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Predisposing Factors, Pathologies, and Precipitating Factors Causing Intracerebral Hemorrhage.

Alice Hosking1, Neshika Samarasekera1, Tom J Moullaali1

  • 1Centre for Clinical Brain Sciences (A.H., N.S., T.J.M., W.N.W., V.P.P., M.A.R., C.S., R.A.-S.S.), The University of Edinburgh, United Kingdom.

Stroke
|December 3, 2025
PubMed
Summary
This summary is machine-generated.

Hypertension is a key risk factor for intracerebral hemorrhage (ICH), but ICH causes are multifactorial. This review proposes a framework for a holistic approach to ICH treatment and prevention.

Keywords:
cerebral hemorrhagecerebral small vessel diseaseshypertensionrisk factorsstroke

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Area of Science:

  • Neurology
  • Vascular Medicine
  • Epidemiology

Background:

  • Hypertension is the primary risk factor for spontaneous intracerebral hemorrhage (ICH).
  • However, ICH development is multifactorial, involving coexisting medical conditions and other predisposing factors.
  • The term 'hypertensive ICH' is an oversimplification of complex causal pathways.

Purpose of the Study:

  • To present a comprehensive framework for attributing causes of ICH.
  • To integrate evidence on predisposing, underlying pathological, and precipitating factors.
  • To support holistic clinical management and identify research gaps.

Main Methods:

  • Systematic review of high-quality evidence.
  • Integration of clinical experience.
  • Development of a multifactorial causal framework for ICH.

Main Results:

  • Existing ICH classification systems often overlook predisposing and precipitating factors.
  • The proposed framework incorporates macrovascular, microvascular, and structural pathologies.
  • Identifies knowledge gaps in the transition from predisposing factors to pathologies and ICH occurrence.

Conclusions:

  • A multifactorial framework is essential for understanding ICH etiology.
  • This framework aids clinical practice in holistic ICH treatment and prevention.
  • Informs future research for a more comprehensive ICH classification system.