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Imaging and Clinical Prognostic Features in Lobar Versus Deep Intracerebral Hemorrhage in an Unselected Swedish Population

Hillal, Amir LU orcid ; Apostolaki‐Hansson, Trine LU orcid ; Ramgren, Birgitta LU ; Norrving, Bo LU ; Hansen, Björn LU orcid ; Wassélius, Johan LU and Ullberg, Teresa LU (2025) In European Journal of Neurology 32(8). p.1-10
Abstract
Background
Hematoma location may influence hematoma volume and risk of expansion, the strongest prognostic predictors in patients with intracerebral hemorrhage (ICH). This study aims to determine differences in imaging and clinical factors affecting survival in patients with lobar vs. deep ICH.

Method
Patients with spontaneous supratentorial ICH residing in Skåne county registered in the Swedish Stroke Register 2016–2020 were included. Baseline non-contrast CT scans were evaluated for hematoma location and volume, subarachnoid or intraventricular extension, hydrocephalus, and midline shift. Multivariable Cox- and logistic regression analyses were used to determine imaging and clinical factors associated with increased... (More)
Background
Hematoma location may influence hematoma volume and risk of expansion, the strongest prognostic predictors in patients with intracerebral hemorrhage (ICH). This study aims to determine differences in imaging and clinical factors affecting survival in patients with lobar vs. deep ICH.

Method
Patients with spontaneous supratentorial ICH residing in Skåne county registered in the Swedish Stroke Register 2016–2020 were included. Baseline non-contrast CT scans were evaluated for hematoma location and volume, subarachnoid or intraventricular extension, hydrocephalus, and midline shift. Multivariable Cox- and logistic regression analyses were used to determine imaging and clinical factors associated with increased 90-day mortality rate and functional dependency (mRS 3–5).

Results
Of 1398 patients, 666 (48%) had lobar, and 732 (52%) had deep ICH. Lobar ICH volumes were larger (median 27 vs. 13 mL, p < 0.001) compared to deep ICH. At 90 days, the unadjusted mortality rate (34% vs. 32%; p = 0.33) and functional dependency (mRS 3–5: 60.4% vs. 62.4%; p = 0.52) were non-significant between deep and lobar ICH patients. In multivariable analysis adjusted for confounders, hematoma volume (≥ 80 mL (HR = 5.90; 95% CI: 3.40–10.23), 30–79 mL (HR = 4.24; 95% CI: 2.81–6.42), and 10–29 mL (HR = 2.21; 95% CI: 1.49–3.27)), deep ICH location (HR = 1.78, 95% CI: 1.39–2.29), hydrocephalus (HR = 1.69, 95% CI: 1.21–2.37), pre-stroke dependency (HR = 1.51, 95% CI: 1.18–1.94), antiplatelets at onset (HR = 1.47, 95% CI: 1.14–1.90), and age (HR =1.03, 95% CI: 1.02–1.04) were significantly associated with an increased 90-day mortality rate.

Conclusion
Despite larger hematoma volumes and older age in lobar ICH patients, lobar hemorrhages were associated with a lower mortality rate compared to deep hemorrhages. Our findings highlight the need to consider lobar and deep ICH separately in therapeutic and prognostic studies. (Less)
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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Neurology
volume
32
issue
8
article number
e70318
pages
1 - 10
publisher
Wiley-Blackwell
external identifiers
  • pmid:40760859
  • scopus:105012611802
ISSN
1351-5101
DOI
10.1111/ene.70318
language
English
LU publication?
yes
id
deff1365-ff82-4a03-8723-91c5975c4693
date added to LUP
2025-09-24 00:57:20
date last changed
2025-10-14 13:13:16
@article{deff1365-ff82-4a03-8723-91c5975c4693,
  abstract     = {{Background<br/>Hematoma location may influence hematoma volume and risk of expansion, the strongest prognostic predictors in patients with intracerebral hemorrhage (ICH). This study aims to determine differences in imaging and clinical factors affecting survival in patients with lobar vs. deep ICH.<br/><br/>Method<br/>Patients with spontaneous supratentorial ICH residing in Skåne county registered in the Swedish Stroke Register 2016–2020 were included. Baseline non-contrast CT scans were evaluated for hematoma location and volume, subarachnoid or intraventricular extension, hydrocephalus, and midline shift. Multivariable Cox- and logistic regression analyses were used to determine imaging and clinical factors associated with increased 90-day mortality rate and functional dependency (mRS 3–5).<br/><br/>Results<br/>Of 1398 patients, 666 (48%) had lobar, and 732 (52%) had deep ICH. Lobar ICH volumes were larger (median 27 vs. 13 mL, p &lt; 0.001) compared to deep ICH. At 90 days, the unadjusted mortality rate (34% vs. 32%; p = 0.33) and functional dependency (mRS 3–5: 60.4% vs. 62.4%; p = 0.52) were non-significant between deep and lobar ICH patients. In multivariable analysis adjusted for confounders, hematoma volume (≥ 80 mL (HR = 5.90; 95% CI: 3.40–10.23), 30–79 mL (HR = 4.24; 95% CI: 2.81–6.42), and 10–29 mL (HR = 2.21; 95% CI: 1.49–3.27)), deep ICH location (HR = 1.78, 95% CI: 1.39–2.29), hydrocephalus (HR = 1.69, 95% CI: 1.21–2.37), pre-stroke dependency (HR = 1.51, 95% CI: 1.18–1.94), antiplatelets at onset (HR = 1.47, 95% CI: 1.14–1.90), and age (HR =1.03, 95% CI: 1.02–1.04) were significantly associated with an increased 90-day mortality rate.<br/><br/>Conclusion<br/>Despite larger hematoma volumes and older age in lobar ICH patients, lobar hemorrhages were associated with a lower mortality rate compared to deep hemorrhages. Our findings highlight the need to consider lobar and deep ICH separately in therapeutic and prognostic studies.}},
  author       = {{Hillal, Amir and Apostolaki‐Hansson, Trine and Ramgren, Birgitta and Norrving, Bo and Hansen, Björn and Wassélius, Johan and Ullberg, Teresa}},
  issn         = {{1351-5101}},
  language     = {{eng}},
  month        = {{08}},
  number       = {{8}},
  pages        = {{1--10}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{European Journal of Neurology}},
  title        = {{Imaging and Clinical Prognostic Features in Lobar Versus Deep Intracerebral Hemorrhage in an Unselected Swedish Population}},
  url          = {{http://dx.doi.org/10.1111/ene.70318}},
  doi          = {{10.1111/ene.70318}},
  volume       = {{32}},
  year         = {{2025}},
}