J Neurol Res

Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc

Journal website https://jnr.elmerpub.com

Original Article

Volume 15, Number 4, December 2025, pages 172-181

Mortality Following Intracerebral Hemorrhage After Intravenous Alteplase in Acute Ischemic Stroke: A Decision Tree-Based Classification Approach

Figure 1. Post-alteplase intracerebral hemorrhage classified by radiographic classifications: (a) hemorrhagic infarction type 1 (HI1), (b) hemorrhagic infarction type 2 (HI2), (c) parenchymal hematoma type 1 (PH1), and (d) parenchymal hematoma type 2 (PH2). Illustration drawn and modified from the original reference [16].

Figure 2. Study flow diagram. asICH: asymptomatic intracerebral hemorrhage; HI: hemorrhagic infarction; ICH: intracerebral hemorrhage; PH: parenchymal hematoma; sICH: symptomatic intracerebral hemorrhage; TOAST: Trial of Org 10172 in Acute Stroke Treatment.

Figure 3. Decision tree diagram. ECASS II: European Cooperative Acute Stroke Study II; HI: hemorrhagic infarction; PH: parenchymal hematoma; Sx: surgery.

**Table 1.** Baseline Characteristics of Patients With Post-Alteplase Intracerebral Hemorrhage Stratified by Survival Status
Baseline characteristics	Dead (n = 25), n (%)	Survived (n = 69), n (%)	P value
IQR: interquartile range; NIHSS: National Institutes of Health Stroke Scale; SD: standard deviation.
Male	12 (48.0)	34 (49.3)	0.376
Age (years), mean ± SD	72.1 ± 8.9	64.9 ± 11.1	0.003
NIHSS, median (IQR)	14 (11, 20)	12 (8, 16)	0.022

Table 1. Baseline Characteristics of Patients With Post-Alteplase Intracerebral Hemorrhage Stratified by Survival Status

Baseline characteristics

Dead (n = 25), n (%)

Survived (n = 69), n (%)

P value

IQR: interquartile range; NIHSS: National Institutes of Health Stroke Scale; SD: standard deviation.

Male

12 (48.0)

34 (49.3)

0.376

Age (years), mean ± SD

72.1 ± 8.9

64.9 ± 11.1

0.003

NIHSS, median (IQR)

14 (11, 20)

12 (8, 16)

0.022

**Table 2.** Radiographic Classifications of Post-Alteplase Intracerebral Hemorrhage Stratified by Survival Status
Radiographic classifications	Dead (n = 25), n (%)	Survived (n = 69), n (%)	P value
HI: hemorrhagic infarction; PH: parenchymal hematoma.
HI1	0 (0)	10 (14.5)	0.044
HI2	1 (4.0)	27 (39.1)	0.001
PH1	7 (28.0)	19 (27.5)	0.962
PH2	17 (68.0)	13 (18.9)	< 0.001

Table 2. Radiographic Classifications of Post-Alteplase Intracerebral Hemorrhage Stratified by Survival Status

Radiographic classifications

Dead (n = 25), n (%)

Survived (n = 69), n (%)

P value

HI: hemorrhagic infarction; PH: parenchymal hematoma.

HI1

0 (0)

10 (14.5)

0.044

HI2

1 (4.0)

27 (39.1)

0.001

PH1

7 (28.0)

19 (27.5)

0.962

PH2

17 (68.0)

13 (18.9)

< 0.001

**Table 3.** Clinical Classifications of Post-Alteplase Intracerebral Hemorrhage Stratified by Survival Status
Clinical classifications	Dead, n (%)	Survived, n (%)	P value
asICH: asymptomatic intracerebral hemorrhage; ECASS II: European Cooperative Acute Stroke Study II; mSITS-MOST: modified Safe Implementation of Thrombolysis in Stroke-Monitoring Study; NINDS: National Institute of Neurological Disorders and Stroke; sICH: symptomatic intracerebral hemorrhage.
NINDS
asICH	0 (0)	43 (100)	0.886
sICH	25 (49.0)	26 (51.0)
ECASS II
asICH	0 (0)	44 (100)	1.000
sICH	25 (50.0)	25 (50.0)
mSITS-MOST
asICH	1 (2.2)	44 (97.8)	0.889
sICH	24 (49.0)	25 (51.0)

Table 3. Clinical Classifications of Post-Alteplase Intracerebral Hemorrhage Stratified by Survival Status

Clinical classifications

Dead, n (%)

Survived, n (%)

P value

asICH: asymptomatic intracerebral hemorrhage; ECASS II: European Cooperative Acute Stroke Study II; mSITS-MOST: modified Safe Implementation of Thrombolysis in Stroke-Monitoring Study; NINDS: National Institute of Neurological Disorders and Stroke; sICH: symptomatic intracerebral hemorrhage.

