Intracerebral hemorrhage in young people - Analysis of risk factors, location, causes, and prognosis

Background and Purpose-The frequency of intracerebral hemorrhages (ICHs) in people aged less than or equal to 40 years has been poorly studied. We inv estigated the incidence, causes, locations, and prognosis of ICH in young p atients. Methods-We evaluated all consecutive patients with neuroimaging evidence or pathological confirmation of symptomatic ICH. We excluded patients with pr imary subarachnoid or traumatic hemorrhage, past evidence of vascular malfo rmation, or brain tumor. We analyzed the risk factors, number, locations, a nd causes of ICH, and final outcome measured by the modified Glasgow Outcom e Scale. Results-We retrospectively evaluated 200 patients (mean age, 27 years; rang e, 15 to 40 years). The most frequent risk factors were tobacco use (20%), hypocholesterolemia (35%), hypertension, (13%), and alcohol use (10%). The locations of ICH were lobar (55%), basal ganglia/internal capsule (22%), an d others (24%). The most common causes of ICH were vascular malformations ( 49%), including cavernous angioma, and hypertension (11%). Cryptogenic ICH was considered in 15%. Other causes included cerebral venous thrombosis (5% ) and sympathomimetic drug use (4%). The majority of patients with ICH that resulted from hypertension were aged >31 years (odds ratio, 3.48), and tho se with ICH that resulted from arteriovenous malformations were aged <20 ye ars (odds ratio, 2.80). The final outcome was considered favorable in 60%, Conclusions-ICHs in young people are mainly lobar in location and result fr om vascular malformation. Hypertension causes most cases in which the ICH i s located in the basal ganglia. Mortality and morbidity in the acute phase are low and are related to hypertension as the cause of ICH.