Background: The presence of intraventricular hemorrhage (IVH) was extensively investigated and was associated with poor outcome in patients with intracerebral hemorrhage (ICH). However, the effect of the speed of ventricular bleeding on outcomes is unknown. Methods and Results: We prospectively included patients with ICH who had baseline computed tomography scans within 6 hours after ictus between January 2016 and October 2021. The clinical characteristics were compared between patients with and without early neurologic deterioration (END). Ultraearly IVH growth (uIVHG) was defined as baseline IVH volume by onset‐to‐imaging time. The association between uIVHG and outcomes was assessed by using multivariable logistic regression analysis. We established the ultraearly IVH growth (uIVH) score and compared the areas under the receiver operating characteristic curves of the existing scores for predicting END. A total of 299 patients were finally enrolled. Of those, 38 patients (12.7%) experienced END at 24 hours and 89 patients (29.8%) had poor outcomes at 90 days. After adjustment for confounding factors, uIVHG (odds ratio, 1.061 [95% CI, 1.011–1.113]; P =0.016) was independently associated with END in multivariable analysis. A prediction score was developed on the basis of the logistic model. The uIVH score was developed as a sum of individual points (0–6) based on age, hematoma volume, National Institutes of Health Stroke Scale, hematoma expansion, and uIVHG ≥2.5 mL/h. In comparison with the ICH score and modified Emergency Department ICH Scale, the uIVH score exhibited best performance in the prediction of END. Conclusions: uIVHG is associated with early neurologic deterioration and poor functional outcome in patients with ICH.

Objective: To assess the prevalence and factors associated with early cognitive impairment in intracerebral hemorrhage (ICH) patients and to describe short‐term recovery trajectories among ICH patients with early cognitive impairment.Methods: We prospectively enrolled ICH patients without baseline dementia in our institutions. Cognitive function was assessed using mini‐mental state examination (MMSE), and functional outcome was evaluated at discharge, 3, and 6 months after symptoms onset using the modified Rankin Scale (mRS). We used multinomial logistic regression models to investigate potential risk factors and generalized linear models to analyze the functional outcome data.Results: Out of 181 patients with ICH, 167 were included in the final analysis. Early cognitive impairment occurred in 60.48% of patients with ICH. Age (odds ratio [OR] per 1‐year increase, 1.037; 95% confidence interval [CI], 1.003–1.071; p = 0.034), National Institutes of Health Stroke Scale (NIHSS) score (OR per 1‐point increase, 1.146; 95% CI, 1.065–1.233; p < 0.001) and lobar ICH location (OR, 4.774; 95% CI, 1.810–12.593; p = 0.002) were associated with early cognitive impairment in ICH patients. Patients with ≥10 years of education were less likely to experience early cognitive impairment (OR, 0.323; 95% CI, 0.133–0.783; p = 0.012). Participants with early cognitive impairment had a higher risk of poor outcome (OR, 4.315; 95% CI, 1.503–12.393; p = 0.005) than those without. Furthermore, there was a significantly faster functional recovery rate for those without early cognitive impairment compared with those with at 3 and 6 months (p < 0.05).Interpretation: Early cognitive impairment was prevalent and associated with poor outcomes in ICH patients, which decelerated short‐term functional recovery.

Intracerebral hemorrhage (ICH) is one of the most lethal subtypes of stroke, associated with high morbidity and mortality. Prevention of hematoma growth and perihematomal edema expansion are promising therapeutic targets currently under investigation. Despite recent improvements in the management of ICH, the ideal treatments are still to be determined. Early stratification and triage of ICH patients enable the adjustment of the standard of care in keeping with the personalized medicine principles. In recent years, research efforts have been concentrated on the development and validation of blood-based biomarkers. The benefit of looking for blood candidate markers is obvious because of their acceptance in terms of sample collection by the general population compared to any other body fluid. Given their ease of accessibility in clinical practice, blood-based biomarkers have been widely used as potential diagnostic, predictive, and prognostic markers. This review identifies some relevant and potentially promising blood biomarkers for ICH. These blood-based markers are summarized by their roles in clinical practice. Well-designed and large-scale studies are required to validate the use of all these biomarkers in the future.

