Clinical Characteristics, Etiology, Radiological Features, and Outcomes of Intracerebral Hemorrhage in Young Adults at King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.

Background: Hypertension is the most common cause of intracerebral hemorrhage (ICH). The presentation, etiology, and outcome of ICH among young adults may vary compared to other age groups. The prior literature from our region has described a variety of etiologies with an inconsistent relationship to hypertension, which is the commonest cause of primary ICH in adults overall. Objective: We aimed to determine the demographic pattern, clinical presentation, underlying etiology, radiological characteristics, and outcome of ICH among young adults in our population. Methods: This was an IRB-approved chart review that included patients from January 2016 to December 2020. Descriptive young adults were defined as people between 15 and 45 years and arbitrarily divided into threee further age groups. A variety of demographic, clinical, and radiological features were compared among the subgroups and presented as descriptive and comparative analyses. Results: A total of 120 patients were included; 110 (91.7%) were males. The mean age was 26.8 ± 7.4 years. Majority, 86 (73.5%), presented with loss of consciousness; 22 (18.8%) had seizures, 14 (13.2%) had headaches, and 13 (11.9%) had vomiting. Traditional vascular risk factors, hypertension (5.8%) and diabetes mellitus (2.5%) were uncommon. Mean GCS was 7 ± 4. The commonest cause was trauma in 101 (84.2%) patients. Lobar hemorrhage was the commonest, 99 (83.2%); 92 (81.4%) had ICH volume < 30 mL, and ventricular involvement was seen in 43 (36.1%). Median ICH score was 2. Higher odds of mortality were observed among the oldest age group (OR 4.30, 95% CI 1.23-14.98, p = 0.022), higher ICH scores (OR 3.37, 95% CI 1.86-6.09, p < 0.001), ICH volume > 30 mL (OR 16.40, 95% CI 5.35-50.26, p < 0.001), ventricular extension (OR 5.60, 95% CI 2.14-14.68, p < 0.001), and nontraumatic ICH etiology (OR 3.59, 95% CI 1.26-10.26, p = 0.017). Conclusions: In our cohort, ICH was more common in young males; trauma being the leading cause of ICH. ICH resulted in significant morbidity and mortality in this population. Larger hemorrhages, ventricular involvement, and relatively older age were poor prognostic factors.