Matthew Broderick1, Luca Rosignoli2, Abhishek Lunagariya3, Nandakumar Nagaraja4. 1. University of Pennsylvania, Philadelphia, Pennsylvania. 2. University of Texas Health Sciences, San Antonio, Texas. 3. Creighton University School of Medicine, Omaha, Nebraska. 4. Department of Neurology, University of Florida College of Medicine, Gainesville, Florida. Electronic address: nandakumar.nagaraja@neurology.ufl.edu.
Abstract
OBJECTIVE: To evaluate the etiology and discharge outcome of nontraumatic intracerebral hemorrhage (ICH) in young adults admitted to a comprehensive stroke center. METHODS: A retrospective chart review was performed on patients with a discharge diagnosis of nontraumatic ICH admitted from 7/1/2011 to 6/30/2016. Data was collected on demographics, clinical history, ICH score, hemorrhage location, do-not-resuscitate (DNR) orders, likely etiology, and discharge disposition. Categorical data was reported as percentage. Chi-squared test was performed to evaluate association of location of ICH, etiology of ICH, and ICH score with the discharge outcome. RESULTS: Sixty-three patients met the study criteria, with mean age 35.4 ± 6.4 years including 26 (41%) women and 40 (64%) whites. Headache (65%) and change in mental status (48%) were the most common presenting symptoms. Hemorrhage was most commonly seen in the deep structures in 29 (46%) patients followed by lobar ICH in 14 (22%) patients. The most common etiology of ICH was hypertension in 23 (37%) patients, followed by vascular abnormalities in 18 (29%) patients. Forty-two (67%) had good outcome defined as discharge to home (n = 25) or acute inpatient rehabilitation (n = 17). Twenty-one (33%) patients had bad outcome with discharge to skilled nursing facility (n = 6), hospice (n = 1) or died in the hospital (n = 14). Hospital DNR orders were noted in 11 (18%) patients. Higher ICH score (P < .0001) and use of DNR orders (P < .0001) were associated with bad outcome. All 11 patients with DNR orders died in the hospital. Location or etiology of hemorrhage were not associated with discharge outcome. CONCLUSIONS: Hypertension, a modifiable risk factor, is a major cause of nontraumatic ICH in young adults. Aggressive management of hypertension is essential to halt the recent increased trends of ICH due to hypertension. Early DNR orders may need to be cautiously used in the hospital.
OBJECTIVE: To evaluate the etiology and discharge outcome of nontraumatic intracerebral hemorrhage (ICH) in young adults admitted to a comprehensive stroke center. METHODS: A retrospective chart review was performed on patients with a discharge diagnosis of nontraumatic ICH admitted from 7/1/2011 to 6/30/2016. Data was collected on demographics, clinical history, ICH score, hemorrhage location, do-not-resuscitate (DNR) orders, likely etiology, and discharge disposition. Categorical data was reported as percentage. Chi-squared test was performed to evaluate association of location of ICH, etiology of ICH, and ICH score with the discharge outcome. RESULTS: Sixty-three patients met the study criteria, with mean age 35.4 ± 6.4 years including 26 (41%) women and 40 (64%) whites. Headache (65%) and change in mental status (48%) were the most common presenting symptoms. Hemorrhage was most commonly seen in the deep structures in 29 (46%) patients followed by lobar ICH in 14 (22%) patients. The most common etiology of ICH was hypertension in 23 (37%) patients, followed by vascular abnormalities in 18 (29%) patients. Forty-two (67%) had good outcome defined as discharge to home (n = 25) or acute inpatient rehabilitation (n = 17). Twenty-one (33%) patients had bad outcome with discharge to skilled nursing facility (n = 6), hospice (n = 1) or died in the hospital (n = 14). Hospital DNR orders were noted in 11 (18%) patients. Higher ICH score (P < .0001) and use of DNR orders (P < .0001) were associated with bad outcome. All 11 patients with DNR orders died in the hospital. Location or etiology of hemorrhage were not associated with discharge outcome. CONCLUSIONS:Hypertension, a modifiable risk factor, is a major cause of nontraumatic ICH in young adults. Aggressive management of hypertension is essential to halt the recent increased trends of ICH due to hypertension. Early DNR orders may need to be cautiously used in the hospital.
Authors: J E Delgado Almandoz; P W Schaefer; J N Goldstein; J Rosand; M H Lev; R G González; J M Romero Journal: AJNR Am J Neuroradiol Date: 2010-06-25 Impact factor: 3.825
Authors: Jessica McFarlin; Claire E Hailey; Wenjing Qi; Peter G Kranz; Weiping Sun; Wei Sun; Marisa Gray; Nicolas Kon Kam King; Daniel T Laskowitz; Michael L James Journal: J Palliat Med Date: 2018-04-20 Impact factor: 2.947
Authors: Loes Ca Rutten-Jacobs; Noortje Am Maaijwee; Renate M Arntz; Hennie C Schoonderwaldt; Lucille D Dorresteijn; Ewoud J van Dijk; Frank-Erik de Leeuw Journal: J Neurol Date: 2014-08-20 Impact factor: 4.849
Authors: José L Ruiz-Sandoval; Samuel Romero-Vargas; Erwin Chiquete; Juan J Padilla-Martínez; Jorge Villarreal-Careaga; Carlos Cantú; Antonio Arauz; Fernando Barinagarrementería Journal: Stroke Date: 2006-11-09 Impact factor: 7.914
Authors: Charlotte Jj van Asch; Merel Ja Luitse; Gabriël Je Rinkel; Ingeborg van der Tweel; Ale Algra; Catharina Jm Klijn Journal: Lancet Neurol Date: 2010-01-05 Impact factor: 44.182
Authors: Darin B Zahuranec; Lynda D Lisabeth; Brisa N Sánchez; Melinda A Smith; Devin L Brown; Nelda M Garcia; Lesli E Skolarus; William J Meurer; James F Burke; Eric E Adelman; Lewis B Morgenstern Journal: Neurology Date: 2014-05-16 Impact factor: 9.910
Authors: Aleksandra Stanisavljevic; Joseph M Schrader; Xiaoyue Zhu; Jennifer M Mattar; Ashley Hanks; Feng Xu; Mark Majchrzak; John K Robinson; William E Van Nostrand Journal: Front Neurosci Date: 2022-03-15 Impact factor: 4.677