Intracerebral Haemorrhage in the Top End of the Northern Territory; Risk Factors, Outcomes and the Presence of Cerebral Amyloid Angiopathy in Indigenous Peoples

Abstract

Objective

The prevalence of intracranial haemorrhage (ICH) and cerebral amyloid angiopathy (CAA) in the Northern Territory (NT) is unknown. This study aims to improve knowledge of haemorrhagic stroke in the NT, to evaluate the relevance of CAA and examine its association with chronic kidney disease (CKD).

Methods

Retrospective assessment of ICH cases admitted at Royal Darwin Hospital from 2015 to 2019. Epidural, traumatic, or aneurysmal subarachnoid haemorrhages were excluded. We assessed neuroimaging, demographics, kidney function, risk factors, and outcome. We examined differences in the Aboriginal and Torres Strait Islander population, the association of CKD with outcome, and CAA prevalence.

Results

We found 156 cases, mean age 63, 45% women and 34.0% Aboriginal and Torres Strait Islanders. MRI was performed in 39% of patients; 25% had possible/probable CAA. Mortality during admission was 37.2% and 32.7% were dependent. Mortality was independently associated with ICH volume and CKD. Aboriginal and Torres Strait Islander patients were younger, with higher smoking prevalence, diabetes, and CKD, and had lower independence at discharge. However, the prevalence of CAA was not different between groups, and CAA was not associated with CKD.

Conclusions

ICH in the NT has a poor outcome. The main predictors of mortality are CKD and ICH volume. There is no association between CKD and CAA, and CAA is not more prevalent in Aboriginal and Torres Strait Islander patients. CAA may be underestimated due to a lack of MRI, which was rarely performed in patients who died. Therefore, a prospective study is warranted to better characterise CAA in the NT.