Recurrence of bleeding in patients with hypertensive intracerebral hemorrhage

To characterize the recurrence of bleeding in patients who had hypertensive intracerebral hemorrhage (HICH), the authors reviewed 989 patients who und erwent treatment for HICH between 1989 and 1995. Fifty-three patients (5.4% ) had two episodes of HICH within a median interval of 22.9 +/- 16.3 months (range 1.5-72 months), and of these 3 (5.7%) had three episodes of HICH. T he recurrence of breeding most commonly occurred within 2 years of the firs t hemorrhage: in 66% of the 53 patients the second hemorrhage occurred soon after the first (within 1 year in 34%, within 1-2 years in 32.1%). The sit e of the second hemorrhage was different from the initial site in all patie nts. Only 1 patient had a third hemorrhage in the same site as the second h emorrhage. The common patterns of recurrence were 'ganglionic (putamen/caud ate nucleus)-thalamic' in 26.8% and 'ganglionic-ganglionic' in 21.4%. The ' lobar-lobar' pattern was noted in only 2 patients. The volume of the hemato ma was increased at the second hemorrhage. The overall mortality was 28.3%. The risk of recurrent hemorrhage significantly increased in the patients w ho had antihypertensive therapy of less than 3 months after the initial att ack compared to those with further long-term therapy (p < 0.005). Long-term regular control for hypertension is needed to prevent recurrent hemorrhage .