scores and higher ICH Scores at admission and 6 hours thereafter. Independent predictors of death included older age, lower BMI, cortical ICH location, hematoma volume ≥ 30 cm3, intraventricular hemorrhage, MLS ≥ 5 mm, lower GCS score, higher ICH Score, elevated systolic blood pressure, higher WBC count and glucose level, and lower hemoglobin and hematocrit levels. On admission, the ICH Score (area under the curve [AUC] 0.890) and GCS score (AUC 0.879) showed a strong predictive performance for mortality, which improved at 6 hours after admission (AUC 0.914 for both). The mICH Score (AUC 0.897) demonstrated predictive accuracy comparable to that of the ICH Score. Twenty-one percent of the patients experienced ICH Score progression at 6 hours, which was associated with a 2.4-fold increase in mortality risk. Findings in this study confirm established predictors of mortality in supratentorial ICH and highlight the prognostic value of neurological assessment 6 hours after admission. The mICH Score offers a practical and similarly accurate alternative to the original ICH Score for predicting in-hospital mortality. These findings underscore the importance of early and serial assessments to guide risk stratification in patients with ICH.

Objective To investigate the effects of nimodipine combined with edaravone on cerebral vasospasm (CVS) and delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH). Methods The consecutive patients with aSAH who underwent microsurgical clipping were included retrospectively. All patients received intravenous prophylaxis with nimodipine, and some patients also used edaravone (30 mg, twice a day for 2 weeks). They were divided into either a CVS group or a non-CVS group according to the findings of transcranial Doppler. They were also divided into a DCI group and a non-DCI group according to the findings of CT reexamination and clinical examination. The demographics, baseline clinical data, Glasgow Coma Scale (GCS) score, Fisher grade, Hunt-Hess grade, and aneurysm location of all patients were collected. The multivariate logistics regression analysis was used to identify the independent risk factors for CVS and DCI. Results A total of 220 patients with aSAH were enrolled in the study, 132 (60.0%) had CVS and 106 (48.2%) had DCI. One hundred twenty-three patients (55.9%) were treated with nimodipine + edaravone, 97 were treated with nimodipine alone, none of them died. The incidences of CVS (51.2% vs. 71.1%; χ2=8.962, P=0.003) and DCI (35.0% vs. 65.0%; χ2=19.535, P<0.001) in patients receiving nimodipine + edaravone therapy were significantly lower than those receiving nimodipine alone. The proportions of hypertension, hyperlipidemia, diabetes, smoking, high Fisher grade in the CVS group were significantly higher than those in the non-CVS group (all P<0.05), while the proportion of patients receiving nimodipine + edaravone therapy (47.7% vs. 68.2%; χ2=8.962, P=0.003) and the GCS score (11.2±3.1 vs. 13.4±2.6; t=5.492, P<0.001) were significantly lower than those in the non-CVS group. Multivariate logistic regression analysis showed that low GCS score (odds ratio [OR] 6.57, 95% confidence interval [CI] 1.04-12.96; P=0.001), high Fisher grade (OR 5.39, 95% CI 4.09-20.15; P=0.004), hyperlipidemia (OR 4.39, 95% CI 2.97-34.15; P=0.004), hypertension (OR 3.24, 95% CI 1.06-13.47; P=0.016) were the independent risk factors for CVS, while received nimodipine + edaravone was the independent protective factor for CVS (OR 0.39, 95% CI 0.13-0.91; P=0.039). The proportions of patients with hypertension, hyperlipidemia, diabetes, smoking, and high Fisher grade in the DCI group were significantly higher than those in the non-DCI group (all P<0.05), while the proportion of patients received nimodipine + edaravone (40.6% vs. 70.2%; χ2=19.535, P<0.001) and the GCS score (10.2±2.4 vs. 13.8±2.6; t=10.648, P<0.001) were significantly lower. Multivariate logistic regression analysis showed that low GCS score (OR 8.92, 95% CI 2.48-26.94; P=0.001), high Fisher grade (OR 7.49, 95% CI 1.96-20.47; P=0.001) were the independent risk factors for DCI, while received nimodipine + edaravone was an independent protective factor for DCI (OR 0.27, 95% CI 0.08-0.97; P=0.020). Conclusions Compared with nimodipine alone, nimodipine combined with edaravone can significantly reduce the incidences of CVS and DCI. The GCS score, high Fisher grade, and hypertension are the independent risk factors for CVS and DCI in patients with aSAH, and nimodipine combined with edaravone is the independent protective factor for CVS and DCI. Key words: Subarachnoid Hemorrhage; Intracranial Aneurysm; Vasospasm, Intracranial; Brain Ischemia; Nimodipine; Free Radical Scavengers; Edaravone

