Admission leukocytosis and its implications on intra cerebral haemorrhage


  • Rajendran Velayudham Department of Medicine, Madras Medical College, Chennai, Tamil Nadu, India
  • Ramesh Dasarathan Department of Medicine, Madras Medical College, Chennai, Tamil Nadu, India
  • Nirumal Khumar S. Department of Medicine, Madras Medical College, Chennai, Tamil Nadu, India
  • Senthil Kumar S. Department of Medicine, Madras Medical College, Chennai, Tamil Nadu, India



Intracerebral haemorrhage, Leukocytosis, Haematoma expansion


Background: Intracerebral haemorrhage is one amongst the most common subtype of stroke. It is a catastrophic disease with significant rate of mortality and may lead to severe disabilities. Immediate and effective treatment is a prime requisite of ICH, as rapid mortality occurs within first 24 hours. Definitive diagnosis of ICH is difficult as its symptoms are similar to ischemic stroke. Aim of current investigation was to establish a relationship between intra-cerebral haemorrhage and leukocytosis and to use it as an early tool for detecting haematoma expansion for prognostication and developing newer drugs using a suitable therapeutic target.  

Methods: Current investigation was an observational study carried out on 100 patients with intra-cerebral haemorrhage. Differential counts were studied with respect to influence of particular subtypes on hematoma expansion. Follow up NCCT was done after 48 hours of the event.  

Results: Results of present investigation revealed that mean age of the patients was 56 years, 82% were males and all the patients were hypertensive. It was observed that majority of patients with neutrophilic leukocytosis, did not show hematoma expansion and neutrophilic leukocytosis was preferentially present in patients with higher initial bleed volumes. Significant association was observed between monocytosis and haematoma expansion and association between lymphocytosis and volume expansion was observed to be non-significant.  

Conclusions: Current study findings can aid in early risk stratification and prognostication of ICH patients and can also provide a tool for identification of new therapeutic targets for controlling haematoma expansion.


Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF. Spontaneous intracerebral hemorrhage. N Engl J Med. 2001;344:1450-60.

Labovitz DL, Halim A, Boden-Albala B, Hauser WA, Sacco RL. The incidence of deep and lobar intracerebral hemorrhage in whites, blacks, and hispanics. Neurology. 2005;65:518-22.

Aguilar MI, Freeman WD. Spontaneous intracerebral hemorrhage. Semin Neurol. 2010;30(5):555-64.

Feigin VL. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009;8(4):355-69.

Lawes CMM, Feigin VL, Bennett DA, Anderson CS. Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol. 2003;2:43-53.

Qureshi AI, Giles WH, Croft JB. Racial differences in the incidence of intracerebral hemorrhage. Neurology. 1999;52(8):1617.

Ariesen MJ. Risk Factors for Intracerebral Hemorrhage in the General Population. Stroke. 2003;34(8):2060-5.

Badjatia N, Rosand J. Intracerebral Hemorrhage. Neurol. 2005;11(6):311-24.

Ziai WC, Carhuapoma JR. Intracerebral Hemorrhage. Continuum. 2018;24(6):1603-22.

Balami JS, Buchan AM. Complications of intracerebral haemorrhage. Lancet Neurol. 2012;11(1):101-18.

Caceres JA, Goldstein JN. Intracranial hemorrhage. Emerg Med Clin North Am. 2012;30(3):771-94.

Shao Z, Tu S, Shao A. Pathophysiological mechanisms and potential therapeutic targets in intracerebral hemorrhage. Front Pharmacol. 2019;10:1079.

Aronowski J, Zhao X. Molecular pathophysiology of cerebral hemorrhage: secondary brain injury. Stroke. 2011;42:1781-6.

Auer RN, Sutherland GR. Primary intracerebral hemorrhage: pathophysiology. Can J Neurol Sci. 2005;32 (Suppl 2):S3-12.

Schlunk F, Greenberg SM. The pathophysiology of intracerebral hemorrhage formation and expansion. Transl Stroke Res. 2015;6(4):257-63.

Brouwers HB, Greenberg SM. Hematoma expansion following acute intracerebral hemorrhage. Cerebrovasc Dis. 2013;35(3):195-201.

Davis SM, Broderick J, Hennerici M, Brun NC, Diringer MN, Mayer SA, et al. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology. 2006;66:1175-81.

Dowlatshahi D, Demchuk AM, Flaherty ML, Ali M, Lyden PL, Smith EE. Defining hematoma expansion in intracerebral hemorrhage: relationship with patient outcomes. Neurology. 2011;76:1238-44.

Davis SM, Broderick J, Hennerici M. Recombinant activated factor vii intracerebral hemorrhage trial investigators hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology. 2006;66:1175-81.

Rost NS, Smith EE, Chang Y. Prediction of functional outcome in patients with primary intracerebral hemorrhage: the FUNC score. Stroke 2008;39:2304-9.

Yu Z, Zheng J, Guo R, Ma L, You C, Li H. Prognostic impact of leukocytosis in intracerebral hemorrhage: A PRISMA-compliant systematic review and meta-analysis. Medicine. 2019;98(28):e16281.

Brunswick AS, Hwang BY, Appelboom G. Serum biomarkers of spontaneous intracerebral hemorrhage induced secondary brain injury. J Neurol Sci 2012;321:1.

Wang J. Preclinical and clinical research on inflammation after intracerebral hemorrhage. Prog Neurobiol 2010;92:463-77.

Yu S, Arima H, Heeley E. White blood cell count and clinical outcomes after intracerebral hemorrhage: the INTERACT2 trial. J Neurol Sci. 2016;361:112-6.

Morotti A, Goldstein JN. Diagnosis and management of acute intracerebral hemorrhage. Emerg Med Clin North Am. 2016;34(4):883-99.






Original Research Articles