PRIMARY INTRACEREBRAL HEMORRHAGE IN THE OXFORDSHIRE COMMUNITY STROKE PROJECT .2. PROGNOSIS

Sixty-six patients with primary intracerebral haemorrhage were identif ied in a prospective, community-based register of 675 consecutive pati ents with first-ever in a lifetime stroke. No patient was lost to foll ow-up (up to 6 years). The 30-day case fatality rate was 52%. For pati ents surviving 30 days the average annual mortality rate was 8% per ye ar for the next 5 years. The main cause of early death (less than or e qual to 30 days) was the neurological sequelae of the original stroke (73%, whilst late deaths (>30 days) were due to either complications o f immobility (45%) or vascular disease (55%). Twenty one percent of al l patients were independent at 6 months (52% of survivors). The main p redictors for death within 30 days were age, reduced conscious level, abnormal proprioception and rupture of blood into the ventricles or su barachnoid space. In addition, the size of the initial haemorrhage was predictive for death at any stage of follow-up, and the degree of lim b weakness was predictive of death or dependency at 6 months. Nine pat ients had 14 recurrent strokes (including 4 definite haemorrhages and 4 definite cerebral infarctions). Five of the recurrences were fatal. The actuarial risk of recurrence in 30-day survivors was 7% per year ( 14 per 100 patient-years) and the actuarial risk of death or recurrenc e in 30-day survivors was 11% per year. Seven patients (11%) had at le ast one seizure during follow-up, the risk of first seizure being 8 pe r 100 patient-years overall. Patients with primary intracerebral haemo rrhage have a high early case fatality but survivors have a similar ou tcome to patients with cerebral infarction.