Risk factors for recurrence of ICH

Q: Out of the following risk factors which one is the most important risk factor for recurrence of intracranial hemorrhage (ICH)?

A) Uncontrolled hypertension 
B) Lobar location of initial ICH 
C) Male gender 
D) Ongoing anticoagulation 
E) Greater number of microbleeds on MRI 


Answer: A

Objective of the above question is two-folds. First is to emphasize that the simple strategy to control blood pressure is the most promising way to avoid recurrence of ICH. Second is to emphasize that the patients can be re-started on anticoagulation if needed though very close monitoring and discussion about risks vs benefits is required. Most patients once out of the acute period can tolerate anticoagulation if necessary. In long run, uncontrolled blood pressure is the biggest risk factor for the recurrence of ICH.

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References:

1. Chen ST, Chiang CY, Hsu CY, et al. Recurrent hypertensive intracerebral hemorrhage. Acta Neurol Scand 1995; 91:128

2. Huhtakangas J, Löppönen P, Tetri S, et al. Predictors for recurrent primary intracerebral hemorrhage: a retrospective population-based study. Stroke 2013; 44:585. 

3. Kase CS, Kurth T. Prevention of intracerebral hemorrhage recurrence. Continuum (Minneap Minn) 2011; 17:1304.