SPECTRUM OF PRIMARY INTRACEREBRAL HEMORRHAGE IN PERTH, WESTERN-AUSTRALIA, 1989-90 - INCIDENCE AND OUTCOME

In a population based register of stroke (n = 536) compiled in Perth, Western Australia during an 18 month period in 1989-90, 60 cases (11%) of primary intracerebral haemorrhage were identified among 56 persons (52% men). The mean age of these patients was 68 (range 23-93) and 46 (77%) events were first ever strokes. The crude annual incidence was 35 per 100 000, with a peak in the eighth decade, and a male predomina nce. Deep and lobar haemorrhages each accounted for almost one third o f all cases. The clinical presentations included sudden coma (12%), he adache (8%), seizures (8%), and pure sensory-motor stroke (3%). Primar y intracerebral haemorrhage was the first presentation of leukaemia in two cases (both fatal) and it followed an alcoholic binge in four cas es. 55% had a history of hypertension. 16 (27%) patients, half of whom had a history of hypertension, were taking antiplatelet agents, and o ne patient was taking warfarin. There were only two confirmed cases of amyloid angiopathy. The overall 28 day case fatality was 35%, but thi s varied from 100% for haemorrhages in the brainstem to 22% for those in the basal ganglionic or thalamic region. Other predictors of early death were intraventricular extension of blood, volume of haematoma, m ass effect, and coma and severe paresis at onset. Although based on sm all numbers, these data confirm the heterogeneous nature of primary in tracerebral haemorrhage, but they also suggest a different clinical sp ectrum of this type of stroke in the community compared with the exper ience of specialist neurological units.