Hypertensive intracerebral hemorrhage in young people: previously unnoticed age-related clinical differences.
OBJECTIVE
Hypertensive intracerebral hemorrhage (ICH) in young people has been the object of only succinct analyses. Therefore, it is unclear whether extrapolation of the information obtained from older patients is also valid for the young. Here we describe young persons with hypertensive ICH and compare them with their older counterparts to determine whether age-related clinical differences exist.


METHODS
From 1988 to 2004, we studied 35 consecutive young patients with ICH (60% men; mean age, 33 years; range, 15 to 40 years) for whom the etiology of the brain hemorrhage was hypertension. For clinical comparisons, sex-matched persons with hypertensive ICH, aged >40 years, were randomly selected by a factor of 3:1 (n=105).


RESULTS
Essential hypertension was present in 26 (74%) young patients and secondary hypertension in 9 (26%), with renovascular hypertension being the most common cause (n=5, 55%). Compared with older patients, the young had higher blood pressures, smaller hemorrhage volumes, lower rates of ventricular extensions (for all, P<0.05), and different distribution pattern of ICHs (P=0.05), without cerebellar and lobar locations. Thirty-day mortality was markedly lower in the young than in older persons (P=0.001), nevertheless at the expense of more incapacitating disabilities.


CONCLUSIONS
Young people presenting with hypertensive ICH differ in clinical characteristics and have a different prognosis when compared with their older counterparts. These findings suggest underlying age-related differences in disease pathogenesis.
Ruiz-Sandoval
José L
JL
Servicio de Neurología y Neurocirugía, Hospital Civil de Guadalajara Fray Antonio Alcalde, Hospital 278, Guadalajara, Jalisco, México CP44280. jorusan@mexis.com
Romero-Vargas
Samuel
S
Chiquete
Erwin
E
Padilla-Martínez
Juan J
JJ
Villarreal-Careaga
Jorge
J
Cantú
Carlos
C
Arauz
Antonio
A
Barinagarrementería
Fernando
F
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000375:Aging / Q000473:pathology*; D005260:Female; D006801:Humans; D020299:Intracranial Hemorrhage, Hypertensive / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome