To examine the relationship between supratentorial ICH location and clinical outcomes

Intracerebral hemorrhage (ICH) has a high rate of morbidity and mortality and is typically classified as "lobar" or "deep." While these terms help describe ICH location, a more detailed examination of the relationship between supratentorial ICH location and clinical outcomes may guide clinician treatment plans and potentially predict survival rates.

In this retrospective, single-center cohort study we identified patients with primary lobar ICH from 2009-2013. ICH due to trauma and structural etiologies were excluded. For patients with multiple ICHs, symptomatic location was determined via chart review.  We compared demographic data, risk factors, ICH location and volume (ABC/2), clinical outcomes, and case-fatality rates and performed Cox regression analyses stratified by lobar location.

We identified 294 ICH patients, of which 94 were frontal (median volume 21.2 mL; IQR 10, 45), 65 temporal (21 mL; 8, 45), 75 parietal (17.2 mL; 7.5, 49), and 60 occipital (17.2 mL; 3.8, 26.3). There were no differences among locations in age (p=0.90), sex (p=0.87), IVH (p=0.22), anticoagulant use (p=0.41), or Charlson (p=0.43). There were significant differences in NIHSS across locations (p<0.0001), with medians from 3 (occipital) to 10 (frontal). Frontal ICH was associated with more SAH (p=0.006); temporal ICH with more seizures (p=0.007). Occipital ICH was associated with better survival rates than frontal, temporal, and parietal ICH over 1 year after adjustment for ICH volume (p=0.039).

We found that occipital ICH was associated with lower 1-year case-fatality rates than ICH in other lobar locations, independent of ICH volume. While occipital ICH may be less likely to cause deficits associated with potentially life-threatening complications, these data suggest it may be important to separate lobar ICH mortality analyses by location to discern other characteristics of these hemorrhages and their relationships to outcomes.