A recent cohort study examined the spatial and temporal distribution of recurrent intracerebral hemorrhage events and revealed significant findings regarding the relationship between the location of these events and underlying conditions such as cerebral amyloid angiopathy.

The study included 733 patients with a total of 1,616 intracerebral hemorrhage (ICH) events, of which 883 were recurrent. Notably, 46.4% of patients experienced recurrent ICH adjacent to a previous event—termed adjacent ICH (adjICH)—while 53.6% had remote ICH (remICH).

According to their findings published in JAMA Neurology, the researchers found that lobar index ICH and the presence of cerebral amyloid angiopathy (CAA) at the index event were associated with higher odds of adjICH. Specifically, lobar index ICH had an adjusted odds ratio of 2.08, and CAA at index ICH was associated with an adjusted odds ratio of 2.21. Conversely, cerebellar index ICH was linked to lower odds of adjICH, with an adjusted odds ratio of 0.25. The median time to recurrence was significantly shorter for adjICH at 1.25 years compared with 2.21 years for remICH.

"These findings suggest that regional, tissue-based factors may facilitate recurrence and that identifying and targeting local vasculopathic changes may represent potential novel treatment targets," wrote Martina B. Goeldlin, MD, PhD, of the Department of Neurology at Inselspital Bern University Hospital and University of Bern in Switzerland, with colleagues.

Previous lobar or convexity subarachnoid hemorrhage, adjICH, and the number of prior ICH events were independently associated with a shorter time to recurrence.

Data collection spanned from 2002 to 2021 and involved a pooled analysis of individual cohort studies from various European hospitals. The analysis utilized multivariable regression and adjusted for factors such as hypertension and antihypertensive treatment.

Further research into the pathophysiological mechanisms of recurrent ICH, particularly in patients with CAA, is needed, the authors noted. They wrote, "Future studies need to further characterize this patient group by including findings from advanced neuroimaging (ie, MRI) studies and histopathology. These studies need to clarify which mechanisms ultimately lead to early and locally adjacent recurrent ICH and whether disease burden, disease progression, or inflammation play critical roles."

Full disclosures are available in the study.