RECURRENT PRIMARY CEREBRAL-HEMORRHAGE - FREQUENCY, MECHANISMS, AND PROGNOSIS

Background and Purpose-The frequency of recurrent primary cerebral hem orrhage (RPCH), mainly in cases related to hypertension, has been cons idered low. This study investigated the frequency, mechanisms, and pro gnosis of RPCH. Methods-We evaluated 359 patients with neuroimaging ev idence of cerebral hemorrhage emd selected 22 with RPCH. Results-Five patients (23%) were older than 70 years at the first cerebral hemorrha ge. Mean ages at the first and second hemorrhages were 60 and 63 years , respectively. Risk factors included hypertension (86%), diabetes (27 %), and tobacco and alcohol use (each 14%). Hypocholesterolemia was de monstrated in 35% of the patients. The most common pattern of recurren t bleeding was ganglionic-ganglionic, mainly related to hypertension. Overall mortality was 32%. Forty-one percent and 27% of patients, resp ectively, had incapacitating and nonincapacitating sequelae; 2 of the latter had RPCH with a lobar location. Ganglionic-ganglionic hemorrhag e was associated with a poor prognosis; otherwise, this pattern was un common in patients with nonincapacitating sequelae. Analysis of the co ntrol of risk factors, primarily hypertension after the first cerebral hemorrhage, disclosed that 56% of patients did not gain subsequent co ntrol. Conclusions-Rebleeding after a first primary intracerebral hemo rrhage is nor uncommon. The main topographic pattern of bleeding, gang lionic-ganglionic, is likely the result of hypertension; the less comm on lobar-lobar pattern probably results from amyloid angiopathy.