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Published on: February 8, 2022
Nontraumatic cerebral hemorrhage in the young: a study of 107 cases
Insights
Intracerebral hemorrhage (ICH) in young adults is uncommon, with systemic hypertension being the leading cause. Most patients do not regain full independence, highlighting the need for better understanding and treatment of ICH in this demographic.
Area of Science:
- Neurology
- Vascular Neurology
- Epidemiology
Background:
- Intracerebral hemorrhage (ICH) in young individuals is infrequently reported, with limited data on its causes and outcomes.
- Understanding the etiology and prognosis of ICH in younger populations is crucial for effective management.
Purpose of the Study:
- To investigate the causes and prognosis of intracerebral hemorrhage in patients aged 6 months to 45 years.
- To pool data from a Saudi Arabian cohort with existing literature to provide a comprehensive analysis.
Main Methods:
- Retrospective review of 107 intracerebral hemorrhage cases from three major hospitals in Saudi Arabia over 15 years.
- Inclusion of patients aged 6 months to 45 years at stroke onset.
- Data pooling with 253 previously reported cases for enhanced statistical power.
Main Results:
- Systemic hypertension (30%) and arteriovenous malformations (AVMs, 20%) were the leading causes of ICH in the young.
- A significant proportion of cases (26%) had an undetermined cause.
- The pooled early mortality rate was approximately 20%, with only about one-third of patients achieving complete autonomy.
Conclusions:
- Systemic hypertension is the primary cause of intracerebral hemorrhage in individuals under 45 years old.
- Intracerebral hemorrhage in the young is associated with high early mortality and poor functional recovery.
- Further research is needed to improve outcomes for young ICH patients.
Background:
Reports on intracerebral hemorrhage (ICH) in the young are rare, and information on the cause and prognosis of ICH in this age-group is sparse.
Methods:
All cases of ICH admitted to three major hospitals in Saudi Arabia over a 15-year period were retrospectively reviewed. Patients aged between 6 months and 45 years at stroke onset were studied. Pooling of our data with those published from other centers was used for final analysis.
Results:
One hundred seven cases (69 male, 38 female), including 12 children younger than 10, were analyzed. The causes of hemorrhage were as follows: arteriovenous malformations (AVMs), 23%; systemic hypertension, 20%; blood dyscrasias, 16%; berry aneurysms, 8%; other causes, 7%. No cause was found in 26%. Sixty-two percent of the ICHs were lobar and 3% multiple. Early death rate was high (27%). Twelve percent of the patients were lost to follow-up, and only 26% returned to a state of complete autonomy.
Conclusion:
The pooling of the causative data from our cases and the 253 others reported in the literature showed that even before 45 years of age systemic hypertension is the leading cause of ICH. It accounts for approximately 30% of the cases, with AVMs (20%) being next. The pooled overall early mortality rate is approximately 20%, and only one third of the patients return to independent living.
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