The Outcomes of Spontaneous Intracerebral Hemorrhage in Young Adults - A Clinical Study

Abstract

ObjectiveSpontaneous intracerebral hemorrhage (ICH) in young adults is rare. The purpose of this study was to investigate causes, sites and other factors affecting the prognosis of ICH in young adults aged ≤ 40 years.MethodsWe reviewed 39 consecutive patients diagnosed with spontaneous ICH between January 2001 and June 2012. Patients with primary subarachnoid hemorrhage, previously diagnosed brain tumor bleeding, or vascular malformation were excluded. We analyzed the differences in prognostic factors such as hemorrhage location and vascular structural etiology. The outcome was measured using the Glasgow outcome scale (GOS), and a good outcome was defined as a score of 4 or more.ResultsWe retrospectively evaluated 39 patients (mean age, 33 years; SD = 6.4, range 17 to 40 years). The most common structural etiology was arteriovenous malformation. A statistically significantly higher proportion of patients with good outcomes had a lower initial systolic blood pressure (SBP ≤ 160 mmHg, p = 0.036), a higher initial Glasgow coma scale (GCS) (9 or more, p = 0.034), lower cholesterol levels (< 200 mg/dl, p = 0.036), and smoking history (at discharge, p = 0.008; 6 months after discharge, p = 0.019).ConclusionIn this study, cryptogenic ICH was the leading cause of spontaneous ICH. A GCS score of 9 or more on admission, a lower serum cholesterol level (< 200 mg/dl), and a lower SBP (< 160 mmHg) predicted a good outcome.

Management of Spontaneous Superficial Intracerebral Hematomas

“…The most common presentation of our patients was deterioration of the conscious level which reported in 12 cases out of 20 patients (60%), Pantazis et al, [30] found 42% of their cases presented with deteriorated consciousness. Cuatico et al, [31] and Talukder et al, [27] stated that the significance of level of consciousness the most important single clinical signs determining the prognosis, the same result we had in our study as we had 5 patients with GCS ≤ 8 (25%) all of them (100%) died regardless the type of treatment, which indicated that when the initial GCS is less than "8" mortality is high, similar results were found by different studies [32] [33] [34] The risk for early neurological deterioration and the high rate of poor long-term outcomes underscores the need for aggressive early management Steiner et al, [35].…”

Blood pressure levels in the acute phase after intracerebral hemorrhage are associated with mortality in young adults

“…Compared with survivors, the patients dying within 3 months had significantly more severe strokes (P < 0.001), with higher National Institutes of Health Stroke Scale scores [32 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35) For the multivariable analyses, SBP ≥ 160 mmHg at admission was independently associated with both 3-month and long-term mortalities ( Table 2).…”

Analysis of Predictive Factors of Mortality in Hemorrhagic Stroke Patients at Soebandi Hospital Jember

“…Usia tua merupakan prediktor yang kuat terhadap prognosis buruk stroke hemoragik termasuk angka rekurensi, perburukan klinis dan mortalitas (Vermeer et al, 2002). Stroke umumnya terjadi pada lanjut usia dan terdapat peningkatan kejadian serangan stroke pada usia di atas 55 tahun, Hal ini dikarenakan adanya Go et al (2013) bahwa GCS awal masuk >8 mempunyai prediksi luaran baik, sedangkan GCS <8 merupakan prediktor luaran yang buruk yaitu mortalitas dalam 2 hari perawatan.…”