Hypertension is a Leading Cause of Nontraumatic Intracerebral Hemorrhage in Young Adults |
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| Institution: | 2. University of Texas Health Sciences, San Antonio, Texas;3. Creighton University School of Medicine, Omaha, Nebraska;4. Department of Neurology, University of Florida College of Medicine, Gainesville, Florida;2. Sobolev Institute of Mathematics, Novosibirsk, Russia;3. Novosibirsk State University, Novosibirsk, Russia;4. Siberian Federal Biomedical Research Center, Ministry for Public Health Care of Russian Federation, Novosibirsk, Russia;2. Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, South Korea;3. Department of Neurology, Eulji General Hospital, Seoul, South Korea;4. Department of Neurology, Chung-Ang University Hospital, Seoul, South Korea;6. Department of Neurology, Soonchunhyang University Hospital, Seoul, South Korea;5. Department of Neurology, Eulji University Hospital, Daejeon, Republic Korea;11. Department of Biostatistics, Korea University, Seoul, South Korea;12. Health Insurance Review and Assessment Service, Wonju, South Korea;8. Department of Medicine, University of Toronto, Toronto, Ontario, Canada;10. St. Michael''s Hospital, Toronto, Ontario, Canada;2. College of medicine, King Saud Bin Abdul Aziz University for Health Sciences, Riyadh, Saudi Arabia;3. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia;4. Almaarrefa University, Ad Diriyah, Saudi Arabia;2. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota;3. Uniform Data System for Medical Rehabilitation, University at Buffalo, Department of Health Promotion, Daemen College, Amherst, New York;2. Faculty of Medicine, McGill University, Montreal, Quebec, Canada;3. Department of Medicine (Neurology), Hamilton General Hospital, McMaster University, Hamilton, Ontario, Canada |
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| Abstract: | Objective: To evaluate the etiology and discharge outcome of nontraumatic intracerebral hemorrhage (ICH) in young adults admitted to a comprehensive stroke center. Methods: A retrospective chart review was performed on patients with a discharge diagnosis of nontraumatic ICH admitted from 7/1/2011 to 6/30/2016. Data was collected on demographics, clinical history, ICH score, hemorrhage location, do-not-resuscitate (DNR) orders, likely etiology, and discharge disposition. Categorical data was reported as percentage. Chi-squared test was performed to evaluate association of location of ICH, etiology of ICH, and ICH score with the discharge outcome. Results: Sixty-three patients met the study criteria, with mean age 35.4 ± 6.4 years including 26 (41%) women and 40 (64%) whites. Headache (65%) and change in mental status (48%) were the most common presenting symptoms. Hemorrhage was most commonly seen in the deep structures in 29 (46%) patients followed by lobar ICH in 14 (22%) patients. The most common etiology of ICH was hypertension in 23 (37%) patients, followed by vascular abnormalities in 18 (29%) patients. Forty-two (67%) had good outcome defined as discharge to home (n = 25) or acute inpatient rehabilitation (n = 17). Twenty-one (33%) patients had bad outcome with discharge to skilled nursing facility (n = 6), hospice (n = 1) or died in the hospital (n = 14). Hospital DNR orders were noted in 11 (18%) patients. Higher ICH score (P < .0001) and use of DNR orders (P < .0001) were associated with bad outcome. All 11 patients with DNR orders died in the hospital. Location or etiology of hemorrhage were not associated with discharge outcome. Conclusions: Hypertension, a modifiable risk factor, is a major cause of nontraumatic ICH in young adults. Aggressive management of hypertension is essential to halt the recent increased trends of ICH due to hypertension. Early DNR orders may need to be cautiously used in the hospital. |
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