BACKGROUND: The use of computerized tomography has led to the detection of second intracerebral hemorrhage (ICH) in some patients. There have, however, only been a few clinical studies of second ICH. SUBJECTS AND METHODS: Thirty patients with a second ICH were analyzed according to clinical criteria. These patients comprised 5.9% of all patients admitted to Chugoku Rosai Hospital for ICH between 1984 and 1992. RESULTS: The mean interval between the first and second ICH was 27.7 months (range 1-144). The incidence of second hemorrhage was especially high within the first year after the initial ICH. Twelve patients bled bilaterally into the basal ganglia or thalamus during either the first or second attack. Most of these patients had poor outcomes and prognoses. The nine patients with good prognoses included patients with high activity of daily living (ADL) prior to the second attack, and those with neurologic grade 1 following the second attack. All of these patients were managed with conservative therapy. The 10 patients who underwent surgery had poor prognoses. CONCLUSIONS: The incidence of second ICHs is greater than that of initial ICHs. Many patients who experience a second ICH will have a poor prognosis, possibly worse than expected. Surgical therapy should not be recommended in such patients, since our data suggest that they will not do well even after surgery.
BACKGROUND: The use of computerized tomography has led to the detection of second intracerebral hemorrhage (ICH) in some patients. There have, however, only been a few clinical studies of second ICH. SUBJECTS AND METHODS: Thirty patients with a second ICH were analyzed according to clinical criteria. These patients comprised 5.9% of all patients admitted to Chugoku Rosai Hospital for ICH between 1984 and 1992. RESULTS: The mean interval between the first and second ICH was 27.7 months (range 1-144). The incidence of second hemorrhage was especially high within the first year after the initial ICH. Twelve patients bled bilaterally into the basal ganglia or thalamus during either the first or second attack. Most of these patients had poor outcomes and prognoses. The nine patients with good prognoses included patients with high activity of daily living (ADL) prior to the second attack, and those with neurologic grade 1 following the second attack. All of these patients were managed with conservative therapy. The 10 patients who underwent surgery had poor prognoses. CONCLUSIONS: The incidence of second ICHs is greater than that of initial ICHs. Many patients who experience a second ICH will have a poor prognosis, possibly worse than expected. Surgical therapy should not be recommended in such patients, since our data suggest that they will not do well even after surgery.