NINDS

asICH

0 (0)

43 (100)

0.886

sICH

25 (49.0)

26 (51.0)

ECASS II

asICH

0 (0)

44 (100)

1.000

sICH

25 (50.0)

mSITS-MOST

asICH

1 (2.2)

44 (97.8)

0.889

sICH

24 (49.0)

25 (51.0)

**Table 4.** Proportion of Symptomatic and Asymptomatic Intracerebral Hemorrhages Across Clinical Definitions
Definitions	NINDS (n = 94), n (%)	ECASS II (n = 94), n (%)	mSITS-MOST (n = 94), n (%)	P value
asICH: asymptomatic intracerebral hemorrhage; ECASS II: European Cooperative Acute Stroke Study II; mSITS-MOST: modified Safe Implementation of Thrombolysis in Stroke-Monitoring Study; NINDS: National Institute of Neurological Disorders and Stroke; sICH: symptomatic intracerebral hemorrhage.
asICH	43 (45.7)	44 (46.8)	45 (47.9)	0.958
sICH	51 (54.3)	50 (53.2)	49 (52.1)

Table 4. Proportion of Symptomatic and Asymptomatic Intracerebral Hemorrhages Across Clinical Definitions

Definitions

NINDS (n = 94), n (%)

ECASS II (n = 94), n (%)

mSITS-MOST (n = 94), n (%)

P value

asICH

43 (45.7)

44 (46.8)

45 (47.9)

0.958

sICH

51 (54.3)

50 (53.2)

49 (52.1)

**Table 5.** Surrogates’ Decisions and 7-Day Mortality According to Neurosurgeon’s Suggestion
Surrogates’ decisions	Neurosurgeon’s suggestion
In each cell, the numerator indicates the number of deaths and the denominator indicates the total number of patients within that stratum, with the percentage shown in parentheses. NA: not applicable.
Complied	6/10 (60.0%)	7/16 (43.8%)
Refused	0/0 (NA)	4/4 (100%)
	-	P = 0.043

Table 5. Surrogates’ Decisions and 7-Day Mortality According to Neurosurgeon’s Suggestion

Surrogates’ decisions

Neurosurgeon’s suggestion

Conservative management (n = 10), dead/total (%)

Neurosurgical intervention (n = 20), dead/total (%)

In each cell, the numerator indicates the number of deaths and the denominator indicates the total number of patients within that stratum, with the percentage shown in parentheses. NA: not applicable.

Complied

6/10 (60.0%)

7/16 (43.8%)

Refused

0/0 (NA)

4/4 (100%)

P = 0.043

**Table 6.** Comparison of NIHSS Categories Across Radiographic Classifications Between Lampang and Saraburi Cohorts
NIHSS	HI1, n (%)	HI2, n (%)	PH1, n (%)	PH2, n (%)
HI: hemorrhagic infarction; NIHSS: National Institutes of Health Stroke Scale; PH: parenchymal hematoma.
Lampang cohort (n = 94)	n = 10	n = 28	n = 26	n = 30
4 - 15	10 (100)	20 (71.4)	13 (50.0)	17 (56.7)
16 - 20	0 (0)	5 (17.9)	10 (38.5)	7 (23.3)
> 20	0 (0)	3 (10.7)	3 (11.5)	6 (20.0)
Saraburi cohort (n = 81) [21]	HI1 + HI2 (n = 38)	n = 17	n = 26
4 - 15	23 (60.5)	9 (52.9)	5 (19.2)
16 - 20	10 (26.3)	5 (29.4)	15 (57.7)
> 20	5 (13.2)	3 (17.7)	6 (23.1)

Table 6. Comparison of NIHSS Categories Across Radiographic Classifications Between Lampang and Saraburi Cohorts

NIHSS

HI1, n (%)

HI2, n (%)

PH1, n (%)

PH2, n (%)

HI: hemorrhagic infarction; NIHSS: National Institutes of Health Stroke Scale; PH: parenchymal hematoma.

Lampang cohort (n = 94)

n = 10

n = 28

n = 26

n = 30

4 - 15

10 (100)

20 (71.4)

13 (50.0)

17 (56.7)

16 - 20

0 (0)

5 (17.9)

10 (38.5)

7 (23.3)

> 20

0 (0)

3 (10.7)

3 (11.5)

6 (20.0)

Saraburi cohort (n = 81) [21]

HI1 + HI2 (n = 38)

n = 17

n = 26

4 - 15

23 (60.5)

9 (52.9)

5 (19.2)

16 - 20

10 (26.3)

5 (29.4)

15 (57.7)

> 20

5 (13.2)

3 (17.7)

6 (23.1)