Purpose: To investigate the incidence and relative factors of Terson’s syndrome (TS) in patients with subarachnoid hemorrhage (SAH) in China.Materials and Methods: A case series study was conducted from November 2009 to June 2010 on 155 patients (310 eyes) with aneurysmal and traumatic SAH. A thorough, direct funduscopic examination was performed on all participants and the incidence of TS analyzed. Associations between TS and gender, state-of-consciousness, Glasgow Coma Scale (GCS) score, Hunt-Hess grade, anatomical location of ruptured aneurysms, and mortality rates were analyzed.Results: TS was diagnosed in 20 of 155 SAH patients (30 eyes), and detected in 16 (14.16%) of 113 patients with aneurysmal SAH and four (9.52%) of 42 patients with traumatic SAH. No correlations were found between state-of-consciousness, GCS scores, and presence of TS in patients with traumatic SAH. Among patients suffering from aneurysmal SAH, however, significant relationships were observed between state-of-consciousness, GCS scores, Hunt-Hess grades, and incidence of TS (p < 0.01). No statistically significant difference was observed between men and women with regard to the incidence of TS (χ2 = 0.821, p = 0.365). Furthermore, no correlation was found between location of ruptured aneurysms (p = 1.000), mortality rates (p = 0.146), and incidence of TS.Conclusions: Compared with traumatic SAH, a higher incidence of TS was observed in patients with aneurysmal SAH, a condition significantly associated with a person’s overall condition. Therefore, aneurysmal SAH patients with consciousness-disturbance, lower GCS scores, and higher Hunt-Hess grades should be paid particular attention by ophthalmologists when performing fundus examinations. The question of whether SAH with TS is prognostic of spontaneous SAH is an area in need of further study.

Recent clinical studies have demonstrated that advanced age and low initial Glasgow Coma Scale (GCS) score were independent predictors of gastrointestinal bleeding (GIB) in patients with primary intracerebral hemorrhage (ICH). However, used singly, age and GCS score have their respective shortcomings in predicting the occurrence of GIB. This study aimed to investigate the association between the age-to-initial GCS score ratio (AGR) and the risk of GIB following ICH. We conducted a single-center, retrospective observational study of consecutive patients presenting with spontaneous primary ICH at our hospital from January 2017 through January 2021. Patients who fulfilled the inclusion and exclusion criteria were categorized into GIB and non-GIB groups. Univariate and multivariate logistic regression analyses were implemented to identify the independent risk factors for the occurrence of GIB, and a multicollinearity test was performed. Furthermore, one-to-one matching was conducted to balance important patient characteristics by the groups' propensity score matching (PSM) analysis. A total of 786 consecutive patients fulfilled the inclusion/exclusion criteria for the study, and 64 (8.14%) patients experienced GIB after primary ICH. Univariate analysis revealed that patients with GIB were significantly older [64.0 (55.0-71.75) years vs. 57.0 (51.0-66.0) years, p = 0.001] and had a higher AGR [7.32 (5.24-8.96) vs. 5.40 (4.31-7.11), p < 0.001] and a lower initial GCS score [9.0 (7.0-11.0) vs. 11.0 (8.0-13.0), p < 0.001]. The multicollinearity test revealed that no multicollinearity was observed in the multivariable models. Multivariate analysis showed that the AGR was a significant independent predictor of GIB [odds ratio (OR) 1.155, 95% confidence interval (CI) 1.041-1.281, p = 0.007], as well as prior anticoagulation or antiplatelet therapy (OR 0.388, 95% CI 0.160-0.940, p = 0.036) and MV used >24 h (OR 0.462, 95% CI 0.252-0.848, p = 0.013). Receiver operating curve (ROC) analysis illustrated that the optimal cutoff value for the AGR as a predictor for GIB in patients with primary ICH was 6.759 [the area under the curve (AUC) was 0.713 with a corresponding sensitivity of 60.94% and specificity of 70.5%, 95% CI 0.680-0.745, p < 0.001]. After 1:1 PSM, the matched GIB group had significantly higher AGR levels compared with the matched non-GIB group [7.47(5.38-9.32) vs. 5.24(4.24-6.40), p <0.001]. The ROC analysis indicated an AUC of 0.747 (the sensitivity was 65.62%, and the specificity was 75.0%, 95% CI 0.662-0.819, p < 0.001) for AGR levels as an independent predictor of GIB in patients with ICH. In addition, AGR levels were statistically correlated with unfunctional 90-day outcomes. A higher AGR was associated with an increased risk of GIB and unfunctional 90-day outcomes in patients with primary ICH.

