Risk Factors for Spontaneous Intracerebral Hemorrhage

Juvela, Seppo; Hillbom, Matti; Palomäki, Heikki

doi:10.1161/01.str.26.9.1558

Cited by 186 publications

(105 citation statements)

References 41 publications

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“…This finding is consistent with the findings of previous case-control studies, which found recent heavy alcohol consumption to be a risk factor for ICH 23 and for ischemic stroke due to cardiogenic brain embolism 24 after controlling for hypertension. Heavy, chronic alcohol consumption is associated with cardiomyopathy, 25 which is known to predispose to cardiac arrhythmias and heart failure, both of which increase the risk for embolic stroke.…”

Section: Mechanismssupporting

confidence: 92%

Increased Stroke Risk Is Related to a Binge Drinking Habit

Sundell

Salomaa

Vartiainen

et al. 2008

Stroke

131

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Background and Purpose-Heavy alcohol consumption increases the risk for all strokes, whereas moderate regular alcohol consumption is associated with a lower risk for ischemic stroke. The purpose of this study was to evaluate the effect of different drinking patterns on stroke risk, independent of average alcohol intake. Methods-A prospective cohort study of 15 965 Finnish men and women age 25 to 64 years who participated in a national risk factor survey and had no history of stroke at baseline were followed up for a 10-year period. The first stroke event during follow-up served as the outcome of interest (Nϭ249 strokes). A binge drinking pattern was defined as consuming 6 or more drinks of the same alcoholic beverage in men or 4 or more drinks in women in 1 session. Cox proportional-hazards models were adjusted for average alcohol consumption, age, sex, hypertension, smoking, diabetes, body mass index, educational status, study area, study year, and history of myocardial infarction. Results-Binge drinking was an independent risk factor for total and ischemic strokes. Compared with non-binge drinkers, the hazard ratio for total strokes among binge drinkers was 1.85 (95% CI, 1.35 to 2.54) after adjusting for average alcohol consumption, age, and sex; the association was diluted after adjustment for other risk factors. Compared with non-binge drinkers, the risk for ischemic stroke was 1.99 (95% CI, 1.39 to 2.87) among binge drinkers; the association remained statistically significant after adjustment for potential confounders. Conclusions-This study found that a pattern of binge drinking is an independent risk factor for all strokes and ischemic stroke.

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Section: Mechanismssupporting

confidence: 92%

Increased Stroke Risk Is Related to a Binge Drinking Habit

Sundell

Salomaa

Vartiainen

et al. 2008

Stroke

131

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“…113 The relative risk for SICH in hypertensive individuals, however, remains 3.9 to 13.3 times that for normotensive individuals. 20 Juvela and colleagues 62 have reported that recent moderate and heavy alcohol intake, hypertension, and anticoagulant treatment appear to be independent risk factors for SICH. Cigarette smoking seems to increase the risk for SAH, but is less strongly associated with SICH.…”

Section: Risk Factorsmentioning

confidence: 99%

Spontaneous intracerebral hemorrhage: a review

Fewel¹,

Thompson²,

Hoff³

2003

FOC

143

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Spontaneous intracerebral hemorrhage (SICH) is a blood clot that arises in the brain parenchyma in the absence of trauma or surgery. This entity accounts for 10 to 15% of all strokes and is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage. Common causes include hypertension, amyloid angiopathy, coagulopathy, vascular anomalies, tumors, and various drugs. Hypertension, however, remains the single greatest modifiable risk factor for SICH. Computerized tomography scanning is the initial diagnostic modality of choice in SICH, and angiography should be considered in all cases except those involving older patients with preexisting hypertension in thalamic, putaminal, or cerebellar hemorrhage. Medical management includes venous thrombosis prophylaxis, gastric cytoprotection, and aggressive rehabilitation. Anticonvulsant agents should be prescribed in supratentorial SICH, whereas the management of hypertension is controversial. To date, nine prospective randomized controlled studies have been conducted to compare surgical and medical management of SICH. Although definitive evidence favoring surgical intervention is lacking, there is good theoretical rationale for early surgical intervention. Surgery should be considered in patients with moderate to large lobar or basal ganglia hemorrhages and those suffering progressive neurological deterioration. Elderly patients in whom the Glasgow Coma Scale score is less than 5, those with brainstem hemorrhages, and those with small hemorrhages do not typically benefit from surgery. Patients with cerebellar hemorrhages larger than 3 cm, those with brainstem compression and hydrocephalus, or those exhibiting neurological deterioration should undergo surgical evacuation of the clot. It is hoped that the forthcoming results of the International Surgical Trial in IntraCerebral Hemorrhage will help formulate evidence-based recommendations regarding the role of surgery in SICH.

