Dennis Martin S
Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
Cerebrovasc Dis. 2003;16 Suppl 1:9-13. doi: 10.1159/000069935.
Between 10 and 20% of strokes are due to intracerebral haemorrhage. The 1-month case fatality is about 42% in unselected cohorts. This relatively low incidence (compared with ischaemic stroke) and high early case fatality means that relatively few patients are available for long-term follow-up and therefore the available data on prognosis are imprecise. Moreover, improvements in diagnostic methods, such as the introduction of gradient echo MRI, which is very sensitive to intracerebral haemorrhage, are altering the types of patients being entered into studies of prognosis. Despite these methodological difficulties, it does appear that the overall prognosis with respect to survival and residual disability is similar to that for ischaemic stroke of equivalent clinical severity. Greater age and stroke severity, whether graded by neurological score or extent of haemorrhage on imaging, are both associated with increased case fatality and poorer functional outcomes. There is no definite evidence of differential recovery between ischaemic and haemorrhagic stroke. Epileptic seizures occur more commonly after haemorrhagic stroke (about 8 per 100 patient-years) compared with ischaemic stroke and more commonly in lobar rather than basal ganglia haemorrhage. There is no reliable evidence to indicate that the risk of recurrent stroke after haemorrhage differs from that after ischaemic stroke. However, strokes due to haemorrhage, like those due to infarction, are heterogeneous not only in terms of severity but also in their causes. The causes (e.g. amyloid angiopathy, hypertension, coagulation deficits) are likely to influence the risk of subsequent stroke. Pooling of data from community-based studies of haemorrhagic stroke that have used consistent definitions and methods represents the only feasible way to obtain more precise data on prognosis after intracerebral haemorrhage.
10%至20%的中风是由脑出血所致。在未经筛选的队列中，1个月时的病死率约为42%。这种相对较低的发病率（与缺血性中风相比）和较高的早期病死率意味着可供长期随访的患者相对较少，因此关于预后的现有数据并不精确。此外，诊断方法的改进，如对脑出血非常敏感的梯度回波磁共振成像的引入，正在改变纳入预后研究的患者类型。尽管存在这些方法学上的困难，但就生存和残留残疾而言，总体预后似乎与同等临床严重程度的缺血性中风相似。年龄越大、中风越严重，无论是根据神经学评分还是影像学上的出血范围分级，都与病死率增加和功能结局较差相关。没有确凿证据表明缺血性中风和出血性中风之间存在不同的恢复情况。与缺血性中风相比，出血性中风后癫痫发作更常见（每100患者年约8例），且在脑叶出血而非基底节出血中更常见。没有可靠证据表明出血后复发性中风的风险与缺血后不同。然而，出血性中风，与梗死性中风一样，不仅在严重程度上，而且在病因方面都是异质性的。病因（如淀粉样血管病、高血压、凝血缺陷）可能会影响随后中风的风险。汇集基于社区的脑出血研究中使用一致定义和方法的数据，是获得关于脑出血后预后更精确数据的唯一可行方法。
