Background and Purpose The goal of the present study was to prospectiv
ely determine how frequently early growth of intracerebral hemorrhage
occurs and whether this early growth is related to early neurological
deterioration. Methods We performed a prospective observational study
of patients with intracerebral hemorrhage within 3 hours of onset. Pat
ients had a neurological evaluation and CT scan performed at baseline,
1 hour after baseline, and 20 hours after baseline. Results Substanti
al growth in the volume of parenchymal hemorrhage occurred in 26% of t
he 103 study patients between the baseline and 1-hour CT scans. An add
itional 12% of patients had substantial growth between the 1- and 20-h
our CT scans. Hemorrhage growth between the baseline and 1-hour CT sca
ns was significantly associated with clinical deterioration, as measur
ed by the change between the baseline and 1-hour Glasgow Coma Scale an
d National Institutes of Health Stroke Scale scores. No baseline clini
cal or CT prediction of hemorrhage growth was identified. Conclusions
Substantial early hemorrhage growth in patients with intracerebral hem
orrhage is common and is associated with neurological deterioration. R
andomized treatment trials are needed to determine whether this early
natural history of ongoing bleeding and frequent neurological deterior
ation can be improved.