Motor impairment is the key determinant of the 1-year modified Rankin Scale in intracerebral haemorrhage.

Authors

Elbert Edy, Ulrike Hammerbeck, David A Jenkins, Daniel F Hanley, Adrian Robert Parry-Jones

Published in

Cerebrovascular diseases (Basel, Switzerland). Pages 1. Aug 17, 2026. Epub Aug 17, 2026.

Abstract

Background Intracerebral haemorrhage (ICH) is associated with significant long-term disability. Precise ICH location is readily available from routine diagnostic imaging and may thus enhance prognostic models. We have previously shown that involvement of motor pathways in the haematoma is highly predictive of poor outcome. However, ICH patients suffer many other impairments, and this is largely governed by ICH location. To better understand the potential prognostic significance of ICH location and guide further research, our aim was to investigate the associations between specific domains of neurological impairment and 1-year functional outcome after ICH and how these association change over time. Methods Data were pooled from 2 ICH trials: CLEAR-III and MISTIE-III. National Institutes of Health Stroke Scale and Stroke Impact Scale-3 subscores from day 30, 180 and 365 were used to construct eight neurological domains: consciousness, language, motor, sensory, vision, ataxia, memory & thinking, and emotions. The primary outcome was 1-year mRS in ICH survivors, dichotomised into good (0-3) or poor (4-5) outcome. Multivariable logistic regression models were used to investigate the association between impairments at days 30, 180, and 365 and good 1-year mRS, adjusting for baseline confounders (age, premorbid mRS, ICH and intraventricular volume on stability CT scans) and treatment group (intervention vs control). Results 736 patients were included in the analysis. Motor (OR 0.937; 95%CI:0.925-0.950) and vision (OR 0.991; 95%CI:0.983-0.999) impairment at day 30 were associated with poor 1-year mRS. At day 180, motor (OR 0.891; 95%CI:0.874-0.908) and memory & thinking (OR 0.987; 95%CI:0.975-0.998) impairment were associated with poor 1-year mRS. At day 365, motor (OR 0.876; 95%CI:0.856-0.897) impairment was significantly associated with poor 1-year mRS, along with memory & thinking (OR 0.982; 95%CI:0.971-0.994) and language (OR 0.982; 95%CI:0.966-0.999) impairment. Conclusion In our secondary analysis of this ICH cohort, motor impairment within the first year after ICH is consistently and strongly associated with 1-year mRS after ICH at all time points. Although the associations are weaker, memory and thinking at days 180 & 365 was also associated with 1-year mRS. Of the other domains, only vision showed a weak association at a single time point (day 30). Our exploratory study suggests that lesion locations impacting on motor function and memory and thinking may worsen functional recovery in ICH patients.

PMID:
42607002
Bibliographic data and abstract were imported from PubMed on 18 Aug 2026.

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