Abstract Body: Background: The prognostic significance of the affected hemisphere in hemorrhagic stroke remains uncertain. We aimed to determine the relationship between the affected hemisphere (right or left) and differences in non-motor outcomes (pain, mood) in patients with acute intracerebral hemorrhage (ICH). These non-motor outcomes are often overlooked in studies following ICH but impact patient recovery and well-being.

Methods: A post-hoc analysis of the MISTIE III study–a randomized, multicenter, placebo-controlled trial of participants with spontaneous, nontraumatic, supratentorial ICH of 30 mL or more that evaluated minimally invasive surgery (MIS) with thrombolysis compared to standard medical care. Prespecified outcomes included modified Rankin scale (mRS) scores, EuroQol Visual Analogue Scale (EQ-VAS), and EQ-5D 3 level version (EQ-5D-3L, composite and individual components) at 30, 180, and 365 days post-ICH. The association of ICH laterality with clinical outcomes was estimated using multiple linear regression models. Prespecified clinical covariates included gender, race (black, white, Asian, other), ethnicity (Hispanic or non-hispanic), premorbid mRS, randomization group (MIS or medical arm), and ICH severity index.

Results: A total of 493 participants were eligible for analysis at day 30 post-ICH. In multivariable analyses, patients with a right hemispheric ICH were more likely to report problems with pain and discomfort at days 30 (β=0.257, [0.131, 0.383], p<0.001), 180 (β=0.213, [0.090, 0.336], p<0.001) and 365 (β=0.209, [0.090, 0.328], p<0.001) post-ICH. Patients with right hemispheric ICH were also more likely to report problems with anxiety and depression at days 30 (β=0.160, [0.030, 0.291], p<0.05) and 180 (β=0.171, [0.049, 0.293], p<0.01) post-ICH. There were no differences between patients with left or right-sided hemorrhages regarding mRS scores.

Conclusions: Right hemispheric lesions were independently associated with increased reports of anxiety and pain in patients with acute ICH across time despite no differences in mRS. Further studies on these outcomes and patient recovery are needed.