To characterize predictors of outcome in patients with concurrently-diagnosed ischemic and hemorrhagic stroke.

Concurrently-diagnosed ischemic and hemorrhagic stroke represents a potentially devastating neurological condition with high morbidity and mortality.  Although such a clinical presentation is reportedly rare, it raises a clinical dilemma regarding management and subsequent use of antithrombotic agents. Additionally, there is limited evidence on factors associated with poor outcome. We aimed to explore potential contributors to acute management and outcomes for these patients.

We conducted a retrospective analysis of data from two comprehensive stroke centers, between June 2018 and August 2021. We identified patients by using RedCap ICH database and primary stroke ICD-10 codes of I61.XX, I62.XX, and I63XX.  We included patients with evidence of hemorrhagic and ischemic stroke on MRI. Patients with spontaneous or induced hemorrhagic transformation of ischemic strokes without primary intracerebral hemorrhage were excluded.  Good outcomes were defined as mRS < 3, whilst poor outcomes were mRS ≥ 3.

Out of 5288 patients identified (1103 from one center, 4185 from the second), 51 patients (0.96%) were diagnosed with concurrent ischemic and hemorrhagic stroke.  Mean age was 67 (± 12) years old and 39% were female. 76% had poor outcome on discharge. Alcohol use, high initial ICH and NIHSS score were associated with poor outcome, while taking statins was a predictor of good outcome.  Atrial fibrillation, tobacco, and recreational drug use were non-significant predictors of poor outcome. Among patients surviving to discharge, antiplatelets or anticoagulants were prescribed to 53% on admission and 54% at discharge.

Concurrently-diagnosed ischemic and hemorrhagic stroke is rare but carries high morbidity. Several factors may impact outcomes in these patients, though future studies are needed to better explore their implications on long-term outcomes.