To investigate the clinical features, risk factors, and outcomes of simultaneous multiple intracerebral hemorrhage (SMICH).

Consecutive patients with acute intracerebral hemorrhage (ICH) admitted to the Department of Neurosurgery, the First Affiliated Hospital of Xi'an Medical University from January 1, 2007 to December 31, 2016 were analyzed retrospectively. The demographics, medical history, clinical data, and imaging features of the patients were collected. SMICH was defined as ICH with two or more lesions at different parts of the brain at the same time on the first brain CT scan. Three months after discharge, patients were assessed by the modified Rankin Scale scores, 0-2 was defined as good outcome, and >2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent risk factors for poor outcomes and death.

A total of 962 patients with ICH were enrolled during the study, 69 of them (7.2%) were SMICH. Among the patients with SMICH, 25 (36.2%) had a good outcome, 44 (63.8%) had a poor outcome, and 42 died, with a mortality rate of 60.9%. Multivariate logistic regression analysis showed that oral anticoagulants (odds ratio [OR] 6.312, 95% confidence interval [CI] 1.967-9.258), ICH etiology classification (OR 9.671, 95% CI 2.315-12.567), hematoma site (OR 1.269, 95% CI 1.018-2.112), and low baseline GCS score (OR 3.267, 95% CI 1.159-5.627) were the independent risk factors for SMICH; age (OR 4.156, 95% CI 2.315-5.669), hematoma site (OR 1.231, 95% CI 1.018-1.972), hematoma broke into the ventricle (OR 1.125, 95% CI 1.007-2.132), and low baseline GCS score (OR 1.336, 95% CI 1.005-2.079) were the independent risk factors for poor outcome in patients with SMICH; age (OR 5.267, 95% CI 1.976-7.228), hematoma broke into the ventricle (OR 1.726, 95% CI 1.011-2.236) and low baseline GCS score (OR 2.111, 95% CI 1.236-3.671) were the independent risk factors for death in patients with SMICH.

SMICH is a rare cerebrovascular disease with a poor outcome and a very high mortality. Oral anticoagulants, ICH etiology classification, hematoma sites, and low baseline GCS score were the independent risk factors for poor outcome of SMICH. Advanced age, hematoma sites, hematoma broke into the ventricle, and low baseline GCS score were the independent risk factors for poor outcomes in patients with SMICH. Advanced age, hematoma broke into the ventricle, and low baseline GCS score were the independent risk factors for death in patients with SMICH.

Cerebral hemorrhage; Risk factors; Treatment outcome