By Matthew E. Fink, MD

Professor and Chairman, Department of Neurology, Weill Cornell Medical College, Neurologist-in-Chief, New York Presbyterian Hospital

Dr. Fink reports no financial relationships relevant to this field of study.

Source: Koivunen RJ, et al. Intracerebral hemorrhage at young age: Long-term prognosis. Eur J Neurol 2015;22:1029-1037.

Intracerebral hemorrhage (ICH) accounts for 10-20% of all strokes in North America and Europe, with an overall incidence of 25 cases per 100,000 population annually. It occurs most commonly in the elderly, has a high early mortality, and a high proportion of survivors are left with serious functional impairments. There is no specific treatment, and in the acute phase, treatment is supportive. In a recent meta-analysis, the 5-year mortality in a general population of all ages was reported as 71% (J Neurol Neurosurg Psychiatry; 2014;85:660-667), and only 22% of patients were independent at 12 months. In this study, the authors evaluated the long-term survival and recovery of 268 1-month survivors ages 16-49 years to assess the prognosis of ICH in the younger group.

One-year survival was 98.1% in those who survived the first month, five-year survival was 93.2%, and 10-year survival was 88.8%. Increased mortality was associated with age, intraventricular hematoma extension, male sex, and diabetes. Poor functional outcome was present in 49% of the entire group, and was associated with a high initial stroke severity scale (NIHSS) and the presence of intraventricular hemorrhage. The etiology of the hemorrhage did not play a significant role in either mortality or long-term impairments. Of note, in 131 patients who could be followed long-term, 84% were living in their homes without requiring assistance outside of their immediate family. Post-ICH epilepsy occurred in 22.9% of patients. There was no association between the development of post-ICH epilepsy and surgical evacuation of the hematoma. Overall, young adults with ICH have a better long-term prognosis then the elderly, but they continue to have a high rate of serious neurological impairment, approximating 50%.