The Influence of Weather on the Incidence of Primary Spontaneous Intracerebral Hemorrhage



      Intracerebral hemorrhage has been associated with changes in various weather conditions. The primary aim of this study was to examine the collective influence of temperature, barometric pressure, and dew point temperature on the incidence of primary spontaneous intracerebral hemorrhage (sICH).


      Between January 2013 and December 2016, patients with sICH due to hypertension or amyloid angiopathy with a known time of onset were identified prospectively. Meteorological variables 6 hours prior to time of onset were obtained from the National Oceanic Atmospheric Administration via two weather stations. Using a Monte-Carlo simulation, random populations of meteorological conditions in a 6-hour time window during the same years were generated. The actual meteorological conditions 6-hours prior to sICH were compared to those from the randomly generated populations. The false discovery rate method was used to identify significant meteorological variables.


      Time of onset was identified in 455 of 603 (75.5%) patients. Distribution curves for change in temperature, mean barometric pressure, and change in barometric pressure 6-hours prior to hemorrhage ictus were found to be significantly different from the random populations. (FDR approach P < .05). For a given change in temperature associated with intracerebral hemorrhage, mean barometric pressure was higher (1018 millibar (mb) versus 1016 mb, P = .03). Barometric pressure data was not influenced by variations in temperature.


      We concluded that barometric pressure primarily influences the incidence of intracerebral hemorrhage. The association described in the literature between temperature and intracerebral hemorrhage is likely confounded by variations in barometric pressure.