Secondary injury of cerebral hemorrhage is induced by systemic inflammatory cascades, which are related to perihematomal brain edema, cellular apoptosis, and the disruption of the blood-brain barrier. This study was to specifically elaborate the relationship of circulating/cerebrospinal T lymphocytes and Glasgow Coma Scale (GCS) score at 6 months after intracerebral hemorrhage (ICH). The enrolled patients were divided into 2 groups based on GCS score: the favorable prognosis group (GCS > 12) and unfavorable prognosis group (GCS ≤ 12). T lymphocyte subpopulations were analyzed by flow cytometry. A total of 30 samples of peripheral blood and 17 samples of cerebrospinal fluid were collected and analyzed, including 19 cases and 12 cases in the favorable prognosis group (GCS > 12) respectively. Both CD3+ and CD3+CD4+ T lymphocyte counts on Day 1 after ICH were lower in the peripheral blood of patients with unfavorable prognosis (GCS ≤ 12) (P = .025 and .022, respectively). There were correlation trends between the GCS scores and CD3+ T lymphocyte count (P = .0144), and CD3+CD4+ T lymphocyte count (P = .0135). In cerebrospinal fluid, there was a close correlation between the GCS scores and CD3+CD4+ percentage, CD4+/CD8+ ratio, CD3+ and CD3+CD4+ T lymphocyte counts. The area under the curve of CD4+/CD8+ T lymphocyte ratio was the largest among them (P = .000 and area under the curve = 0.917), with a significantly high specificity and sensitivity (0.917 and 1.000). Based on cerebrospinal fluid samples, the CD4+/CD8+ T lymphocyte ratio on Day 1 after ICH may be a more significant indicator to predict the short-term prognosis at 6 months after ICH.

Little information is available on the efficacy of aggressive treatment such as surgery in improving the outcome of severely affected patients after supratentorial intracerebral hemorrhage (ICH). Our objective was to assess the effect of hematoma removal and ventricular drainage on the mortality of patients with severe primary supratentorial ICH. We studied 103 consecutive patients who were admitted to the intensive care unit and diagnosed with primary supratentorial ICH. The impacts of clinical factors on 30-day mortality were assessed, including surgery, Glasgow Coma Scale (GCS) score and pupillary abnormality at admission, hematoma volume, and other related factors. The 30-day mortality rate was 42%, and the median time between admission and death was 3 days (range: 1 to 27 days). Hematoma removal and ventricular drainage, within the first 24 hours of admission, were performed on 11 and 17 patients, respectively. Two patients who were treated with removal and four with drainage died. A logistic regression model for predicting 30-day mortality was performed. After controlling for GCS score, pupillary abnormality, hydrocephalus, and hematoma volume, hematoma removal was identified as an independent predictor of survival (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.02 to 0.92). Ventricular drainage also tended to decrease mortality rate greatly (OR, 0.31; 95% CI, 0.06 to 1.76). Patients with GCS scores of 3 or 4 were 4.01 times more likely to die (95% CI, 1.13 to 14.26) than those with GCS of at least 5. Hematoma removal may reduce the mortality rate of patients with severe supratentorial ICH.

Background: The significance of early neurological improvement (ENI) and deterioration (END) in patients with primary intracerebral hemorrhage (ICH) is unclear. We sought to determine the prevalence and predictors of ENI and END and their impact on long term clinical outcome in patients with primary ICH recruited within 4.5 hours after symptom onset. Methods: We analyzed data from Antihypertensive Treatment at Acute Cerebral Hemorrhage (ATACH)-2 trial. ENI and END were defined by ≥ 4 points decrease or increase in NIHSS score within 24 hours post randomization, respectively. Baseline characteristics of patients that predicted ENI and END were identified. The association between ENI and END with favorable 90-day outcome (defined as modified Rankin Scale (mRS) &lt;2) was analyzed after adjustment for potential confounders. Results: Ninety five of 1000 patients with ICH had END (9.5%). END was more common among non-Asians compared to Asians (55% vs 42%), patients with hematoma volume &gt;=30 cc (26% vs 8%, p=&lt;.0001) and intraventricular hemorrhage (IVH) (41% vs 25%, p=0.0015). Similarly, patients with END had higher baseline NIHSS score (median value 14 vs 10, p=&lt;.0001). Patients with END had significantly lower rate of favorable 90-day outcome (6% vs 28%, p=&lt;.0001). ENI was seen in 165 (19%) of patients. ENI was associated with lower initial Glasgow Coma Scale (GCS) score, lack of IVH, basal ganglia hematoma, and prior antihypertensive treatment. Patients with ENI had significantly higher chance of favorable 90-day outcome (29% vs 20%, p=0.019). In multivariate models that adjusted for initial GCS score, age and presence of IVH, both ENI and END were independent predictors of 90-day favorable outcome with (RR=1.40; 95% CI: 1.00, 1.97) and (RR=0.26; 95% CI: 0.11, 0.63), respectively. IVH and GCS score were independent predictors of early neurological changes. Conclusions: We found a relatively high prevalence of early neurological improvement or deterioration in ICH patients. Both ENI and END are independent predictors of 90-day functional outcome.

