Surgery for patients with severe supratentorial intracerebral hemorrhage

Introduction  Little information is available on the efficacy of aggressive treatment such as surgery in improving the outcome of severely affected patients after supratentorial intracerebral hemorrhage (ICH). Our objective was to assess the effect of hematoma removal and ventricular drainage on the mortality of patients with severe primary supratentorial ICH. Methods  We studied 103 consecutive patients who were admitted to the intensive care unit and diagnosed with primary supratentorial ICH. The impacts of clinical factors on 30-day mortality were assessed, including surgery, Glasgow Coma Scale (GCS) score and pupillary abnormality at admission, hematoma volume, and other related factors. Results  The 30-day mortality rate was 42%, and the median time between admission and death was 3 days (range: 1 to 27 days). Hematoma removal and ventricular drainage, within the first 24 hours of admission, were performed on 11 and 17 patients, respectively. Two patients who were treated with removal and four with drainage died. A logistic regression model for predicting 30-day mortality was performed. After controlling for GCS score, pupillary abnormality, hydrocephalus, and hematoma volume, hematoma removal was identified as an independent predictor of survival (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.02 to 0.92). Ventricular drainage also tended to decrease mortality rate greatly (OR, 0.31; 95% CI, 0.06 to 1.76). Patients with GCS scores of 3 or 4 were 4.01 times more likely to die (95% CI, 1.13 to 14.26) than those with GCS of at least 5. Conclusions  Hematoma removal may reduce the mortality rate of patients with severe supratentorial ICH.     

Artificial neural networks improve the prediction of mortality in intracerebral hemorrhage.

BACKGROUND: Artificial neural network (ANN) analysis methods have led to more sensitive diagnosis of myocardial infarction and improved prediction of mortality in breast cancer, prostate cancer, and trauma patients. Prognostic studies have identified early clinical and radiographic predictors of mortality after intracerebral hemorrhage (ICH). To date, published models have not achieved the accuracy necessary for use in making decisions to limit medical interventions. We recently reported a logistic regression model that correctly classified 79% of patients who died and 90% of patients who survived. In an attempt to improve prediction of mortality we computed an ANN model with the same data. OBJECTIVE: To determine whether an ANN analysis would provide a more accurate prediction of mortality after ICH when compared with multiple logistic regression models computed using the same data. METHODS: Analyses were conducted on data collected prospectively on 81 patients with supratentorial ICH. Multiple logistic regression was used to predict hospital mortality, then an ANN analysis was applied to the same data set. Input variables were age, gender, race, hydrocephalus, mean arterial pressure, pulse pressure, Glasgow Coma Scale score, intraventricular hemorrhage, hydrocephalus, hematoma size, hematoma location (ganglionic, thalamic, or lobar), cisternal effacement, pineal shift, history of hypertension, history of diabetes, and age. RESULTS: The ANN model correctly classified all patients (100%) as alive or dead compared with 85% correct classification for the logistic regression model. A second ANN verification model was equally accurate. The ANN was superior to the logistic regression model on all objective measures of fit. CONCLUSIONS: ANN analysis more effectively uses information for prediction of mortality in this sample of patients with ICH. A well-validated ANN may have a role in the clinical management of ICH.     

Incidence and prognostic significance of fever following intracerebral hemorrhage

OBJECTIVE: To investigate the incidence and prognostic significance of fever on presentation and during the subsequent 72 hours in patients with spontaneous supratentorial intracerebral hemorrhage (ICH). METHODS: We analyzed 251 patients. On admission, body temperature, Glasgow Coma Scale (GCS) score, age, sex, blood pressure, blood glucose level, and presumed origin of hemorrhage were analyzed. From the initial CT scan, hematoma volume, location, and presence of intraventricular hemorrhage were determined. From the first 72 hours, hematoma enlargement, duration of increased temperatures, blood pressure, and blood glucose level were determined. Outcome was classified on discharge with the Glasgow Outcome Scale (GOS) score. RESULTS: Outcomes included no symptoms in 23 (9%), moderate disability in 64 (26%), severe disability in 104 (41%), vegetative state in 5 (2%), and death in 55 (22%) patients. Prognostic factors retained from a logistic regression model with a dichotomized GOS scale (GOS score of 1 or 2 versus GOS score of 3 to 5) as response variables were GCS score of 7 or less, age older than 75 years, hematoma volume of more than 60 cm3, ventricular hemorrhage, and presence of a coagulation disorder (p < 0.05). Fever was associated with intraventricular hemorrhage. From 196 patients, data from the first 72 hours were analyzed. A total of 18 patients (9%) had normal temperatures throughout the study. The duration of fever (> or =37.5 degrees C) was less than 24 hours in 66 (34%), 24 to 48 hours in 70 (36%), and more than 48 hours in 42 patients (21%). Independent prognostic factors during the first 72 hours were duration of fever, secondary hemorrhage, GCS score of 7 or less, ventricular hemorrhage, hematoma volume of more than 60 cm3, duration of increased blood pressure of more than 48 hours, and duration of increased blood glucose of more than 48 hours. CONCLUSIONS: The incidence of fever after supratentorial ICH is high, especially in patients with ventricular hemorrhage. In patients surviving the first 72 hours after hospital admission, the duration of fever is associated with poor outcome and seems to be an independent prognostic factor in these patients.     