The management of acute intracerebral hemorrhage (ICH) primarily involves medical treatment and surgical intervention. However, current evidence regarding the effectiveness and safety of surgical treatment remains controversial. Thus, we conducted a real-world investigation, aimed to explore the actual situation of spontaneous ICH patients receiving different treatment and compare the impact on the prognosis. The study consecutively collected spontaneous supratentorial ICH patients aged 18 to 80 years within 72 hours of symptom onset from 2019 to 2022. Propensity score matching was employed to ensure the comparability of baseline characteristics, and a subgroup analysis was performed according to hematoma volume. The primary outcome was defined as 3-month functional status. A total of 568 patients met the inclusion criteria. Of these, 401 received conservative medical treatment, while 167 underwent surgical intervention. After propensity score matching, 76 patients were included in each group. The surgical group demonstrated a reduced mortality rate (P = 0.047) but had a lower incidence of achieving functional independence (P = 0.006) and higher incidence of moderate disability (P = 0.047). Subgroup analysis revealed that minimally invasive surgical treatment was associated with a decreased mortality in patients with hematomas of 30-100 mL. While surgical intervention can reduce mortality, it may have a negative impact on functional independence. Minimally invasive surgical treatment for patients with large-size hematoma (30-100 mL) may be beneficial. Personalized treatment strategies are essential to identify patients who may benefit most from surgical intervention.

The mortality of stroke increases on weekends and during off-hour periods. We investigated the effect of off-hour admission on the outcomes of intracerebral hemorrhage (ICH) patients. We retrospectively analyzed a prospective cohort of ICH patients, admitted between January 2017 and December 2019 at the First Affiliated Hospital of Chongqing Medical University. Acute ICH within 72 h after onset with a baseline computed tomography and 3-month follow-up were included in our study. Multivariable logistic regression analysis was performed for calculating the odds ratios (OR) and 95% confidence interval (CI) for the outcome measurements. Of the 656 participants, 318 (48.5%) were admitted during on-hours, whereas 338 (51.5%) were admitted during off-hours. Patients with a poor outcome had a larger median baseline hematoma volume, of 27 mL (interquartile range 11.1–53.2 mL), and a lower median time from onset to imaging, of 2.8 h (interquartile range 1.4–9.6 h). Off-hour admission was significantly associated with a poor functional outcome at 3 months, after adjusting for cofounders (adjusted OR 2.17, 95% CI 1.35–3.47; p = 0.001). We found that patients admitted during off-hours had a higher risk of poor functional outcomes at 3 months than those admitted during working hours.

Objective: Early neurological deterioration (END) adversely affects outcomes in patients with intracerebral hemorrhage (ICH). This study aimed to determine the location‐specific hematoma volumes for END in supratentorial ICH patients. Methods: We retrospectively analyzed supratentorial ICH patients presenting from two prospective cohorts. END was defined as a ≥ 4‐point increase in the National Institutes of Health Stroke Scale (NIHSS) score or a ≥ 2‐point decrease in the Glasgow Coma Scale score within 24 h of admission. The training cohort was used to determine location‐specific hematoma volume cutoffs for END and to develop the location‐specific hematoma volume for early neurological deterioration (LIVED) score. Internal validation used 30% of the cohort, with external validation in a separate cohort. Results: A total of 1199 patients with supratentorial ICH were included, divided into training ( n = 633), internal validation ( n = 272), and external validation ( n = 294) cohorts. Hematoma volume thresholds for END were 21 mL for basal ganglia, 12 mL for thalamus, and 32 mL for lobar hemorrhages. Multivariable logistic regression identified location‐specific hematoma volume, right‐sided ICH, prior ischemic stroke, and NIHSS score as independent predictors, forming the LIVED score (range 0–5 points). The LIVED score showed superior predictive performance for END compared with established ICH scores, with the highest area under the curve (AUC) across cohorts. Additionally, it exhibited strong discrimination for 3‐month outcomes, including functional independence, poor outcomes, and mortality, with AUCs > 0.70 in all cohorts. Interpretation: Location‐specific hematoma volume thresholds independently predicted END, and the LIVED score demonstrated reliable performance for risk stratification in supratentorial ICH.