BackgroundWe aimed to examine current practice of the management and secondary prevention of intracerebral haemorrhage (ICH) in China where the disease is more common than in Western populations.MethodsData on baseline characteristics, management in-hospital and post-stroke, and outcome of ICH patients are from the ChinaQUEST (QUality Evaluation of Stroke Care and Treatment) study, a multi-centre, prospective, 62 hospital registry in China during 2006-07.ResultsNearly all ICH patients (n = 1572) received an intravenous haemodiluting agent such as mannitol (96%) or a neuroprotectant (72%), and there was high use of intravenous traditional Chinese medicine (TCM) (42%). Neurosurgery was undertaken in 137 (9%) patients; being overweight, having a low Glasgow Coma Scale (GCS) score on admission, and Total Anterior Circulation Syndrome (TACS) clinical pattern on admission, were the only baseline factors associated with this intervention in multivariate analyses. Neurosurgery was associated with nearly three times higher risk of death/disability at 3 months post-stroke (odd ratio [OR] 2.60, p < 0.001). Continuation of antihypertensives in-hospital and at 3 and 12 months post-stroke was reported in 732/935 (78%), 775/935 (83%), and 752/935 (80%) living patients with hypertension, respectively.ConclusionsThe management of ICH in China is characterised by high rates of use of intravenous haemodiluting agents, neuroprotectants, and TCM, and of antihypertensives for secondary prevention. The controversial efficacy of these therapies, coupled with the current lack of treatments of proven benefit, is a call for action for more outcomes based research in ICH.

Objective Both free triiodothyronine (FT3) level and Glasgow Coma scale (GCS) scores have been separately described as prognostic predictors for mortality in hypertensive intracerebral hemorrhage (HICH). This study is conducted to investigate the relationship and prognostic impact of low-T3 syndrome and GCS in HICH patients. Methods Two hundred and thirty patients with HICH, admitted to our hospital from January 2015 to January 2016, were chosen and performed thyroid hormone levels examination (FT3, FT4 and thyroid stimulating hormone [TSH] 3). According to the thyroid hormone results, these patients were divided into low T3 group I (FT3 7.5), and low T3 group II (FT3 2.85 pmol/L). Telephone follow-up was performed every 6 months, and using death or re-bleeding during follow-up period as end point of the event, prognostic values of FT3 level and GCS scores defined by ROC curve in mortality and re-bleeding rate were recorded; survival rate of these patients were analyzed by Kaplan-Meier curves and compared between each two groups; multivariate Cox regression was used to analyze the relations of FT3 level and GCS scores with mortality and re-bleeding rate. Results As compared with normal thyroid function group, low T3 group I had significantly higher re-bleeding rate, percentage of patients with blood loss>30 mL, and rate of breaking into the ventricles, and statistically lower GCS scores at admission and FT3 level (P<0.05); the mean age in patients of low T3 group I was significantly elder than that in patients of normal thyroid function group (P<0.05). ROC results indicated that the sensitivity and specificity of GCS scores in predicting mortality and re-bleeding rate were 63% and 73%, and those of FT3 level were 45% and 73%. Kaplan-Meier curves showed that both low GCS group and low T3 group II had significantly increased mortality and re-bleeding rate as compared with high GCS group and high T3 group (P<0.05). Unified prediction results indicated that patients from low T3 and low GCS group had significantly higher mortality and re-bleeding rate as compared with patients from low T3 and high GCS group, high T3 and low GCS group, and high T3 and high GCS group (P<0.05). Conclusion Low T3 syndrome is common in patients with HICH; FT3 level and GCS scores appear to be important predictors for mortality and recurrence in patients with HICH. Key words: Hypertensive intracerebral hemorrhage; Glasgow coma scale; Free triiodothyronine; Prognosis