Risk factors for acute symptomatic cerebral infarctions after spontaneous supratentorial intra-cerebral hemorrhage

Cerebral infarctions are unfavorable outcomes of spontaneous intra-cerebral hemorrhage (ICH). To date, there have been no reports on risk factors that are predictive of acute symptomatic cerebral infarctions. With the aim of determining the potential risk factors that are predictive of acute symptomatic cerebral infarctions in patients with spontaneous supratentorial ICH, we have retrospectively evaluated 212 hospitalized patients with spontaneous ICH and compared those who developed a complicated cerebral infarction with those who did not. Cerebral infarctions developed in 8.02% (17/212) of the patient cohort. Neuro-imaging findings between the two patient groups revealed that the presence of intra-ventricular hemorrhage (IVH), hydrocephalus, and the median value of intra-cranial hematoma on admission were significant factors, as well as neurosurgical intervention. However, the multiple logistic regression analysis revealed that only the presence of IVH had an odds ratio of 4.7 (95% confidence interval 0.06–0.75; p = 0.016) in patients with acute symptomatic infarctions. The results indicate that the presence of IVH may imply a danger of cerebrovascular complications when treating spontaneous supratentorial ICH during hospitalization. The frequency of acute symptomatic cerebral infarctions in patients with spontaneous supratentorial ICH is high (8%) and is associated with longer hospitalization and worse outcome.     

A priority treatment of the intraventricular hemorrhage (IVH) should be performed in the patients suffering intracerebral hemorrhage with large IVH

Background

In patients suffering from intracerebral hemorrhage (ICH) with ventricular hemorrhage (IVH), the IVH severity is thought to be associated with prognosis. Therefore, treating IVH may be a beneficial therapeutic target. In this study, by examining the associations among IVH severity, hydrocephalus, initial level of consciousness and prognosis, we attempted to identify which grade of IVH severity should be considered for surgical treatment.

Methods

One hundred twenty-nine patients with spontaneous supratentorial ICH treated in our hospital between 2005 and 2006 were screened in this study. Of these patients, 100 with an ICH volume less than 60 ml were categorized into either the ICH patients without IVH (no-IVH) group (n = 65) or the ICH patients with IVH (IVH) group (n = 35). The Karnofsky Performance Status (KPS) scale assessed at the time of discharge was employed as an outcome index, and a KPS score of ≤40 was defined as the bedridden state. Age, gender, hemorrhage location, volume of ICH, IVH grade (according to the Graeb score), acute hydrocephalus, surgical ICH removal, and ventricular drainage were selected for univariate analyses with logistic regression.

Results

Elderly patients, IVH volume, acute hydrocephalus, and poor initial level of consciousness were significantly associated with an unfavorable prognosis in the IVH group. Poor level of consciousness was significantly dependent on acute hydrocephalus, and significantly more occurrences of acute hydrocephalus were found in patients with a high IVH volume (Graeb score ≥6) than in patients with low to moderate IVH volume (Graeb score ≤6).

Conclusions

IVH severity influenced the occurrence of acute hydrocephalus and initial level of consciousness, which was significantly associated with prognosis. Our results suggest that priority treatment of the IVH should be given to those ICH patients with IVH admitted with a Graeb score of 6 or more.     

Clinical discriminators of lobar and deep hemorrhages: the Stroke Data Bank.

