High case fatality from intracerebral hemorrhage in Algarve

Hipólito Nzwalo has studied the incidence of spontaneous intracerebral hemorrhage in Algarve, Portugal, and identified factors related to prognosis.


  1. The case fatality rate from spontaneous intracerebral hemorrhage in Algarve is among the highest in Europe.
  2. Using vitamin K antagonists is among the factors related to worse short-term prognosis following intracerebral hemorrhage in Algarve.
  3. Stroke unit admission is associated with reduced risk of both short-term and long-term death after intracerebral hemorrhage.


Thesis: Incidence and outcome of spontaneous intracerebral hemorrhage in Algarve, Portugal
Candidate: Hipólito Nzwalo
Time: January 18, 2019 at 10:05
Place: Haukeland University Hospital, Armauer Hansen House: Auditorium
Link to university website (in Norwegian)


(1) 82 of 280,081 persons living in a subregion of Algarve, Portugal, had a spontaneous intracerebral hemorrhage in 2015. This incidence rate of 29.2/100,000 is high compared to most European countries, but still within the figures found in some parts of the continent.

Hypertension, alcoholism and diabetes were the most pronounced risk factors of a spontaneous intracerebral hemorrhage. The incidence rate was markedly higher in men than in women. Moreover, the 30-day case-fatality was 40 %, among the highest reported in western countries.

(2) 30-day mortality was 34.4 % among 549 cases of spontaneous intracerebral hemorrhage in Algarve between 2009 and 2014. Each added year of age was associated with approximately 10 % increased short-term mortality risk. Use of vitamin K antagonists seemed to increase the risk by 5-fold, whereas a low admission score on the Glasgow Coma Scale was linked to 20-fold increased risk. Other predictors of poor prognosis were hematoma volume, intraventricular dissection, admission serum glucose and pneumonia.

Admission to a stroke unit predicted 60 % lower risk of 30-day mortality, and was the only independent predictor of reduced risk.

(3) Stroke unit traetment also predicted long-term survival, with a 40 % reduction in risk among admitted patients. 24 % of the short-term survivors died within two years of a spontaneous intracerebral hemorrhage. 40 % died from pneumonia, 10 % from cardiovascular complications, 8 % from non-respiratory infections, and 7 % from neoplasia, indicating that alarge proportion of deaths could potentially be prevented. 5 patients died from a new stroke.

Two-year survivors were significantly younger than those who died. They were also more independent at hospital discharge, were less often discharged to a nursing home, and were less often hospitalized during the first year after discharge.


(1) Nzwalo, H., Nogueira, J., Félix, C., Guilherme, P., Baptista, A., Figueiredo, T., Ferreira, F., Marreiros, A., Thomassen, L., & Logallo, N. (2017). Incidence and case-fatality from spontaneous intracerebral hemorrhage in a southern region of PortugalJournal of the neurological sciences380, 74-78.

(2) Nzwalo, H., Nogueira, J., Félix, A. C., Guilherme, P., Abreu, P., Figueiredo, T., Ferreira, F., Marreiros, A., Thomassen, L., & Logallo, N. (2018). Short-term outcome of spontaneous intracerebral hemorrhage in Algarve, Portugal: retrospective hospital-based studyJournal of Stroke and Cerebrovascular Diseases27(2), 346-351.

(3) Nzwalo, H., Félix, C., Nogueira, J., Guilherme, P., Ferreira, F., Salero, T., Ramalhete, S., Martinez, J., Mouzinho, M., Marreiros, A., Thomassen, L., & Logallo, N. (2018). Predictors of long-term survival after spontaneous intracerebral hemorrhage in southern Portugal: A retrospective study of a community representative populationJournal of the neurological sciences394, 122.

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