Among prestroke-independent 90-day ICH survivors with complete follow-up, functional outcomes remained dynamic beyond 90 days, particularly among patients with moderate disability, suggesting that longer-term outcome assessment may provide additional clinically relevant information in future ICH studies and clinical trials.
Most patients had unchanged functional status between 90 days and 1 year after ICH, but a substantial minority improved, worsened or died.
Patients with moderate disability (mRS 3) at 90 days had the highest rate of recovery by 1 year.
Patients already at mRS 0-2 at 90 days were very likely to remain in that category at 1 year.
A meaningful proportion of patients with severe disability (mRS 4-5) at 90 days improved by 1 year.
Increasing age and higher 90-day disability were associated with less favourable trajectories, while male sex was associated with greater likelihood of improvement.
The study cohort was derived from a large national register through successive eligibility and data-availability restrictions.
The authors conclude that longer-term outcome assessment beyond 90 days may add clinically relevant information in future ICH studies and trials.
This study used Sweden's national stroke register to look at how people recover after a stroke caused by bleeding in the brain (intracerebral haemorrhage). Disability is usually measured at 90 days, but the researchers asked what happens between 90 days and one year. They followed 3030 people who were independent before their stroke, survived to 90 days, and had disability scores recorded at both time points. Most people (about two-thirds) stayed at the same level of function. About 1 in 5 improved, around 5% got worse, and almost 6% died. Recovery was most common in people with moderate disability at 90 days: about 62% of them reached a level of slight or no disability by one year. Among those who had already recovered well at 90 days, over 92% stayed that way. Even among those with severe disability, about 1 in 5 improved to a milder level. Older age and greater disability at 90 days were linked to less favourable courses, while men were more likely to improve. This research suggests that recovery after this type of stroke does not stop at 90 days, especially for people with moderate disability. This may matter for how future studies and trials measure outcomes. The findings apply only to people with complete follow-up data, so they may not represent everyone with this type of stroke.
Johnsson M, Hansen B, Apostolaki-Hansson T, Pihlsgård M, Norrving B, Ullberg T. (2026). Functional trajectories between 90 days and 1 year after intracerebral haemorrhage: a Swedish Stroke Register (Riksstroke) study.. European stroke journal. https://doi.org/10.1093/esj/aakag129