Of the 1,805 patients with acute stroke enrolled in the Stroke Data Bank, 237 had parenchymatous hemorrhage. After excluding 34 secondary intracerebral and 31 infratentorial hemorrhage patients, a logistic regression analysis of the 172 patients with primary supratentorial intracerebral hemorrhage (ICH) elucidated clinical factors that distinguished the 65 patients with lobar hemorrhage (LH) from the 107 patients with deep hemorrhage (DH) located in the basal ganglia and thalamus. In LH, severe headache was more common than in DH, while hypertension and motor deficit were significantly less common. Patients with either LH or DH had a similar prognosis and mean Glasgow Coma Scale (GCS) scores, despite the hematoma volume measured on the initial CT being significantly greater for LH than DH. The presence of intraventricular extension (IVH) was more frequent in DH. The frequency of IVH increased with hematoma volume in LH, but remained constant for DH. Two CT variables (IVH and hematoma volume) that differed in these two hemorrhage groups were important predictors of coma (GCS less than or equal to 8) in a logistic regression model. Differences in the frequency of IVH may help explain why the degree of impairment in consciousness was similar in the two groups. Among patients with supratentorial ICH, location of the hematoma is related to both volume and IVH, which are important determinants of the level of consciousness.     

Predictors of tracheostomy in patients with spontaneous intracerebral hemorrhage

Background

One third of patients with intracerebral hemorrhage (ICH) require mechanical ventilation; in most, tracheostomy may be necessary. Limited data exist about predictors of tracheostomy in ICH. The aim of our study is to identify predictors of tracheostomy in ICH.

Methods

We reviewed medical records of patients seen in our institution between 2005 and 2009, using ICD-9 codes for ICH, for admission clinical and radiological parameters. A stepwise logistic regression model was used to identify tracheostomy predictors.

Results

Ninety patients with ICH were included in the analysis, eleven of which required tracheostomy. Patients requiring a tracheostomy were more likely to have a large hematoma volume (≥30 mL) (63.4% vs. 29.1%, p = 0.037), intraventricular hemorrhage (81.8% vs. 27.8%, p < 0.0001), hydrocephalus (81.8% vs. 8.8%, p < 0.0001), admission GCS < 8 (81.8% vs. 5.1%, p < 0.0001), intubation ≥ 14 days (54.5% vs. 1.27%, p < 0.0001) and pneumonia (63.6% vs. 17.7%, p = 0.003). Stepwise logistic regression yielded admission GCS (OR = 80.55, p = 0.0003) and intubation days (OR = 87.49, p < 0.006) as most important predictors.

Conclusion

We could potentially predict the need for tracheostomy early in the course of ICH based on the admission GCS score; duration of intubation is another predictor for tracheostomy. Early tracheostomy could decrease the time, and therefore risks of prolonged endotracheal intubation and length of hospital stay.     

Lumbar drainage for communicating hydrocephalus after ICH with ventricular hemorrhage

Introduction  

Our objective was to investigate the feasibility of lumbar drainage (LD) as a new therapeutic approach for the treatment of communicating hydrocephalus in patients with supratentorial intracerebral hemorrhage (ICH) and ventricular extension (IVH) who initially required an external ventricular drain (EVD).     

Stereotactic computed tomographic-guided aspiration and thrombolysis of intracerebral hematoma : protocol and preliminary experience

BACKGROUND AND PURPOSE: We review preliminary experience with patients harboring intracerebral hematoma (ICH) treated by stereotactic computed tomographic (CT) guided thrombolysis and aspiration and assess procedure feasibility and safety. METHODS: Twelve patients with supratentorial ICH >/=25 mL without suspected underlying structural etiology or coagulopathy and an initial Glasgow Coma Scale (GCS) score of >/=5 were treated. A catheter was directed stereotactically or manually into the ICH through a burr hole under CT guidance. Hematoma aspiration was followed by instillation of urokinase (5 000 to 10 000 IU). This was repeated every 6 to 8 hours at bedside, with interval CT imaging, until the ICH volume diminished to <25 mL, less than half of its initial volume, or after a maximum of 10 aspirations/instillations. RESULTS: Mean age was 69 years (range 55 to 82 years). Median initial GCS was 12 (range 5 to 14). There were 7 ganglionic and 5 lobar ICH, and baseline hematoma size ranged 29 to 70 mL (mean 46 mL). Final ICH volume ranged from 14 to 51 mL (mean 21 mL), with ICH volume reduction by an average of 57% (range 38% to 70%). One patient (8. 3%) suffered hematoma expansion during the procedure. At 6 months after the procedure, 3 patients (25%) had achieved a good recovery (Glasgow Outcome Scale [GOS] score of 5), 5 patients (42%) were dependent (GOS 3), and 1 (8.3%) remained vegetative (GOS 2). Three patients (25%) died in hospital (1 from cardiac arrhythmia and 2 from respiratory failure). CONCLUSIONS: CT-guided thrombolysis and aspiration appears safe and effective in the reduction of ICH volume. Further studies are needed to assess optimal thrombolytic dosage and must include controlled comparisons of mortality, disability outcome, time until convalescence, and cost of care in treated and untreated patients.     

