Primary cerebral amyloidoma

Objective: To characterize the rates of recurrent intracranial hemorrhage (ICH), ischemic stroke, and death in survivors of primary ICH. Methods: Systematic review of studies reporting recurrent stroke in survivors of primary ICH, identified at index ICH and followed forward. Studies were identified by computerized search of the literature and review of reference lists. Results: Ten studies published between 1982 and 2000 reporting 1,880 survivors of ICH, followed for a total of 6,326 patient-years (mean follow-up, 3.4 patient-years), were included. The aggregate rate of all stroke from five studies was 4.3% per patient-year (95% CI, 3.5% to 5.4%). The rate in the three population-based studies was higher than in the two hospital-based studies, 6.2% versus 4.0% per patient-year (p 0.04). About three fourths of recurrent strokes were ICH. Considering all 10 studies, a total of 147 patients had a recurrent ICH, an aggregate rate of 2.3% per patient-year (95% CI, 1.9% to 2.7%). Based on data from four studies, patients with a primary lobar ICH had a higher rate of recurrent ICH than those with a deep, hemispheric ICH (4.4% versus 2.1% per patientyear; p 0.002). The aggregate rates of subsequent ischemic stroke and mortality were 1.1% per patient-year (95% CI, 0.8% to 1.7%) and 8.8% per patient-year (95% CI, 5.2% to 11.0%). Conclusions: Recurrent stroke among survivors of primary ICH occurs at a rate of about 4% per patient-year, and most are recurrent ICH. Survivors of ICH have a higher risk of recurrent ICH than of ischemic stroke, and this has implications for the use of antithrombotic agents in these patients. NEUROLOGY 2001;56:773-777 Intracranial hemorrhage (ICH) accounts for 10% to 15% of all strokes and carries substantial associated mortality and often permanent disability for those affected. 1 For the estimated 50,000 Americans who survive ICH each year, the risk of recurrent stroke and death are unclear. We undertook a systematic review of this issue, seeking to characterize the occurrence of recurrent ICH, ischemic stroke and death among survivors of primary ICH, as well as to identify predictors of recurrent stroke. We hypothesized a priori that recurrence of ICH would be infrequent and that subsequent stroke more often would be ischemic than hemorrhagic.