Arboix Adrià, Massons Joan, García-Eroles Luís, Comes Emili, Targa Cecilia, Oliveres Montserrat
Unidad de Enfermedades Vasculares Cerebrales, Servicio de Neurología, Capio-Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, España.
Med Clin (Barc). 2012 Nov 17;139(12):538-41. doi: 10.1016/j.medcli.2012.05.009. Epub 2012 Jul 3.
To characterize the clinical factors and prognosis and identify determinants of hemorrhage recurrence (HCR) in patients with acute non-traumatic intracerebral hemorrhage.
Stroke patterns were studied in 28 consecutive recurrent non-traumatic intracerebral hemorrhage patients admitted to the Department of Neurology of the Sagrat Cor Hospital of Barcelona for a 19 year period. Demographic, risk factors, clinical, neuroimaging and outcome variables were analyzed and compared with patients with first-ever non-traumatic intracerebral hemorrhage (n=380) to identify predictors of hemorrhage recurrence. Significant variables were entered into a multivariate logistic regression analysis.
HCR accounted for 6.8% of all patients with acute consecutive non-traumatic intracerebral hemorrhages. The HCR were mostly lobar (67.9%). Other topographies include: thalamus (10.7%), capsule-ganglionar (7.1%), intraventricular (3.6%) and multiple topographies (10.7%). Although the HCR have poor prognosis, it is not worse compared to the first-ever intracerebral hemorrhages, both at the high hospital mortality (17.9 vs. 28.2%) as the low frequency of absence of limitation at discharge (3.6 vs. 6.1%). The clinical profile significantly associated with HCR was: valvular heart disease (odds ratio [OR] 5.32; 95% confidence interval [95% CI] 1.45-19.47), lobar topography (OR 3.53, 95% IC 1.53-8.13), and the presence of nausea and vomiting (OR 2.43, 95% IC 1.06-5.52).
HCR constitute less than one tenth of non-traumatic intracerebral hemorrhages and are most commonly located in the brain lobes. Although the prognosis is serious, this is no worse during the acute phase, than of the first-ever non-traumatic intracerebral hemorrhages. Clinical profiles were different in recurrent non-traumatic intracerebral hemorrhage patients when compared to first-ever non-traumatic intracerebral hemorrhage patients.
明确急性非创伤性脑出血患者的临床因素、预后情况，并确定出血复发（HCR）的决定因素。
对巴塞罗那圣十字医院神经科连续收治的28例复发性非创伤性脑出血患者进行了为期19年的卒中模式研究。分析了人口统计学、危险因素、临床、神经影像学和结局变量，并与首次发生非创伤性脑出血的患者（n = 380）进行比较，以确定出血复发的预测因素。将显著变量纳入多因素逻辑回归分析。
HCR占所有连续急性非创伤性脑出血患者的6.8%。HCR大多位于脑叶（67.9%）。其他部位包括：丘脑（10.7%）、壳核-神经节（7.1%）、脑室内（3.6%）和多个部位（10.7%）。尽管HCR预后较差，但与首次脑出血相比，在高医院死亡率（17.9%对28.2%）和出院时无功能受限的低发生率（3.6%对6.1%）方面并不更差。与HCR显著相关的临床特征为：心脏瓣膜病（比值比[OR] 5.32；95%置信区间[95% CI] 1.45 - 19.47）、脑叶部位（OR 3.53，95% IC 1.53 - 8.13）以及恶心和呕吐的存在（OR 2.43，95% IC 1.06 - 5.52）。
HCR占非创伤性脑出血的比例不到十分之一，最常见于脑叶。尽管预后严重，但在急性期并不比首次非创伤性脑出血更差。与首次非创伤性脑出血患者相比，复发性非创伤性脑出血患者的临床特征有所不同。
