Multiple acute spontaneous cerebral hemorrhages is a rare condition without well-defined causes. In this study, we report the frequency and etiology of multiple acute cerebral hemorrhage cases and identify associated comorbidities.

We identified all patients admitted between 2016 and 2019 with acute spontaneous intracerebral hemorrhage from a hospital-based stroke registry. We abstracted medical records and collected baseline demographic information, vascular risk factors, stroke severity and neuroimaging studies. We identified patients with multiple acute spontaneous cerebral hemorrhage - defined as identical appearing hemorrhages on neuroimaging. All images were evaluated by a neurologist with special training in vascular neurology.

Among 432 patients who were admitted with spontaneous intracerebral hemorrhage during the study period, only 8 (2%) met criteria for multiple acute cerebral hemorrhages. The mean age was 62 years (age range 34-85 years) and half were men. A common comorbidity among 62% of the cases was hypertension or new onset BP > 140/90. Five were due to amyloid angiopathy, one was due to posterior reversible leukoencephalopathy syndrome (PRESS), and one was secondary to endocarditis. History of kidney disease, cancer history, and dyslipidemia or new onset LDL > 100 were common associated medical conditions in at least two of the patients. Three patients (37.5%) had also experienced at least one prior stroke.

Multiple acute cerebral hemorrhage is a rare condition occurring in approximately 2% of all spontaneous brain bleeds. The majority are due to amyloid angiopathy. Hypertension and a previous stroke are associated comorbidities.