title: Clinical characteristics and outcome of intracerebral hemorrhage in young adults.
abstract: Data on determinants of prognosis after intracerebral hemorrhage (ICH) in young adults are scarce. Our aim was to identify clinical determinants of prognosis after ICH in adults aged 18-50. We investigated 98 consecutive patients with an ICH, aged 18-50 years, admitted to our hospital between 1980 and 2010. Collected ICH characteristics included presenting symptoms, etiology, location, severity and Glasgow Coma Scale (GCS). Outcomes were case-fatality (death within 30 days), poor functional outcome (modified Rankin Scale >2), long-term mortality and recurrent ICH. We assessed discriminatory power of factors associated with case-fatality [area under receiver operating curve (AUC)]. Case-fatality was 20.4 % (n = 20) and well predicted by the GCS (AUC 0.83). Among 30-day survivors, a poor functional outcome at discharge was present in 51.3 %. During a mean follow-up of 11.3 years mortality was only increased in patients aged 40-50 years [standardized mortality ratio 4.8 (95 % CI 2.3-8.6)], but not in patients aged 18-40 years. Recurrent ICH occurred in 6 patients [10-year cumulative incidence 12.2 % (95 % CI 1.5-22.9 %)], all with the index ICH attributable to structural vascular malformations. Prognosis after ICH in young adults is poor, mainly due to high case-fatality, that is well predicted by the GCS. An exception is 30-day survivors <40 years, who have a similar risk of dying as the general population. Recurrence risk is especially present in patients with structural vascular malformations, whereas risk seems to be very low in other patients.
authors.affiliation: Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands, lr406@medschl.cam.ac.uk.
authors.forename: Loes Ca
authors.initials: LC
authors.lastname: Rutten-Jacobs
authors.forename: Noortje Am
authors.initials: NA
authors.lastname: Maaijwee
authors.forename: Renate M
authors.initials: RM
authors.lastname: Arntz
authors.forename: Hennie C
authors.initials: HC
authors.lastname: Schoonderwaldt
authors.forename: Lucille D
authors.initials: LD
authors.lastname: Dorresteijn
authors.forename: Ewoud J
authors.initials: EJ
authors.lastname: van Dijk
authors.forename: Frank-Erik
authors.initials: FE
authors.lastname: de Leeuw
mesh_terms: D000328:Adult; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D055815:Young Adult