title: Intracerebral hemorrhage in young patients from a tertiary neurology center in North India.
abstract: OBJECTIVE
  There is paucity of information on the etiology and predictors of outcome of intracerebral hemorrhage (ICH) in young patients which may have regional and ethnic differences. In this study, we report the etiology and predictors of outcome of ICH in young patients from North India.
  
  
  METHODS
  404 young patients with ICH (16-50 years) were retrospectively reviewed who were admitted in neurology service of a tertiary care teaching hospital in North India. The data were retrieved from the computerized hospital information service. The information about the demography, risk factors, clinical status, laboratory findings, CT/MRI features and angiography (CT, MRI or digital substraction) were noted. The etiology of ICH was ascertained based on clinical, laboratory and radiological findings. Outcome at 1 month was assessed using Glasgow Outcome Scale (GOS).
  
  
  RESULTS
  The mean age of the patients was 41.6 years and 23.8% were females. Hypertension (57.2%), hypocholesterolemia (33.7%), alcohol (15.8%) and anticoagulant (3.5%) were the important risk factors. The etiology of ICH was hypertension in 320 (79.2%), vascular malformation in 17 (4.2%), coagulopathy in 16 (4%), cerebral venous sinus thrombosis (CVST) in 9 (2.2%), thrombocytopenia in 3 (0.7%), vasculitis in 2 (0.5%) and cryptogenic in 37 (9.2%) patients. The patients with cryptogenic ICH were younger, had better Glasgow coma scale (GCS) on admission and good outcome compared those with known etiology. The most common location of ICH was basal ganglion and thalamus (71.3%). 102 (25%) patients died, 161 (39.9%) had poor and 141 (34.9%) had good outcome. Hypertensive ICH patients had frequent death or disability (P<0.001). On multivariate analysis, low GCS score (P <0.001), large ICH (P=0.01) and high leukocyte count on admission (P=0.03) were significantly related to the 1 month mortality.
  
  
  CONCLUSIONS
  Hypertension is the commonest cause of ICH in young Indian adults and its outcome is related to volume of ICH, GCS score and admission leukocyte count.
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Medical Sciences, Lucknow, India.
authors.forename: Jayantee
authors.initials: J
authors.lastname: Kalita
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Medical Sciences, Lucknow, India.
authors.forename: Gourav
authors.initials: G
authors.lastname: Goyal
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Medical Sciences, Lucknow, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Department of Neurology, Sanjay Gandhi Post Graduate Medical Sciences, Lucknow, India. Electronic address: drukmisra@rediffmail.com.
authors.forename: Usha K
authors.initials: UK
authors.lastname: Misra
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000639:trends; D055815:Young Adult
keywords: Etiology; Hypertension; Intracerebral hemorrhage; Outcome; Prognosis; Stroke; Young