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Nontraumatic intracerebral hemorrhage in young adult
Insights
Nontraumatic intracerebral hemorrhage (ICH) in young adults has multiple causes, primarily arterial hypertension and arteriovenous malformations. Early diagnosis and blood pressure control are crucial for improving outcomes in these patients.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Neurology
Background:
- Nontraumatic intracerebral hemorrhage (ICH) is a serious condition, particularly in young adults.
- Identifying the underlying causes of ICH in this demographic is critical for effective management and prognosis.
Purpose of the Study:
- To review the causes, diagnostic methods, and outcomes of nontraumatic ICH in patients aged 15 to 40 years.
- To emphasize the importance of early diagnosis and management strategies for young ICH patients.
Main Methods:
- Retrospective review of 91 patients with nontraumatic ICH (1991-1994).
- Analysis of presumed causes, including arterial hypertension and arteriovenous malformations.
- Evaluation of diagnostic arteriography and patient outcomes (recovery and survival rates).
Main Results:
- Arterial hypertension (60% of putaminal) and ruptured arteriovenous malformations (26.5% of lobar) were leading causes.
- Arteriography was diagnostic in 23 of 36 patients.
- Survival rates at 1 year were 76.9%; 32% achieved good recovery, 35% fair, 15% poor, and 18% died.
Conclusions:
- Arterial hypertension is a significant cause of ICH in young adults, underscoring the need for regular blood pressure monitoring.
- Early arteriography, especially for lobar hemorrhages, is valuable for etiological diagnosis.
- Drug abuse should be considered as a potential cause, even with incomplete history.
Abstract:
We reviewed our experience with 91 patients aged 15 to 40 years with nontraumatic intracerebral hemorrhage (ICH) from January 1991 through December 1994 and found more than ten presumed causes for the nontraumatic ICH in 68 patients (74.7%). The leading two causes were arterial hypertension and ruptured arteriovenous malformations. Most cases of ICH were lobar and putaminal. Of the lobar hemorrhages, 26.5% resulted from ruptured arteriovenous malformations. Of the putaminal hemorrhages, we found 60% resulted from arterial hypertension. Arteriography was performed in 36 patients, and was diagnostic in 23. A history of drug abuse was found in 3 patients. The survival rate was 82.4% at 1 month, 78.0% at 6 months and 76.9% at 1 year. The in-hospital survival rate of all patients in this study was 78.0%. The outcome was determined at one month after hemorrhage. Thirty-two percent of our cases made a good recovery (back to normality), 35% a fair recovery (moderately disabled but independent), 15% a poor recovery (severely disabled and dependent), and 18% died. Arterial hypertensive hemorrhage accounted for almost 30% of our young ICH patients which reminds us of the importance of regular control of blood pressure even in the young adults. Arteriography performed early in the course of nontraumatic ICH in young adults, particularly in lobar hemorrhages, is a valuable adjunct in determining cause. Although the details of history of drug abuse were frequently lacking, physicians should keep this abuse in mind as a possible cause for nontraumatic ICH.