Spontaneous intracerebral hemorrhage in young adults

Abstract

Few studies have addressed intracerebral hemorrhage (ICH) in younger adults. We studied spontaneous ICH in adults <or=45 years of age. We retrospectively reviewed patients hospitalized with ICH between 2000 and 2001 to investigate incidence, etiology, risk factors, bleeding sites, management, and prognosis. Patients (224 men, 72 women; 37.0 +/- 7.7 years) had a mortality rate of 24%. The most common risk factor for mortality was hypertension (HTN) (48.7%). Bleeding was most common in the ganglion (49.0%). Multiple hemorrhages (83.3%) caused the highest mortality, with the most common cause of mortality being HTN (46.6%). Coagulopathy (62.5%) caused the highest mortality based on etiologic classification. Recurrent HTN-induced hemorrhage rate was 3.6%. In Taiwanese adults <or=45 years of age, ICHs mainly involve the ganglion and result from HTN. Rates of HTN-induced hemorrhage are higher in Taiwan (46.6%) than elsewhere. Differences between races or countries should be investigated further.

Predictors of Early Mortality in Young Adults After Intracerebral Hemorrhage

“…Other independent factors associated with increased 3-month mortality included more severe symptoms on admission, infratentorial hematoma location, hydrocephalus, herniation, and multiple hemorrhages. Our results on the general clinicoradiologic prognostic characteristics are in line with previous studies involving younger 1 and older patients. 3,4 These have reported higher mortality in patients with intraventricular extension, hydrocephalus, Glasgow Coma Scale <8, and hematoma volume of >30 mL, as well as infratentorial ICH location.…”

“…3,4 These have reported higher mortality in patients with intraventricular extension, hydrocephalus, Glasgow Coma Scale <8, and hematoma volume of >30 mL, as well as infratentorial ICH location. 1,3,4 According to previous randomized trials, no advantage over conservative treatment has been achieved with surgical treatment. 5,6 However, our study and the randomized trials are not comparable because of our study's observational nature, older study populations of the trials, and the fact that trials excluded patients with infratentorial ICH and ICH related to structural causes.…”

“…Limited information is available on prognosis in this patient population. 1 We aimed to describe the relationship of characteristics of ICH with 3-month mortality and to evaluate whether neurosurgical interventions are associated with improved survival in young patients with ICH.…”

Increased risk of intracerebral hemorrhage among patients with chronic osteomyelitis

“…16,18,20,21,24 However, risk factors for 10%-25% of ICH patients remain unclear, especially in the younger population. 16,18,21,24 Studies have documented well the role of chronic inflammation in triggering arterial ectasia and microaneurysm formation in the coronary artery. 7,21,24 Studies have also associated ICH with similar chronic inflammatory abbreviatioNs CKD = chronic kidney disease; COM = chronic osteomyelitis; HR = hazard ratio; ICH = intracerebral hemorrhage; IR = incidence rate; IRR = incidence rate ratio; NHI = National Health Insurance; RA = rheumatoid arthritis; SLE = systemic lupus erythematosus; VZV = varicella-zoster virus.…”

“…10,28,31 These noninfectious pathological changes can be triggered by some conventional risk factors for ICH, such as hypertension, diabetes, hyperlipidemia, and chronic kidney disease (CKD). 16,18,20,21,24 However, risk factors for 10%-25% of ICH patients remain unclear, especially in the younger population. 16,18,21,24 Studies have documented well the role of chronic inflammation in triggering arterial ectasia and microaneurysm formation in the coronary artery.…”