title: The etiologic subtype of intracerebral hemorrhage may influence the risk of significant hematoma expansion.
abstract: BACKGROUND
  Intracerebral hemorrhage (ICH) growth is an important independent predictor of clinical deterioration and outcome. Little is known about the association between etiology of ICH and occurrence of hematoma expansion (HE). The aim of the present study was to assess whether ICH etiologic subtype may influence the risk of significant HE.
  
  
  METHODS
  We conducted an analysis on retrospectively collected data of 424 consecutive patients with ICH, who were admitted to the Verona General Hospital, from March 2011 to December 2014. Using the SMASH-U (Structural vascular lesions, Medication, Amyloid angiopathy, Systemic disease, Hypertension, or Undetermined) classification, we identified the ICH etiologic subtypes. Outcome measure was significant HE (an absolute increase in ICH volume>12.5 mL or >50%) within 48 h.
  
  
  RESULTS
  Significant HE occurred in 11/57 (19.3%) Amyloid, 7/14 (50%) Structural, 31/57 (54.4%) Medication, 25/44 (56.8%) in Systemic, 62/139 (44.6%) Hypertensive, and 21/68 (30.9%) Undetermined ICH. Baseline ICH volume (OR 1.011 per mL, 95% CI 1.006-1.017, p<0.001) and onset-to-baseline CT time (OR 0.919 per hour, 95% CI 0.852-0.990, p=0.027) were predictors of significant HE. Compared with Amyloid ICH, ORs for significant HE were higher in patients with Structural ICH (OR 1.430, 95% CI 1.060-1.948, p=0.023), Medication ICH (OR 4.344, 95% CI 1.382-13.653, p=0.012), Systemic ICH (OR 1.796, 95% CI 1.070-3.015, p=0.027), and Hypertensive ICH (OR 3.081, 95% CI 1.426-6.655, p=0.004).
  
  
  CONCLUSIONS
  Our study shows that Structural, Medication, Systemic, and Hypertensive ICH were the etiologic subtypes associated with a higher risk of significant HE, compared with Amyloid ICH patients.
authors.affiliation: Stroke Unit, Division of Neurology, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Italy. Electronic address: manuel_cappellari@libero.it.
authors.forename: Manuel
authors.initials: M
authors.lastname: Cappellari
authors.affiliation: Stroke Unit, Division of Neurology, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Zivelonghi
authors.affiliation: Stroke Unit, Division of Neurology, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Moretto
authors.affiliation: Stroke Unit, Division of Neurology, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Micheletti
authors.affiliation: Stroke Unit, Division of Neurology, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Carletti
authors.affiliation: Stroke Unit, Division of Neurology, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Tomelleri
authors.affiliation: Stroke Unit, Division of Neurology, Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bovi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016657:Cerebral Amyloid Angiopathy / Q000209:etiology; D002543:Cerebral Hemorrhage / Q000150:complications*; D005260:Female; D006406:Hematoma / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015898:Tomography Scanners, X-Ray Computed
keywords: Etiology; Expansion; Growth; Hematoma; Intracerebral hemorrhage; SMASH-U