MATCHED lesion stroke analysis found hemorrhagic stroke caused worse disability and higher DALYs than ischemic stroke by year five.
Hemorrhagic vs Ischemic Stroke Outcomes in Matched Lesions
Worse disability is often reported after hemorrhagic stroke than ischemic stroke, but it has been unclear whether that difference reflects stroke etiology or differences in lesion size and location. In this analysis, investigators compared functional outcome, long term survival, and burden of disease in patients with intracerebral hemorrhage and acute ischemic stroke after matching cases for lesion size and affected brain location.
The study drew on two hospital-based datasets and focused on patients with a single stroke lesion in the middle cerebral artery territory. Lesion location was balanced using Alberta Stroke Program Early CT Score (ASPECTS) regions, and propensity score matching was applied to align baseline characteristics and imaging features. After matching, 194 patients were analyzed, split evenly between acute ischemic stroke and intracerebral hemorrhage.
Disability Signals Persist Despite Similar Survival
At 3 months, the modified Rankin scale distribution shifted toward better outcomes for acute ischemic stroke compared with intracerebral hemorrhage, with an odds ratio of 1.69 (95% CI: 1.02–2.79). The gap appeared most pronounced in patients younger than 75 years and in those with smaller lesions under 15 mL, where the odds ratios favoring ischemic stroke were 3.23 and 4.48, respectively.
Despite these functional differences, 5-year survival did not differ between groups. However, burden of disease was consistently higher after intracerebral hemorrhage. Mean disability adjusted life years were 8.39 after intracerebral hemorrhage versus 5.90 after acute ischemic stroke, and the burden per milliliter of lesion volume was also higher following intracerebral hemorrhage.
Clinical Meaning for Prognosis Conversations
These findings suggest that even when hemorrhagic and ischemic strokes are matched for lesion size and location, hemorrhagic stroke is associated with greater long term disability related burden. For clinicians counseling patients and families, the results reinforce that prognosis may diverge by stroke type in ways not fully explained by imaging matched lesion characteristics alone, particularly among younger patients and those with smaller lesions.
Reference: Balk S et al. Functional outcome, five-year survival and burden of disease after size- and location-matched hemorrhagic versus ischemic stroke. Neurol. Res. Pract. 2026; DOI: 10.1186/s42466-026-00456-w.
