Wake-up intracerebral hemorrhage: hematoma expansion and outcomes
IntroductionWhile understudied, wake-up intracerebral hemorrhage (WU-ICH) is not uncommon (8.8–20.3% of ICH patients). Since the risk of hematoma expansion (HE) decreases as time passes, an uncertain onset time in WU-ICH may influence the risk of in-hospital HE and the potential effects of HE-preven...
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Frontiers Media S.A.
2025-07-01
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1620170/full |
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| author | Tove Almqvist Tove Almqvist Anna Falk Delgado Anna Falk Delgado Christina Sjöstrand Christina Sjöstrand Michael V. Mazya Michael V. Mazya |
| author_facet | Tove Almqvist Tove Almqvist Anna Falk Delgado Anna Falk Delgado Christina Sjöstrand Christina Sjöstrand Michael V. Mazya Michael V. Mazya |
| author_sort | Tove Almqvist |
| collection | DOAJ |
| description | IntroductionWhile understudied, wake-up intracerebral hemorrhage (WU-ICH) is not uncommon (8.8–20.3% of ICH patients). Since the risk of hematoma expansion (HE) decreases as time passes, an uncertain onset time in WU-ICH may influence the risk of in-hospital HE and the potential effects of HE-preventive treatments. We aimed to evaluate HE and outcomes in WU-ICH compared to known-onset ICH.MethodsWe included ICH patients admitted to the Karolinska University Hospital from 2016 to 2022, comparing WU-ICH vs. known-onset ICH regarding baseline characteristics, HE, and outcomes.ResultsOf 763 patients, 147 (19%) had WU-ICH and 616 (81%) had known onset, median (IQR) last-known-well to hospital time 9.6 h (5.9–12.2 h) vs. 1.3 h (0.9–2.0 h). WU-ICH patients more often had dementia (15% vs. 5%, p < 0.001), oral anticoagulants (26% vs. 16%, p = 0.005), and pre-stroke modified Rankin Scale 3–5 (24% vs. 15%, p = 0.01). Baseline ICH volume was 14 mL (6–35 mL) vs. 13 mL (5–34 mL). Among patients who underwent CT angiography at admission, 15% of WU-ICH vs. 27% of known-onset ICH had spot signs (p = 0.002). Of patients with CT follow-up <72 h, HE occurred in 24/77 (31.2%) in WU-ICH, and 123/356 (34.6%) in known-onset ICH, p = 0.57. Wake-up onset was not associated with HE in multivariable analysis, adjusted OR = 0.79 (95% CI 0.43–1.42). Analysis of the 3-month modified Rankin Scale showed no differences (median 4 vs. 4), unadjusted p = 0.35 and adjusted p = 0.78.ConclusionWU-ICH had a similar risk of HE and similar 3-month outcomes as known-onset ICH. Excluding WU-ICH from future trials targeting HE may be unwarranted. |
| format | Article |
| id | doaj-art-8342b23c1d814a5aa910bcaf5e78ce98 |
| institution | DOAJ |
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| language | English |
| publishDate | 2025-07-01 |
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| series | Frontiers in Neurology |
| spelling | doaj-art-8342b23c1d814a5aa910bcaf5e78ce982025-08-20T02:48:17ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-07-011610.3389/fneur.2025.16201701620170Wake-up intracerebral hemorrhage: hematoma expansion and outcomesTove Almqvist0Tove Almqvist1Anna Falk Delgado2Anna Falk Delgado3Christina Sjöstrand4Christina Sjöstrand5Michael V. Mazya6Michael V. Mazya7Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, SwedenDepartment of Neurology, Karolinska University Hospital, Stockholm, SwedenDepartment of Clinical Neuroscience, Karolinska Institutet, Stockholm, SwedenDepartment of Neuroradiology, Karolinska University Hospital, Stockholm, SwedenDepartment of Clinical Neuroscience, Karolinska Institutet, Stockholm, SwedenDepartment of Neurology, Danderyd Hospital, Stockholm, SwedenDepartment of Clinical Neuroscience, Karolinska Institutet, Stockholm, SwedenDepartment of Neurology, Karolinska University Hospital, Stockholm, SwedenIntroductionWhile understudied, wake-up intracerebral hemorrhage (WU-ICH) is not uncommon (8.8–20.3% of ICH patients). Since the risk of hematoma expansion (HE) decreases as time passes, an uncertain onset time in WU-ICH may influence the risk of in-hospital HE and the potential effects of HE-preventive treatments. We aimed to evaluate HE and outcomes in WU-ICH compared to known-onset ICH.MethodsWe included ICH patients admitted to the Karolinska University Hospital from 2016 to 2022, comparing WU-ICH vs. known-onset ICH regarding baseline characteristics, HE, and outcomes.ResultsOf 763 patients, 147 (19%) had WU-ICH and 616 (81%) had known onset, median (IQR) last-known-well to hospital time 9.6 h (5.9–12.2 h) vs. 1.3 h (0.9–2.0 h). WU-ICH patients more often had dementia (15% vs. 5%, p < 0.001), oral anticoagulants (26% vs. 16%, p = 0.005), and pre-stroke modified Rankin Scale 3–5 (24% vs. 15%, p = 0.01). Baseline ICH volume was 14 mL (6–35 mL) vs. 13 mL (5–34 mL). Among patients who underwent CT angiography at admission, 15% of WU-ICH vs. 27% of known-onset ICH had spot signs (p = 0.002). Of patients with CT follow-up <72 h, HE occurred in 24/77 (31.2%) in WU-ICH, and 123/356 (34.6%) in known-onset ICH, p = 0.57. Wake-up onset was not associated with HE in multivariable analysis, adjusted OR = 0.79 (95% CI 0.43–1.42). Analysis of the 3-month modified Rankin Scale showed no differences (median 4 vs. 4), unadjusted p = 0.35 and adjusted p = 0.78.ConclusionWU-ICH had a similar risk of HE and similar 3-month outcomes as known-onset ICH. Excluding WU-ICH from future trials targeting HE may be unwarranted.https://www.frontiersin.org/articles/10.3389/fneur.2025.1620170/fullintracerebral hemorrhageacute strokecomputed tomographymortalityoutcomes assessment |
| spellingShingle | Tove Almqvist Tove Almqvist Anna Falk Delgado Anna Falk Delgado Christina Sjöstrand Christina Sjöstrand Michael V. Mazya Michael V. Mazya Wake-up intracerebral hemorrhage: hematoma expansion and outcomes Frontiers in Neurology intracerebral hemorrhage acute stroke computed tomography mortality outcomes assessment |
| title | Wake-up intracerebral hemorrhage: hematoma expansion and outcomes |
| title_full | Wake-up intracerebral hemorrhage: hematoma expansion and outcomes |
| title_fullStr | Wake-up intracerebral hemorrhage: hematoma expansion and outcomes |
| title_full_unstemmed | Wake-up intracerebral hemorrhage: hematoma expansion and outcomes |
| title_short | Wake-up intracerebral hemorrhage: hematoma expansion and outcomes |
| title_sort | wake up intracerebral hemorrhage hematoma expansion and outcomes |
| topic | intracerebral hemorrhage acute stroke computed tomography mortality outcomes assessment |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1620170/full |
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