title: Incidence, risk factors, etiology, severity and short-term outcome of non-traumatic intracerebral hemorrhage in young adults.
abstract: OBJECTIVE
  Intracerebral hemorrhage (ICH) is a common and severe form of stroke but is scarcely studied in young adults. Our aim was to study risk factors, clinical presentation and early mortality of ICH in the young and compare these features with older patients.
  
  
  METHODS
  All consecutive patients aged between 16 and 49 diagnosed with a first-ever ICH at the Departments of Neurology or Neurosurgery of the Helsinki University Central Hospital between January 2000 and March 2010 (n = 336) were analyzed retrospectively. Comparisons were performed amongst demographic subgroups and with patients over 49 years of age enrolled between January 2005 and March 2010 (n = 921).
  
  
  RESULTS
  In the young patients, median age was 42 years (interquartile range 34-47), 59.5% were male, and annual incidence was 4.9 (95% confidence interval 4.5-5.3) per 100 000. The most prevalent risk factors were hypertension (29.8%) and smoking (22.3%). Compared with older patients hypertensive microangiopathy was less common (25.0% vs. 34.3%, P = 0.002) and structural lesions more common (25.0% vs. 4.9%, P < 0.001) assumed etiologies of ICH. The cause remained elusive in 32.1% of all young patients and in 22.5% of those who underwent magnetic resonance imaging and any angiography (n = 89, P = 0.023). Three-month mortality rate was lower in young patients compared with older ones (17.0% vs. 32.7%, P < 0.001). Hematoma volumes were similar across all ages (P = 0.324) and independently predicted mortality in older patients but not in the young.
  
  
  CONCLUSIONS
  Intracerebral hemorrhage (ICH) in the young appears less fatal and has a different spectrum of causes and factors associated with short-term mortality than for the elderly.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: R-J
authors.initials: RJ
authors.lastname: Koivunen
authors.forename: J
authors.initials: J
authors.lastname: Satopää
authors.forename: A
authors.initials: A
authors.lastname: Meretoja
authors.forename: D
authors.initials: D
authors.lastname: Strbian
authors.forename: E
authors.initials: E
authors.lastname: Haapaniemi
authors.forename: M
authors.initials: M
authors.lastname: Niemelä
authors.forename: T
authors.initials: T
authors.lastname: Tatlisumak
authors.forename: J
authors.initials: J
authors.lastname: Putaala
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D059345:Cerebral Small Vessel Diseases / Q000150:complications; D005260:Female; D006406:Hematoma / Q000473:pathology; D006801:Humans; D006973:Hypertension / Q000150:complications*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects*; D055815:Young Adult
keywords: etiology; intracerebral hemorrhage; outcome; risk factors; stroke in young adults; stroke severity