JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v5i3.2457 jpsim.v5i3.2457 Original Research Correlation of Variation in Weather Conditions and Non-Traumatic Intracerebral Hemorrhage (NTICH) Shaikh Saima Ali Sajjad Shahid Mateen Khan Mohammad Imran Islam Sadia Irfan Muhammad irfan201@gmail.com * Khawaja Mohammad Safdar Medical College llama Iqbal Memorial Teaching Hospital Sialkot, Rashid Lateef Medical College Lahore Punjab Medical College Faisalabad *Correspondence: Muhammad Irfan (irfan201@gmail.com) 30 08 2024 2024 5 3 644 648 15 02 2024 07 08 2024 Copyright © 2024 The Author(s) 2024 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective

To assess the correlation of non-traumatic intracerebral hemorrhage with variation in weather conditions in Sialkot.

 Methodology

A cross-sectional survey was conducted, 178 patients that reported with intracerebral hemorrhage at the emergency department were included in this study. After the diagnostic confirmation through imaging studies patients’ demographic information, month of ICH was recorded. Weather pattern (low, high, and average temperature) corresponding to the incidence of ICH were also recorded. The frequency of NTICH was calculated by measuring the NTICH event reported at the study setting during each month of the year. The relationship between NTICH frequency with seasonal variations and the risk factors was measured using Pearson correlation at p ≤ 0.05 level of significance.

 Results

Statistically strong relation was found between the number of NTICH cases reported with the variation in average temperature corresponding month (p=0.01) as well as the seasonal variation (p=0.01). Similarly, strong positive relation of hypertension with frequency of NTICH cases (p=0.01).

 Conclusion

There is increased risk of non-traumatic intracerebral hemorrhage during winter months, especially with ambient temperature around less than 10oC. This risk specifically high in patients with known comorbidity of hypertension.