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“…1,2 On the other hand, liver cirrhosis is frequently associated with hematologic complications, especially thrombocytopenia and coagulation disorders. 3 The risk for development of ICH in patients with liver cirrhosis remains elusive.…”

mentioning

confidence: 99%

Liver Cirrhosis and Risk of Intracerebral Hemorrhage

Lai

Cheng

Chen

2011

Stroke

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Background and Purpose-The purpose of this study was to investigate the risk of future intracerebral hemorrhage development in patients with liver cirrhosis. Methods-Data were collected from the National Health Insurance Research Database of Taiwan. The study cohort included 948 patients with liver cirrhosis diagnosed in 1999 and 9480 age-and sex-matched patients of the same year. All patients were tracked from their index visits for 9 years. Results-Intracerebral hemorrhage developed in 1.3% of patients with liver cirrhosis and 1.0% of patients in the comparison cohort during the follow-up period. Log-rank test analysis showed no significant difference between the 2 cohorts (Pϭ0.39). A stratified Cox proportional regression model showed an adjusted hazard ratio of 1.62 (95% CI, 0.85 to 3.10) for patients with liver cirrhosis to develop intracerebral hemorrhage compared with patients without liver cirrhosis. Conclusions-Patients with liver cirrhosis had a similar intracerebral hemorrhage incidence rate but a trend of increased risk for intracerebral hemorrhage compared with the comparison cohort during the 9-year follow-up period. (Stroke. 2011;42:2615-2617.)Key Words: epidemiology Ⅲ intracerebral hemorrhage Ⅲ liver cirrhosis H ypertension, high alcohol intake, and old age are wellknown independent risk factors for intracerebral hemorrhage (ICH). 1,2 On the other hand, liver cirrhosis is frequently associated with hematologic complications, especially thrombocytopenia and coagulation disorders. 3 The risk for development of ICH in patients with liver cirrhosis remains elusive. Only a few studies have proposed that liver cirrhosis is a risk factor for ICH. 4 -6 However, these studies were either case series or case-control methodologies. The purpose of this study was to investigate the risk of ICH in patients with liver cirrhosis using a nationwide administrative database. Methods DatabaseThe National Health Insurance Research Database is a large computerized database released by the Bureau of National Health Insurance. The National Health Insurance Research Database is provided to the public in Taiwan for research purposes. This study used the Longitudinal Health Insurance Database 2005, which contains all the original claims data of 1 million beneficiaries randomly selected from 25.68 million individuals in the registry. Because confidentiality assurances were addressed by the Bureau of National Health Insurance, 7 Institutional Review Board approval was waived. SubjectsThe study cohort comprised patients seeking outpatient care in 1999 and who received a diagnosis of liver cirrhosis, International Classification of Diseases, 9th Revision, Clinical Modification, code 571.2 or 571.5. We assigned their first visit for the diagnosis of liver cirrhosis as the index visit. To enhance diagnostic validity, we selected only patients who had Ն2 consistent diagnoses of liver cirrhosis during January 1, 1999, to December 31, 1999, for the study group (nϭ1043). We excluded patients Ͻ20 years and those Ͼ80 years (nϭ16) and...

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Risk Factors for Spontaneous Intracerebral Hemorrhage

Abstract: Recent moderate and heavy alcohol intake as well as hypertension and likely also anticoagulant treatment seem to be independent risk factors for intracerebral hemorrhage.

Cited by 186 publications

References 41 publications

Increased Stroke Risk Is Related to a Binge Drinking Habit

Increased Stroke Risk Is Related to a Binge Drinking Habit

Spontaneous intracerebral hemorrhage: a review

Liver Cirrhosis and Risk of Intracerebral Hemorrhage

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