Intracerebral haemorrhage: a need for more data and new research directions

GA Donnan, GJ Hankey, SM Davis - The Lancet Neurology, 2010 - thelancet.com
GA Donnan, GJ Hankey, SM Davis
The Lancet Neurology, 2010thelancet.com
Only about 15% of all strokes are caused by intracerebral haemorrhage (ICH), but this stroke
subtype is the most feared because of its high case-fatality rate and poor functional outcome.
1 Although care in a stroke unit is probably as effective for ICH as for ischaemic stroke, there
are few effective acute interventions to alter the clinical course of ICH. 2 In such situations, it
is useful to consolidate available data into an accessible form, to enable investigators to
assess the information and clarify future research needs. In this issue of The Lancet …
Only about 15% of all strokes are caused by intracerebral haemorrhage (ICH), but this stroke subtype is the most feared because of its high case-fatality rate and poor functional outcome. 1 Although care in a stroke unit is probably as effective for ICH as for ischaemic stroke, there are few effective acute interventions to alter the clinical course of ICH. 2 In such situations, it is useful to consolidate available data into an accessible form, to enable investigators to assess the information and clarify future research needs. In this issue of The Lancet Neurology, van Asch and colleagues3 have produced a timely meta-analysis of the incidence, case fatality, and functional outcome of ICH.
The authors included population-based studies from 1980 to 2008 and assessed data from 36 eligible studies to show that the overall incidence of ICH was about 24 cases per 100 000 person-years, a proportion that increased dramatically with age. Incidence was also higher in men than in women, particularly in Japan. The incidence of ICH in Asia was about twice as high as elsewhere, with about 52 cases per 100 000 person-years. Perhaps surprisingly, there was no significant decrease in incidence of ICH over recent decades, which contrasts with the reductions seen in cases of ischaemic stroke in developed countries. 4, 5 The case fatality was high, with an overall median of 42% at 1 month in countries with available data excluding Japan, where case fatality was much lower (about 17%). These differences emphasise the importance of research into effective acute interventions for ICH, a
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