 Keywords Hypertension Non-traumatic intracerebral hemorrhage Cold Weather Seasonal Variation. References Fischbein NJ, Wijman CA. Nontraumatic intracranial hemorrhage. Neuroimag Clin. 2010;20(4):469-92. Weimar C, Kleine-Borgmann J. Epidemiology, prognosis and prevention of non-traumatic intracerebral hemorrhage. Curr Pharma Design. 2017;23(15):2193-6. Cordonnier C, Demchuk A, Ziai W, Anderson CS. Intracerebral haemorrhage: current approaches to acute management. Lancet. 2018;392(10154):1257-68. Wang S, Zou XL, Wu LX, Zhou HF, Xiao L, Yao T et al. Epidemiology of intracerebral hemorrhage: A systematic review and meta-analysis. Front Neurol. 2022; 10.3389/fneur.2022.915813. On S, Poh R, Salor RS, Philip RG, Chekkattu RH, Lim MA, Thien A. The burden and risks factors for intracerebral hemorrhage in a Southeast Asian population. Clin Neurol Neurosurg. 2022;214(1):107145. Cordonnier C, Demchuk A, Ziai W, Anderson CS. Intracerebral haemorrhage: current approaches to acute management. Lancet. 2018;392(10154):1257-68. Alerhand S, Lay C. Spontaneous intracerebral hemorrhage. Emerg Med Clin. 2017;35(4):825-45. An SJ, Kim TJ, Yoon BW. Epidemiology, risk factors, and clinical features of intracerebral hemorrhage: an update. J Stroke. 2017;19(1):3. Garg RK, Ouyang B, Pandya V, Garcia-Cano R, Da Silva I, Hall D, John S, Bleck TP, Berkelhammer M. The influence of weather on the incidence of primary spontaneous intracerebral hemorrhage. J Stroke Cerebrovasc Dis. 2019;28(2):405-11. Wang X, Cao Y, Hong D, Zheng D, Richtering S, Sandset EC, Leong TH, Arima H, Islam S, Salam A, Anderson C. Ambient temperature and stroke occurrence: a systematic review and meta-analysis. Int J Environment Res Public Health. 2016;13(7):698. Shigematsu K, Watanabe Y, Nakano H, Kyoto Stroke Registry Committee. Higher ratio of ischemic stroke to hemorrhagic stroke in summer. Acta Neurologica Scandinavica. 2015;132(6):423-9. Fang CW, Ma MC, Lin HJ, Chen CH. Ambient temperature and spontaneous intracerebral haemorrhage: a cross-sectional analysis in Tainan, Taiwan. BMJ Open. 2012;2(3):e000842. Polcaro-Pichet S, Kosatsky T, Potter BJ, Bilodeau-Bertrand M, Auger N. Effects of cold temperature and snowfall on stroke mortality: a case-crossover analysis. Environment Int. 2019;(5)126:89-95. Yoder AS, Hines CB. Thrombocytopenia: Effect in Ischemic and Hemorrhagic Stroke. Dim Crit Care Nurs. 2021;40(3):139-48. Charach L, Grosskopf I, Karniel E, Charach G. A Meteorological Paradox: Low Atmospheric Pressure-Associated Decrease in Blood Pressure Is Accompanied by More Cardiac and Cerebrovascular Complications: Five-Year Follow-Up of Elderly Hypertensive Patients. Atmosphere. 2022;13(2):235. Alpérovitch A, Lacombe JM, Hanon O, Dartigues JF, Ritchie K, Ducimetière P, Tzourio C. Relationship between blood pressure and outdoor temperature in a large sample of elderly individuals: the Three-City study. Arch Internal Med. 2009;169(1):75-80. Aubinière-Robb L, Jeemon P, Hastie CE, Patel RK, McCallum L, Morrison D, Walters M, Dawson J, Sloan W, Muir S, Dominiczak AF. Blood pressure response to patterns of weather fluctuations and effect on mortality. Hypertension. 2013;62(1):190-6. Zheng D, Arima H, Sato S, Gasparrini A, Heeley E, Delcourt C, Lo S, Huang Y, Wang J, Stapf C, Robinson T. Low ambient temperature and intracerebral hemorrhage: the INTERACT2 Study. PLoS One. 2016;11(2):e0149040. Yamada T, Natori Y. Examination of seasonal variations in the incidence of subarachnoid hemorrhage. Interdiscip Neurosurg. 2020;19:100581. Lavados PM, Olavarría VV, Hoffmeister L. Ambient temperature and stroke risk: evidence supporting a short-term effect at a population level from acute environmental exposures. Stroke. 2018;49(1):255-61. McKee K, Nelson S, Batra A, Klein JP, Henderson GV. Diving into the ice bucket challenge: intraparenchymal hemorrhage and the mammalian diving reflex. Neurohospitalist. 2015;5(3):182-4. Nakaguchi H, Matsuno A, Teraoka A. Prediction of the incidence of spontaneous intracerebral hemorrhage from meteorological data. Int J Biometeorol. 2008;52(1):323-9. Tatlisumak T, Cucchiara B, Kuroda S, Kasner SE, Putaala J. Nontraumatic intracerebral haemorrhage in young adults. Nat Rev Neurol. 2018;14(4):237-50. Kwaan HC. Nonhematologic and hematologic factors in spontaneous intracerebral hemorrhage. InSeminars Thromb Hemost. 2022;48(3):338-43). Madaniyazi L, Zhou Y, Li S, Williams G, Jaakkola JJ, Liang X, Liu Y, Wu S, Guo Y. Outdoor temperature, heart rate and blood pressure in Chinese adults: effect modification by individual characteristics. Scient Reports. 2016;6(1):1-9. Stergiou GS, Palatini P, Modesti PA, Asayama K, Asmar R, Bilo G, De La Sierra A, Dolan E, Head G, Kario K, Kollias A. Seasonal variation in blood pressure: Evidence, consensus and recommendations for clinical practice. Consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. J Hypertense. 2020;38(7):1235-43. Lewington S, Li L, Sherliker P, Guo Y. Seasonal variation in blood pressure and its relationship with outdoor temperature in 10 diverse regions of China: the China Kadoorie Biobank. J Hypertens 2012;30(7):1383-91. Kang Y, Han Y, Guan T, Wang X, Xue T, Chen Z, Jiang L, Zhang L, Zheng C, Wang Z, Gao R. Clinical blood pressure responses to daily ambient temperature exposure in China: An analysis based on a representative nationwide population. Sci Total Environment. 2020;705(2):135762. Díaz A, Gerschcovich ER, Díaz AA, Antía F, Gonorazky S. Seasonal variation and trends in stroke hospitalizations and mortality in a South American community hospital. J Stroke Cerebrovasc Dis. 2013;22(7):e66-9. Fares A. Winter cardiovascular diseases phenomenon. North Am J Med Sci. 2013;5(4):266. Wang K, Li H, Liu W, You C. Seasonal variation in spontaneous intracerebral hemorrhage frequency in Chengdu, China, is independent of conventional risk factors. J Clin Neurosci. 2013;20(4):565-9. Kumar N, Venkatraman A, Garg N. Seasonality in acute ischemic stroke related hospitalizations and case fatality rate in the United States. Int J Cardiol. 2015;195:134-5. Telman G, Sviri GE, Sprecher E, Amsalem Y, Avizov R. Seasonal variation in spontaneous intracerebral hemorrhage in northern Israel. Chronobiol Int. 2017;34(5):563-70.