Intracerebral Hemorrhage Mortality [Neurosurgery Wiki]

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===== Intracerebral Hemorrhage Mortality =====

**Intracerebral hemorrhage (ICH)** is associated with **high early mortality** and poor long-term outcomes, making it one of the deadliest types of stroke.

==== Early Mortality ====
  * **30-day mortality**: ~**35–50%**
    * Most deaths occur in the first 2 days, often due to hematoma expansion, herniation, or brainstem involvement.
  * **In-hospital mortality**: ~**20–30%**, depending on hematoma volume, location, and patient comorbidities.
  * **Higher mortality** seen in:
    * Brainstem and cerebellar hemorrhages
    * Large hematomas (>30–60 mL)
    * Intraventricular extension
    * Depressed level of consciousness at admission (GCS < 8)

==== Long-Term Outcomes ====
  * **1-year survival**: ~**35–40%**
  * Only **10–20%** of survivors regain **functional independence** (modified Rankin Score ≤2).
  * Risk of death remains elevated for months due to recurrent stroke, infections, and comorbid conditions.

==== Predictors of Mortality ====
  * Age > 80 years
  * Low Glasgow Coma Scale at presentation
  * Large hematoma volume
  * Infratentorial location
  * Intraventricular hemorrhage
  * High blood pressure on admission
  * Lack of early surgical or ICU management when indicated

==== Prognostic Tools ====
  * [[ICH Score]]: validated clinical tool to estimate 30-day mortality based on:
    * GCS
    * Age
    * Hematoma volume
    * Intraventricular extension
    * Infratentorial origin

==== Related Sections ====
  * [[Intracerebral hemorrhage definition]]
  * [[ICH Score]]
  * [[Intracerebral hemorrhage management]]

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[[PM2.5]] [[exposure]]—particularly household-related in low [[Socio-demographic Index]] regions—continues to drive significant [[intracerebral hemorrhage mortality]] and morbidity despite global reductions in age-standardized rates. Disparities persist, with low SDI areas experiencing a 24.7-fold higher ASMR than high SDI regions. Projections indicate a resurgence in PM2.5-related ICH burden by 2050, emphasizing the need for tailored public health interventions targeting APMP and HAP, especially in Asia and Sub-Saharan Africa
((Wu E, Su R, Tang T, Zhu G, Geng D. Ambient versus household PM2.5 exposure and socioeconomic disparities in intracerebral hemorrhage burden: a 32-year global analysis (1990-2021) with projections to 2050. Front Public Health. 2025 Jun 18;13:1615934. doi: 10.3389/fpubh.2025.1615934. PMID: 40606082; PMCID: PMC12213839.))