Risk Factors, Site and Outcome of Intracranial Hemorrhage in Young Adults

Authors

  • Salma Haji
  • Munir Afzal

Keywords:

Lobar, Arteriovenous malformation, Hypertension, Intracranial hemmorhage

Abstract

Objective: To determine risk factors and the site and outcome of intracranial Hemorrhage in young adults.

Methodology: This cross-sectional observational study was conducted in neuromedicine ward 28 at Jinnah Postgraduate Medical center, Karachi, from September 2020 to August 2023. All emergency patients with evidence of Neuroimaging and symptomatic intracranial Hemorrhage were included. Using the Glasgow outcome scale, we investigated the risk factors, cause, location and prognosis of intracranial hemorrhage. Traumatic hemorrhages, primary sub-arachnoid hemorrhage and brain tumors were excluded.

Results: 72 patients aged 16 to 40 years were included. Forty were Male patients, 55%, and 32 were female patients, 45%. The risk factors for intracranial hemorrhages were hypertension 60/72 (83.33%), ArterioVenous malformation 7/ 72 (9.33%), Cryptogenic 2/72 (2.77%), drug-induced 1/72 (1.38%), hypocholesterolemia 1/72(1.38%) and tobacco and alcohol intake 1/72 (1.38%). In 36/72 (50%), the location was basal ganglia, 25/72(34.72%) was in lobar, 7/72 (9.72%) in Subarachnoid, and 4/72 (5.55%) in other locations. The outcome was favorable in 65/72 (90.27%) patients.

Conclusion: It has been found that hypertension, even in adults, is the leading risk factor for intracranial Hemorrhage below 40 years of age. Intracranial Hemorrhage is primarily present in the basal ganglia. AV malformation is the second most common risk factor in adults at our setup, and the outcome is good in adults. Drug, smoking, and hypocholesterolemia are less common causes of intracranial Hemorrhage in young adults.

References

Ruíz-Sandoval JL, Cantú C, Barinagarrementeria F. Intracerebral hemorrhage in young people: analysis of risk factors, location, causes, and prognosis. Stroke. 1999; 30(3): 537-41. doi: 10.1161/01.str.30.3.537.

Morotti A, Goldstein JN. Diagnosis and management of acute intracerebral Hemorrhage. Emerg Med Clin North AM. 2016; 34(4): 883-899. doi: 10.1016/j.emc.2016.06.010.

Ruiz-Sandoval JL, Romero-Vargas S, Chiquete E, Padilla-Martínez JJ, Villarreal-Careaga J, Cantú C, Arauz A et al. Hypertensive intracerebral hemorrhage in young people: previously unnoticed age-related clinical differences. Stroke. 2006; 37(12): 2946-50. doi: 10.1161/01.STR.0000248766.22741.4b. Epub 2006 Nov 9.

Huang WY, Saver JL, Wu YL, Lin CJ, Lee M, Ovbiagele B. Frequency of intracranial Hemorrhage with low-dose aspirin in individuals without symptomatic cardiovascular Disease: a systematic review and meta-analysis. JAMA Neurol. 2019; 76(8): 906-14. doi: 10.1001/jamaneurol.2019.1120.

Capodanno D, Angiolillo DJ. Aspirin for primary cardiovascular risk prevention and beyond in diabetes mellitus. Circulation. 2016; 134(20): 1579-94. doi: 10.1161/CIRCULATIONAHA.116.023164. Epub 2016 Oct 11.

Lei H, Gao Q, Liu SR, Xu J. The benefit and safety of aspirin for primary prevention of ischemic stroke: a meta-analysis of randomized trials. Front Pharmacol. 2016; 7: 440. doi: 10.3389/fphar.2016.00440.

Rajashekar D, Liang JW. Intracerebral Hemorrhage. In: StatPearls[Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.

Rigamonti D, Drayer BP, Johnson PC, Hadley MN, Zabramski J, Spetzler RF. The MRI appearance of cavernous malformations (angiomas). J Neurosurg. 1987; 67(4): 518-24. doi: 10.3171/jns.1987.67.4.0518.

Lee SU, Kim T, Kwon OK, Bang JS, Ban SP, Byoun HS, Oh CW. Trends in the incidence and treatment of cerebrovascular diseases in Korea: part I. Intracranial Aneurysm, Intracerebral Hemorrhage, and Arteriovenous Malformation. J Korean Neurosurg Soc. 2020; 63(1): 56-68. doi: 10.3340/jkns.2018.0179. Epub 2019 May 8.

Altschul D, Smith ML, Grant SP. Medscape [Internet]. 25 April 2022. Intracranial arteriovenous Malformation, Cavernous Angioma, Venous Angioma and Capillary Telangiectasia. Available from: https://emedicine.medscape.com/article/252426-overview.

Gaillard F, Baba Y, Bell D. Radiopaedia [Internet]. 19 Oct 2021. Cerebellum. Available from: https://radiopaedia.org/articles/cerebellum.

Jena M. Narayana Health [Internet]. 2 April 2020. Hypertensive Intracranial Hemorrhage. Available from: https://www.narayanahealth.org/blog/hypertensive-intracranial-haemorrhage/

Le NK, Kesayan T, Chang JY, Rose DZ. Cryptogenic intracranial hemorrhagic strokes associated with hypervitaminosis E and acutely elevated ?-tocopherol levels. J Stroke Cerebrovasc Dis. 2020; 29(5): 104747. doi: 10.1016/j.jstrokecerebrovasdis.2020.104747. Epub 2020 Mar 6.

Sharma R, Matsushita K, Wu A, Jack Jr CR, Griswold M, Mosley TH et al. Common medications and intracerebral Hemorrhage: The ARIC study. J Am Heart Assoc. 2021; 10(5): e014270. doi: 10.1161/JAHA.120.014270. Epub 2021 Feb 15.

Cho S, Rehni AK, Dave KR. Tobacco use: a major risk factor of intracerebral Hemorrhage. J Stroke. 2021; 23(1): 37-50. doi: 10.5853/jos.2020.04770. Epub 2021 Jan 31.

Hartmann A, Mast H, Mohr JP, Koennecke HC, Osipov A, Pile-Spellman J et al. Morbidity of intracranial Hemorrhage in patients with cerebral arteriovenous malformation. Stroke. 1998; 29(5): 931-4. doi: 10.1161/01.str.29.5.931.

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Published

28-06-2024

How to Cite

1.
Salma Haji SH, Munir Afzal MA. Risk Factors, Site and Outcome of Intracranial Hemorrhage in Young Adults. J Liaq Uni Med Health Sci [Internet]. 2024 Jun. 28 [cited 2024 Nov. 22];23(02):151-4. Available from: http://ojs.lumhs.edu.pk/index.php/jlumhs/article/view/1260