Silent microbleeds are associated with volume of primary intracerebral hemorrhage

The authors performed a correlative radiologic study on the micro-bleeds and volume of intracerebral hemorrhage in the supratentorial ICH patients. In the patients with lobar or putaminal hemorrhage, the hemorrhage volumes increased more than twofold or threefold in the patients with micro-bleeds. Moreover, the presence of microbleeds was an independent risk factor for large-sized hemorrhage. These data show that microbleeds may be associated with a larger ICH volume.     

幕上高血压性脑出血微创颅内血肿抽吸引流术1年预后相关因素分析

目的 探讨幕上高血压性脑出血（intracerebral h emorrhage,ICH）微创颅内血肿抽吸引流术1年预后及其相关因素。      

CAS-R-2无框架与Leksell框架立体定向仪辅助钻孔引流术治疗高血压性脑出血的对比分析

目的比较CAS-R-2无框架脑立体定向仪与Leksell框架立体定向仪辅助钻孔引流术治疗高血压性脑出血(血肿量20~40 mL)患者的简易性、疗效、安全性、社会经济负担和预后的不同。方法选择聊城市人民医院脑科医院神经外科自2012年12月至2019年12月收治的120例幕上高血压性脑出血患者,其中应用CAS-R-2无框架脑立体定向仪辅助钻孔引流术治疗65例(无框架组),应用Leksell框架立体定向仪辅助钻孔引流术治疗55例(有框架组)。回顾性分析患者的临床资料,比较2组患者的手术时间、术后7 d的血肿排空率、住院期间再出血和颅内感染发生率、住院时间和住院费用、术后6个月改良Rankin量表(mRS)评分的差异。结果无框架组患者的手术时间[(0.5±0.1)h vs.(2.2±0.5)h]、住院期间再出血率(0.0%vs.9.1%)和颅内感染发生率(1.5%vs.9.1%)均低于有框架组,差异有统计学意义(P<0.05)。有框架组患者的住院费用低于无框架组,差异有统计学意义(P<0.05)。2组患者术后7 d的血肿排空率、住院时间、治疗后6个月死亡率及mRS评分的差异均无统计学意义(P>0.05)。结论CAS-R-2无框架脑立体定向仪与Leksell框架立体定向仪辅助钻孔引流术治疗高血压性脑出血的疗效和预后相同,但前者操作简易性和安全性高,后者的费用低。     

幕上自发性脑出血患者痫性发作的发生率及其相关因素分析——来自中国国家卒中登记数据库

【摘要】 目的 评价幕上自发性脑出血患者伴发痫性症状的发生率以及其相关危险因素。 方法 本研究为前瞻性队列研究,纳入2007年9月～2008年8月中国国家卒中登记数据库的2862例既 往无癫痫病史的发病14 d内住院的幕上自发性脑出血患者。住院时记录患者发病时或住院期间是否 合并痫性发作症状,根据是否合并痫性发作分为合并痫性发作组和未合并痫性发作组,比较两组 患者的基本特征。采用多因素回归模型评价患者的人口学特征、既往史、入院时格拉斯哥昏迷量表 （Glasgow Coma Scale,GCS）评分、幕上脑出血累及部位和体积、住院合并症与痫性发作的相关性。 结果 2862例幕上自发性脑出血患者,年龄中位数62.0岁（四分位间距53.0～72.0）,1115例（39.0%）为 女性,1921例（67.1%）既往有高血压病史。133例（4.6%）患者合并痫性发作。与未合并痫性发作患者相 比,合并痫性发作患者GCS平均评分低（9.5 vs 12.5,P =0.006）,合并脑积水（5.3% vs 1.5%,P =0.050） 和肺炎（30.1% vs 17.0%,P＜0.001）的比例高。在多因素回归分析中,下列因素与幕上自发性脑出血 患者伴发痫性发作独立相关：入院时GCS评分每降低2分［比值比（odds ratio,OR）1.32,95%可信区间 （confidence interval,CI）1.21～1.45］、血肿累及皮层（OR 5.82,95%CI 3.88～8.72）、合并脑积水（OR 2.73, 95%CI 1.14～6.56）和合并肺炎（OR 1.65,95%CI 1.09～2.52）。 结论 痫性发作是幕上自发性脑出血患者较为常见的神经系统并发症。昏迷程度、血肿累及皮层, 以及合并脑积水和肺炎是并发痫性发作症状的危险因素。     

