{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T12:18:22Z","timestamp":1785327502335,"version":"3.55.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T00:00:00Z","timestamp":1753401600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>While understudied, wake-up intracerebral hemorrhage (WU-ICH) is not uncommon (8.8\u201320.3% of ICH patients). Since the risk of hematoma expansion (HE) decreases as time passes, an uncertain onset time in WU-ICH may influence the risk of in-hospital HE and the potential effects of HE-preventive treatments. We aimed to evaluate HE and outcomes in WU-ICH compared to known-onset ICH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We included ICH patients admitted to the Karolinska University Hospital from 2016 to 2022, comparing WU-ICH vs. known-onset ICH regarding baseline characteristics, HE, and outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 763 patients, 147 (19%) had WU-ICH and 616 (81%) had known onset, median (IQR) last-known-well to hospital time 9.6\u202fh (5.9\u201312.2\u202fh) vs. 1.3\u202fh (0.9\u20132.0\u202fh). WU-ICH patients more often had dementia (15% vs. 5%, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001), oral anticoagulants (26% vs. 16%, <jats:italic>p<\/jats:italic>\u202f=\u202f0.005), and pre-stroke modified Rankin Scale 3\u20135 (24% vs. 15%, <jats:italic>p<\/jats:italic>\u202f=\u202f0.01). Baseline ICH volume was 14\u202fmL (6\u201335\u202fmL) vs. 13\u202fmL (5\u201334\u202fmL). Among patients who underwent CT angiography at admission, 15% of WU-ICH vs. 27% of known-onset ICH had spot signs (<jats:italic>p<\/jats:italic>\u202f=\u202f0.002). Of patients with CT follow-up &amp;lt;72\u202fh, HE occurred in 24\/77 (31.2%) in WU-ICH, and 123\/356 (34.6%) in known-onset ICH, <jats:italic>p<\/jats:italic>\u202f=\u202f0.57. Wake-up onset was not associated with HE in multivariable analysis, adjusted OR\u202f=\u202f0.79 (95% CI 0.43\u20131.42). Analysis of the 3-month modified Rankin Scale showed no differences (median 4 vs. 4), unadjusted <jats:italic>p<\/jats:italic>\u202f=\u202f0.35 and adjusted <jats:italic>p<\/jats:italic>\u202f=\u202f0.78.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>WU-ICH had a similar risk of HE and similar 3-month outcomes as known-onset ICH. Excluding WU-ICH from future trials targeting HE may be unwarranted.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1620170","type":"journal-article","created":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T06:17:27Z","timestamp":1753424247000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Wake-up intracerebral hemorrhage: hematoma expansion and outcomes"],"prefix":"10.3389","volume":"16","author":[{"given":"Tove","family":"Almqvist","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Falk","family":"Delgado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Sj\u00f6strand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael 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