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        • Ramirez-Lassepas M.
        • Haus E.
        • Lakatua D.J.
        • et al.
        Seasonal (circannual) periodicity of spontaneous intracerebral hemorrhage in Minnesota.
        Ann Neurol. 1980; 8: 539-541
        • Biller J.
        • Jones M.P.
        • Bruno A.
        • et al.
        Seasonal variation of stroke–does it exist?.
        Neuroepidemiology. 1988; 7: 89-98
        • Suzuki K.
        • Kutsuzawa T.
        • Takita K.
        • et al.
        Clinico-epidemiologic study of stroke in Akita, Japan.
        Stroke. 1987; 18: 402-406
        • Jakovljevic D.
        • Salomaa V.
        • Sivenius J.
        • et al.
        Seasonal variation in the occurrence of stroke in a Finnish adult population. The FINMONICA Stroke Register. Finnish monitoring trends and determinants in cardiovascular disease.
        Stroke. 1996; 27: 1774-1779
        • Sobel E.
        • Zhang Z.X.
        • Alter M.
        • et al.
        Stroke in the Lehigh Valley: seasonal variation in incidence rates.
        Stroke. 1987; 18: 38-42
        • Shinkawa A.
        • Ueda K.
        • Hasuo Y.
        • et al.
        Seasonal variation in stroke incidence in Hisayama, Japan.
        Stroke. 1990; 21: 1262-1267
        • Capon A.
        • Demeurisse G.
        • Zheng L.
        Seasonal variation of cerebral hemorrhage in 236 consecutive cases in Brussels.
        Stroke. 1992; 23: 24-27
        • Jeong T.S.
        • Park C.W.
        • Yoo C.J.
        • et al.
        Association between the daily temperature range and occurrence of spontaneous intracerebral hemorrhage.
        J Cerebrovasc Endovasc Neurosurg. 2013; 15: 152-157
        • Zheng D.
        • Arima H.
        • Sato S.
        • et al.
        Low ambient temperature and intracerebral hemorrhage: the INTERACT2 Study.
        PLoS One. 2016; 11e0149040
        • Nakaguchi H.
        • Matsuno A.
        • Teraoka A.
        Prediction of the incidence of spontaneous intracerebral hemorrhage from meteorological data.
        Int J Biometeorol. 2008; 52: 323-329
        • Knudsen K.A.
        • Rosand J.
        • Karluk D.
        • et al.
        Clinical diagnosis of cerebral amyloid angiopathy: validation of the Boston criteria.
        Neurology. 2001; 56: 537-539
        • Peel M.C.
        • Finlayson B.L.
        • McMahon T.A.
        Updated world map of the Köppen-Geiger climate classification.
        Hydrol Earth Syst Sci. 2007; 11: 1633-1644
        • Panneton W.M.
        The mammalian diving response: an enigmatic reflex to preserve life?.
        Physiology. 2013; 28: 284-297
        • McKee K.
        • Nelson S.
        • Batra A.
        • et al.
        Diving into the ice bucket challenge: intraparenchymal hemorrhage and the mammalian diving reflex.
        Neurohospitalist. 2015; 5: 182-184
        • Madsen C.
        • Nafstad P.
        Associations between environmental exposure and blood pressure among participants in the Oslo Health Study (HUBRO).
        Eur J Epidemiol. 2006; 21: 485-491
        • Alperovitch A.
        • Lacombe J.M.
        • Hanon O.
        • et al.
        Relationship between blood pressure and outdoor temperature in a large sample of elderly individuals: the Three-City study.
        Arch Intern Med. 2009; 169: 75-80
        • Lewington S.
        • Li L.
        • Sherliker P.
        • Guo Y.
        • et al.
        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: 1383-1391
        • van den Hurk K.
        • de Kort W.L.
        • Deinum J.
        • et al.
        Higher outdoor temperatures are progressively associated with lower blood pressure: a longitudinal study in 100,000 healthy individuals.
        J Am Soc Hypertens: JASH. 2015; 9: 536-543
        • Leech J.A.
        • Nelson W.C.
        • Burnett R.T.
        • et al.
        It's about time: a comparison of Canadian and American time–activity patterns.
        J Expo Anal Environ Epidemiol. 2002; 12: 427
        • Kristal-Boneh E.
        • Harari G.
        • Green M.S.
        • et al.
        Seasonal changes in ambulatory blood pressure in employees under different indoor temperatures.
        Occup Environ Med. 1995; 52: 715-721
        • Brook R.D.
        • Shin H.H.
        • Bard R.L.
        • et al.
        Can personal exposures to higher nighttime and early-morning temperatures increase blood pressure?.
        J Clin Hypertens. 2011; 13: 881-888
        • Hintenlang D.E.
        • Al-Ahmady K.K.
        Pressure differentials for radon entry coupled to periodic atmospheric pressure variations.
        Indoor Air. 1992; 2: 208-215
        • Cull R.E.
        Barometric pressure and other factors in migraine.
        Headache. 1981; 21: 102-103
        • Landers A.T.
        • Narotam P.K.
        • Govender S.T.
        • et al.
        The effect of changes in barometric pressure on the risk of rupture of intracranial aneurysms.
        Br J Neurosurg. 1997; 11: 191-195
        • Setzer M.
        • Beck J.
        • Hermann E.
        • et al.
        The influence of barometric pressure changes and standard meteorological variables on the occurrence and clinical features of subarachnoid hemorrhage.
        Surg Neurol. 2007; 67 (discussion 72): 264-272
        • Kimoto K.
        • Aiba S.
        • Takashima R.
        • et al.
        Influence of barometric pressure in patients with migraine headache.
        Intern Med. 2011; 50: 1923-1928
        • van Donkelaar C.E.
        • Potgieser A.R.E.
        • Groen H.
        • et al.
        Atmospheric pressure variation is a delayed trigger for aneurysmal subarachnoid hemorrhage.
        World Neurosurg. 2018;
        • Potasman I.
        • Rofe O.
        • Weller B.
        Flight-associated headaches-prevalence and characteristics.
        Cephalalgia. 2008; 28: 863-867
        • Messlinger K.
        • Funakubo M.
        • Sato J.
        • et al.
        Increases in neuronal activity in rat spinal trigeminal nucleus following changes in barometric pressure–relevance for weather-associated headaches?.
        Headache. 2010; 50: 1449-1463
        • Meuwly C.
        • Golanov E.
        • Chowdhury T.
        • et al.
        Trigeminal cardiac reflex: new thinking model about the definition based on a literature review.
        Medicine. 2015; 94: e484
        • Mieske K.
        • Flaherty G.
        • O'Brien T.
        Journeys to high altitude–risks and recommendations for travelers with preexisting medical conditions.
        J Travel Med. 2010; 17: 48-62
        • Paran E.
        • Neuman L.
        • Sukenik S.
        Blood pressure changes at the Dead Sea (a low altitude area).
        J Hum Hypertens. 1998; 12: 551-555
        • Melnikov V.N.
        • Krivoschekov S.G.
        • Komlyagina T.G.
        • et al.
        Limb muscle hemodynamics and arterial distensibility depend on atmospheric pressure in hypertensive men.
        Biomed Environ Sci: BES. 2013; 26: 284-294
        • Honig A.
        • Eliahou R.
        • Pikkel Y.Y.
        • et al.
        Drops in barometric pressure are associated with deep intracerebral hemorrhage.
        J Stroke Cerebrovasc Dis. 2016; 25: 872-876