The prognostic value of the CT scan in conservatively treated patients with intracerebral hematoma

Prognostic factors for survival and neurological recovery were assessed in 42 patients with nontraumatic intracerebral hematoma (ICH) diagnosed by CT scan. None underwent surgical evacuation of hematoma. CT scans were used to determine location and volume of ICH and presence or absence of intraventricular hemorrhage (IVH). Only 11 patients (26%) died and 17 patients (40.5%) recovered fully. Mortality was associated with: 1) loss of consciousness as a presenting symptom (63.5% mortality rate versus 13% when there was no loss of consciousness at the onset; p less than 0.01). 2) extension of the bleeding into the ventricular system (45% mortality rate versus 9% when hemorrhages were confined to brain parenchyma; p less than 0.01). 3) location of hematoma in the posterior fossa (mortality rate of 43% versus 23% for intrahemispheric hematomas). Mortality was unaffected by age of patients and size of ICH. Full neurological and functional recovery occurred mainly when estimated volume of hematomas was less than 15 cc and with lobar hematomas regardless of size. In survivors there is CT evidence of complete resolution of ICH. Our data indicates a favourable outcome in a relatively large percentage of patients with ICH treated conservatively and therefore questions the need for surgical evacuation of hematoma.     

Mannitol in intracerebral hemorrhage: a randomized controlled study

OBJECTIVE: To study the usefulness of mannitol in spontaneous intracerebral hemorrhage (ICH) patients. METHOD: 128 CT proven supratentorial ICH patients within 6 days of ictus were randomized into study and control groups. The study group received mannitol 20%, 100 ml every 4 h for 5 days, tapered in the next 2 days. The control group received sham infusion. Primary endpoint was 1-month mortality and secondary endpoint functional disability at 3 months assessed by Barthel index score. RESULTS: There were 65 patients in study and 63 in control groups. The study and control groups were evenly matched regarding age, Glasgow coma scale (GCS) score, Canadian Neurological Scale (CNS) score, pupillary asymmetry, pyramidal signs on non-hemiplegic side, and location, midline shift and ventricular extension of hematoma. At 1 month, 16 patients died in each group. The primary and secondary endpoints were not significantly different between the two groups. CONCLUSION: Low dose mannitol does not seem to be beneficial in patients with ICH.     

原发性幕上脑出血患者的CT特征与预后的关系

目的研究首次原发性幕上脑出血CT特征与预后的关系。方法前瞻性登记首次原发性幕上脑出血患者的临床资料及CT特征,并随访6个月。对CT特征等预后因素与预后依次进行单因素和多因素Logistic回归分析。结果(1)血肿体积是脑出血患者1个月、3个月、6个月末死亡的CT预测因素;(2)血肿体积和继发性脑室出血是脑出血患者6个月末死亡／残疾的CT预测因素。结论(1)血肿体积可用于预测脑出血的死亡风险;(2)血肿体积和继发性脑室出血可用于预测脑出血死亡／残疾的风险。     

Neurosurgical management of spontaneous cerebral hemorrhage

Intracerebral hemorrhage (ICH) accounts for 10 to 20% of strokes, but carries the highest rate of morbidity and mortality. Until now, there is no proven benefit in the literature for surgical treatment of ICH, and management of ICH varies greatly in neurosurgical centers. Surgery can be performed through standard craniotomy, or with a stereotactic procedure for deep-seated ICH. Conscious patients with minimal neurological deficit and small ICH are nonsurgical candidates. Patients with a Glasgow Coma Score lower than 4, with large deep-seated ICH are also non surgical candidates. In other situations, the following arguments could lead to the decision of surgery: superficial (so-called lobar) ICH, size above 3 cm in diameter, midline shift, secondary neurological worsening, young patient, underlying vascular malformation. Acute hydrocephalus from ventricular hemorrhage may be treated with external ventricular drainage if the associated deep-seated ICH is small in size. Indications of surgery are more frequent for cerebellar ICH, as the risks for brainstem compression and hydrocephalus from ventricular obstruction are important.     

