J Cerebrovasc Endovasc Neurosurg.  2024 Sep;26(3):274-283. 10.7461/jcen.2024.E2023.11.001.

Contributing factors of spontaneous intracerebral hemorrhage development in young adults

• Jang JS
• Park Ys

• KMID: 2559437
• DOI: http://doi.org/10.7461/jcen.2024.E2023.11.001

Abstract

Objective
The incidence of spontaneous intracerebral hemorrhage (ICH) in young people is relatively low; however, it leads to devastating lifelong neurologic deficits. We focused on spontaneous ICH occurring in young adults between 30 and 50 years of age.
Methods
We retrospectively reviewed the records of 139 patients, aged 30–50 years, diagnosed with spontaneous ICH between 2011 and 2021. Cases of ICH attributable to discernible causative lesions were excluded. Demographic data, laboratory results, image findings, and clinical outcome were analyzed.
Results
After exclusions, 73 patients were included in this study. Common characteristics among the study patients included male sex (83.6%), high body mass index (>25 kg/m², 45.8%), smoking history (47.2%), heavy alcohol consumption (30.6%), previously diagnosed hypertension (41.1%), high serum triglyceride level (>150 mg/dL, 33.3%), and microbleeds or white matter changes observed on magnetic resonance images (51.3%). In the multivariate analysis, previously diagnosed hypertension was the sole significant risk factor for cerebral small vessel (OR 7.769, P=0.031). Age, brain stem location, Glasgow Coma Scale score at admission, and hematoma volume were associated with poor outcomes.
Conclusions
Hypertension, obesity, smoking, and cerebral small vessel disease were important factors associated with non-lesional spontaneous intracerebral hemorrhage in young patients. Radiologic changes corresponding to cerebral small vessel disease appeared in young patients (in their 30s) and they were associated with hypertension.

Keyword

Cerebral hemorrhage; Cerebral small vessel disease; Hypertension; Young adult

Figure

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  Fig. 1. Seventy-three patients were included in this study after applying the inclusion and exclusion criteria. AVM, arteriovenous malformation; CM, cavernous malformation; DVA, developmental venous anomaly; MCA, middle cerebral artery

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  Fig. 2. Neurologic outcomes at discharge: 39.7% fully recovered (GOS 5), 8.2% in a vegetative state (GOS 4), 13.7% required support for daily living (GOS 3), 19.2% had some deficits but were able to independently carry out activities of daily living (GOS 2), and 39.7% died (GOS 1). GOS: Glasgow outcome scale

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  Fig. 3. Hematoma locations. 54.8% in the deep brain, 26.0% in the lobar location, 11.0% in the brain stem, and 8.2% in the cerebellum.

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