Characteristics of Early Presenters after Intracerebral Hemorrhage

Intracerebral hemorrhage (ICH) expansion represents an appealing therapeutic target [1]. The risk of hematoma expansion (HE) is highest in the first few hours after onset and declines with longer time to imaging . The therapeutic window is therefore narrow and early presentation (EP) is one of the key inclusion criteria for randomized controlled trials targeting HE. The aim of our study was to describe the characteristics of ICH patients with EP.We retrospectively selected ICH patients admitted at the following sites: Charité Hospital, Berlin, Germany (2014-2019), Spedali Civili, Brescia, Italy (2008-2019), Arcispedale S. Anna, Ferrara, Italy (2010-2019), IRCCS Mondino Foundation, Pavia, Italy (2017-2019), and IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy (2015-2019). We selected patients with: (1) primary, spontaneous, non-traumatic ICH; (2) age >18 years; (3) baseline non-contrast computed tomography (NCCT) within 24 hours from onset/last seen well (LSW). Patients with secondary ICH and infratentorial hemorrhages were excluded. Amongst 1,684 patients screened, 1,335 were included, of whom 297 (22.2%) had EP. Excluded patients had smaller volume and a higher frequency of anticoagulation and hypertension. The remaining characteristics were similar (all P>0.1). A total of 395 (29.6%) subjects had an unclear symptom onset, of whom 13 (3.3%) presented within 2 hours from LSW.EP was associated with higher GCS, deep hemorrhages, anticoagulation, history of hypertension, and higher SBP values on admission. In conclusion, deep location, SBP, and history of hypertension are the main variables associated with EP and less than one in four ICH patients presented within 2 hours. These findings may inform future studies targeting ICH subjects in the ultra-early time window.