Simultaneous multiple intracerebral haemorrhages: aetiology, risk factors and clinical presentations

Abstract

Background: Simultaneous multiple intracerebral haemorrhages (SMICH) is hemorrhage in different arterial territories and are a rare clinical entity. The primary cause of single ICH is hypertension; however, the causes and risk factors of simultaneous multiple ICH are still unknown. Aim: To clarify the aetiology, risk factors and functional outcome of SMICH compared with solitary intracerebral haemorrhages (ICH). Materials and Methods: A total of 718 consecutive patients with spontaneous ICH admitted to our hospital were prospectively studied. Nine SMICH cases were identified, and 19 risk factors, clinical and neuroimaging variables were compared between SMICH and solitary ICH cases using the unpaired t-test, chi-square test, and multiple logistic regression. Results: 709 (98.75%) patients with ICH and 9 (1.25%) patients with SMICH were enrolled in the study. The age, sex distribution, and other associated risk factors were comparable between the groups (all P>0.05). By SMASH-U classification, arterial hypertension was identified in 6 (66.7%), and it was the most common cause in the SMICH group. Bilateral thalamic or putamenal haemorrhages (33.3% versus 33.3%) were the most common combinations of simultaneous bleedings. Age and NIHSS at admission were associated with 90-day mortality in multivariable analyses (OR 1.018; 95% CI, 1.000-1.036; p=0.044; versus OR 1.080; 95% CI, 1.029-1.135; p=0.002), but GCS was not (OR 0.834; 95% CI, 0.734-0.948; p=0.006). Conclusion: Patients with SMICH have risk factors and clinical characteristics similar to those of patients with solitary ICH, but they have a much poorer outcome.