Epidemiology, Risk Factors, and Clinical Features of Intracerebral Hemorrhage: An Update

Abstract

Intracerebral hemorrhage (ICH) is the second most common subtype of stroke and a critical disease usually leading to severe disability or death. ICH is more common in Asians, advanced age, male sex, and low- and middle-income countries. The case fatality rate of ICH is high (40% at 1 month and 54% at 1 year), and only 12% to 39% of survivors can achieve long-term functional independence. Risk factors of ICH are hypertension, current smoking, excessive alcohol consumption, hypocholesterolemia, and drugs. Old age, male sex, Asian ethnicity, chronic kidney disease, cerebral amyloid angiopathy (CAA), and cerebral microbleeds (CMBs) increase the risk of ICH. Clinical presentation varies according to the size and location of hematoma, and intraventricular extension of hemorrhage. Patients with CAA-related ICH frequently have concomitant cognitive impairment. Anticoagulation related ICH is increasing recently as the elderly population who have atrial fibrillation is increasing. As non-vitamin K antagonist oral anticoagulants (NOACs) are currently replacing warfarin, management of NOAC-associated ICH has become an emerging issue.

Epidemiology of Intracranial Hemorrhage Associated with Oral Anticoagulants in Spain: Trends in Anticoagulation Complications Registry – The TAC 2 Study

“…Part of the increased percentage in our study could be due to better control of arterial hypertension, which could have helped to reduce the incidence of the main cause of spontaneous ICH [19]. Nevertheless, global incidence in our study was greater than previously described (2.9 per 100,000 inhabitants/year in the TAC Registry 1 study), possibly due in part to the increase in the incidence of AF coinciding with aging of the population or prescription of anticoagulants.…”

Oligodendrocytes in intracerebral hemorrhage

“…Accumulating evidence suggests that age is a major risk factor for ICH . It has been shown that aging increases the incidence of ICH due to worse chronic conditions, such as hypertension, atrial fibrillation, and diabetes .…”

“…Accumulating evidence suggests that age is a major risk factor for ICH. 93,94 It has been shown that aging increases the incidence of ICH due to worse chronic conditions, such as hypertension, atrial fibrillation, and diabetes. 3 In addition, age-related changes in brain vasculature, including increased blood-brain barrier permeability, endothelial dysfunction, and decreased vascular density, also contribute to the pathogenesis of ICH.…”

Prediction of cerebral hemorrhagic supratentorial stroke acute period outcome on the basis of the assessment of secondary intraventricular hemorrhage severity in the onset of the disease

“…The 30-day mortality rate from CHS constitutes 35-52 %, and about 80 % among survived patients, have severe consequences in the form of pronounced neurological deficit, which causes permanent disability and need for physical assistance in everyday life [3,8].…”