Previous antiplatelet therapy is an independent predictor of 30–day mortality after spontaneous supratentorial intracerebral hemorrhage

Background Intracerebral hemorrhage (ICH) constitutes 10% to 15% of all strokes. Despite several existing outcome prediction models for ICH, there are some factors with equivocal value as well as others that still have not been evaluated. Patients and methods All patients with first ever supratentorial ICH presenting to our institution between December 1995 and December 2002 were prospectively enrolled into the study. Patients with historic modified Rankin Scale > 2 and those under anticoagulant treatment or with multiple ICH were excluded. The following parameters were analyzed in 194 consecutive patients: age, gender, past history of hypertension, diabetes mellitus, hypercholesterolemia, past history of ischemic stroke, presence of ischemic heart disease or cardioembolic disease, current antiplatelet treatment, current alcohol overuse, smoking, Glasgow Coma Scale score (GSS) at admission, volume and location (deep or lobar) of ICH, ventricular extension, glycemia and temperature at admission, and leukoaraiosis. We correlated these data with the 30–day mortality identifying the independent predictors by logistic regression analysis. Results Factors independently associated with 30–day mortality were: age, Glasgow Coma Scale score at admission, ICH volume, ventricular extension, glucose level at admission, and previous antiplatelet use. Conclusions Apart from the classical outcome predictors, the previous use of antiplatelet agents and the glucose value at admission are independent predictors of 30–day mortality in patients suffering a supratentorial ICH.     

Early neurological change in patients with spontaneous supratentorial intracerebral hemorrhage

The frequency and causes of neurological change that occurs in patients within 24 hours after the onset of intracerebral hemorrhage (ICH), as well as their relationship to outcome, have seldom been reported. This study evaluated 184 patients with supratentorial ICH and neurological deterioration or improvement; measuring their level of consciousness (LOC) and motor skills the day after admission using the National Institutes of Health Stroke Scale. Nineteen patients (10%) deteriorated and 114 (62%) improved. Patient age, hematoma volume, and change in hematoma volume were independent predictors of early neurological improvement (p < 0.05). Independent predictors of 1-month functional outcome were age, LOC score at admission, motor score at admission, and change in motor score the day after admission (p < 0.05). Approximately 70% of the patients showed early neurological change. Observing early changes in hemiparesis was important for predicting functional outcome.     

Radiopacity of intracerebral hemorrhage correlates with perihemorrhagic edema

Background: Experimental evidence indicates that iron plays a key role in edema formation after intracerebral hemorrhage (ICH). We investigated the relationship between ICH radiopacity on CT as a marker of hematoma iron content and perihemorrhagic edema (PHE) after ICH. Methods: We retrospectively investigated patients with spontaneous lobar and ganglionic supratentorial ICH who received follow‐up CT scans during the first 7 days after symptom onset (d1, d2–4, d5–7). Measurements of ICH and edema volumes were taken using a semiautomatic threshold‐based volumetric algorithm. Radiopacity of the blood clot was determined using the mean Hounsfield unit (HU) count of the ICH. Results: A total of 117 patients aged 71.92 ± 11.55 years with spontaneous ICH (34.63 ± 32.44 ml) were included in the analysis. Mean ICH radiopacity was 59.7 ± 3.4 HU. We found significantly larger relative PHE at d2–4 (1.7 ± 0.9 vs. 1.3 ± 0.8; P = 0.032) and d5–7 (2.0 ± 1.3 vs. 1.3 ± 0.9; P = 0.007) and larger peak relative PHE (2.3 ± 1.6 vs. 1.6 ± 1.1; P = 0.006) in patients with ICH radiopacity >60 HU (n = 59), as compared to patients with ICH radiopacity <60 HU (n = 58). Conclusions: Higher ICH radiopacity, reflecting higher in vivo hematoma iron content, is associated with more PHE after ICH.