Ultra-early hematoma growth (uHG) has been shown to predict hematoma expansion (HE) and poor outcomes in intracerebral hemorrhage (ICH) patients. Gastrointestinal bleeding, a severe ICH complication, has been found to correlate with hematoma volumes. This study analyzes the correlation between uHG and the risk of post-ICH gastrointestinal bleeding.

We prospectively recruited consecutive ICH patients. uHG was identified as the hematoma volume on the baseline computed tomography (CT) scan, divided by time from onset to CT (ml/h). Univariate and multivariate logistic regression models identified risk factors for gastrointestinal bleeding. Predictive models were formulated and evaluated using receiver operating characteristic (ROC) curves.

Our study involved 138 patients, and 52 (37.7 %) had gastrointestinal bleeding after ICH. Multivariate analysis revealed uHG (aOR: 1.061; 95 % CI: 1.002–1.123; p = 0.041) as an independent predictor of gastrointestinal bleeding in ICH patients. uHG also correlated significantly with 90-day outcomes (aOR: 1.109; 95 % CI: 1.012–1.215; p = 0.026). ROC analysis showed the uHG − incorporated predictive model had strong predictive power for gastrointestinal bleeding.

uHG was linked to higher risks of gastrointestinal bleeding and 90-day poor outcomes among primary ICH patients.

Hematoma growth rarely occurs after 24 h in patients with intracerebral hemorrhage (ICH). Here we report a case with delayed hematoma growth caused by thrombocytopenia.

A 68-year-old leukemia patient presented with sudden left-sided weakness. Initial computed tomography scans revealed a small basal ganglia hemorrhage without early expansion. However, three days later, there was a significant hematoma expansion coupled with thrombocytopenia. The patient’s condition remained stable after treatment. Our case suggests that hematoma expansion may occur even 3 days after symptom onset in patients with ICH.

This underscores the significance of promptly recognizing and closely monitoring delayed hematoma growth in cases of ICH associated with leukemia to facilitate timely intervention.