Long-Term Outcomes in Patients With Spontaneous Cerebellar Hemorrhage: An International Cohort Study

Jasper R Senff; Sanjula D Singh; Marco Pasi; Wilmar M T Jolink; Mark A Rodrigues; Floris H B M Schreuder; Julie Staals; Tobien Schreuder; Jules P J Douwes; Jelmer Talsma; Brenna N McKaig; Christina Kourkoulis; Nirupama Yechoor; Christopher D Anderson; Laurent Puy; Charlotte Cordonnier; Marieke J H Wermer; Peter M Rothwell; Jonathan Rosand; Catharina J M Klijn; Rustam Al-Shahi Salman; Gabriël J E Rinkel; Anand Viswanathan; Joshua N Goldstein; H Bart Brouwers

doi:10.1161/STROKEAHA.123.044622

Long-Term Outcomes in Patients With Spontaneous Cerebellar Hemorrhage: An International Cohort Study

Stroke. 2024 May;55(5):1210-1217. doi: 10.1161/STROKEAHA.123.044622. Epub 2024 Mar 15.

Authors

Jasper R Senff^#^{1

2

3

4

5}, Sanjula D Singh^#^{1

2

6

3

4

5}, Marco Pasi^{6

7

8}, Wilmar M T Jolink⁹, Mark A Rodrigues^{10

11}, Floris H B M Schreuder¹², Julie Staals¹³, Tobien Schreuder¹⁴, Jules P J Douwes¹, Jelmer Talsma¹, Brenna N McKaig¹⁵, Christina Kourkoulis^{2

3

4

5}, Nirupama Yechoor^{2

3

4

5}, Christopher D Anderson^{2

4

5

16}, Laurent Puy⁷, Charlotte Cordonnier⁷, Marieke J H Wermer¹⁷, Peter M Rothwell¹⁸, Jonathan Rosand^{2

3

4

5}, Catharina J M Klijn¹², Rustam Al-Shahi Salman¹⁰, Gabriël J E Rinkel¹, Anand Viswanathan⁶, Joshua N Goldstein^#¹⁵, H Bart Brouwers^#^{1

19}

Affiliations

¹ Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (J.R.S., S.D.S., J.P.J.D., J.T., G.J.E.R., H.B.B.).
² Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston (J.R.S., S.D.S., C.K., N.Y., C.D.A., J.R.).
³ Department of Neurology (J.R.S., S.D.S., C.K., N.Y., J.R.), Massachusetts General Hospital, Boston.
⁴ Center for Genomic Medicine (J.R.S., C.K., N.Y., C.D.A., S.D.S., J.R.), Massachusetts General Hospital, Boston.
⁵ Broad Institute, Cambridge (J.R.S., S.D.S., J.R.S., C.K., N.Y., C.D.A., J.R.).
⁶ JPK Stroke Center (S.D.S., M.P., A.V.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston.
⁷ University Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, France (M.P., L.P., C.C.).
⁸ Neurology Department, University Hospital of Tours, INSERM U1253 iBrain, France (M.P.).
⁹ Department of Neurology, Isala Hospital, Zwolle, the Netherlands (W.M.T.J.).
¹⁰ Centre for Clinical Brain Sciences, The University of Edinburgh, United Kingdom (M.A.R., R.A.-S.S.).
¹¹ Department of Neuroradiology, NHS Lothian, United Kingdom (M.A.R.).
¹² Department of Neurology, Donders Institute for Brain Cognition & Behavior, Radboud University Medical Center, Nijmegen, the Netherlands (F.H.B.M.S., C.J.M.K.).
¹³ Department of Neurology and School for Cardiovascular Diseases (CARIM), Maastricht University Medical Center, the Netherlands (J.S.).
¹⁴ Department of Neurology, Zuyderland Medical Center, Heerlen, the Netherlands (T.S.).
¹⁵ Department of Emergency Medicine (B.N.M., J.N.G.), Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston.
¹⁶ Department of Neurology, Brigham and Women's Hospital, Boston (C.D.A.).
¹⁷ Department of Neurology, LUMC, Leiden, the Netherlands (M.J.H.W.).
¹⁸ Wolfson Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom (P.M.R.).
¹⁹ Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands (H.B.B.).

^# Contributed equally.

Abstract

Background: Spontaneous intracerebral hemorrhage (ICH) in the cerebellum has a poor short-term prognosis, whereas data on the long-term case fatality and recurrent vascular events are sparse. Herewith, we aimed to assess the long-term case fatality and recurrence rate of vascular events after a first cerebellar ICH.

Methods: In this international cohort study, we included patients from 10 hospitals (the United States and Europe from 1997 to 2017) aged ≥18 years with a first spontaneous cerebellar ICH who were discharged alive. Data on long-term case fatality and recurrence of vascular events (recurrent ICH [supratentoria or infratentorial], ischemic stroke, myocardial infarction, or major vascular surgery) were collected for survival analysis and absolute event rate calculation.

Results: We included 405 patients with cerebellar ICH (mean age [SD], 72 [13] years, 49% female). The median survival time was 67 months (interquartile range, 23-100 months), with a cumulative survival rate of 34% at 10-year follow-up (median follow-up time per center ranged: 15-80 months). In the 347 patients with data on vascular events 92 events occurred in 78 patients, after initial cerebellar ICH: 31 (8.9%) patients had a recurrent ICH (absolute event rate, 1.8 per 100 patient-years [95% CI, 1.2-2.6]), 39 (11%) had an ischemic stroke (absolute event rate, 2.3 [95% CI, 1.6-3.2]), 13 (3.7%) had a myocardial infarction (absolute event rate, 0.8 [95% CI, 0.4-1.3]), and 5 (1.4%) underwent major vascular surgery (absolute event rate, 0.3 [95% CI, 0.1-0.7]). The median time to a first vascular event during follow-up was 27 months (interquartile range, 8.7-50 months), with a cumulative hazard of 47% at 10 years.

Conclusions: The long-term prognosis of patients who survive a first spontaneous cerebellar ICH is poor and comparable to that of patients who survive a first supratentorial ICH. Further identification of patients at high risk of vascular events following the initial cerebellar ICH is needed. Including patients with cerebellar ICH in randomized controlled trials on secondary prevention of patients with ICH is warranted.

Keywords: cerebellum; cohort studies; hemorrhagic stroke; recurrence; stroke; survival.

Abstract

Grants and funding