Background: Early haematoma absorption (HA) has been insufficiently investigated in patients with intracerebral haemorrhage (ICH). This study aimed to determine the prevalence of HA and evaluate its association with neurological and functional outcomes.
Methods: We analysed prospectively collected data from patients with primary ICH who underwent baseline computed tomography within 6 hours of symptom onset and follow-up imaging within 30 hours. HA was defined as an absolute reduction in haematoma volume >2 mL or a relative decrease >10%. Early neurological deterioration and improvement were defined using changes in the National Institutes of Health Stroke Scale (NIHSS). Functional outcome at 3 months was assessed using the modified Rankin Scale (mRS), with scores of 4–6 indicating poor outcome.
Results: Among 515 patients, 109 (21.2%) exhibited early HA. HA was independently associated with absence of hypertension and presence of intraventricular haemorrhage (OR 2.18, 95% CI 1.32–3.60; P = 0.002). HA was significantly associated with greater early neurological improvement, reflected by a larger reduction in NIHSS score (β = −2.093, 95% CI −3.369 to −0.816; P = 0.001). Although no significant association with 3-month functional outcome was observed, a consistent trend towards reduced risk of poor outcome was noted, particularly in patients with pronounced HA.
Conclusions: Early haematoma absorption occurs in approximately one-fifth of patients with acute ICH and is associated with favourable early neurological evolution. These findings suggest that HA reflects endogenous haematoma resolution processes and may represent a potential therapeutic target in ICH.