HEMORRAGIAS CEREBRALES NO TRAUMATICAS EN SUJETOS JOVENES

We review 42 patients younger than 45 years of age with non-traumatic intracerebral hemorrhage. Twenty-two patients were men and 20 were women. Age ranged form 15 to 44 years with a mean of 30 years. Computed tomography demonstrated 25 lobar, 5 putaminal, 5 pontine, 3 caudate, 2 cerebellar, and 2 ventricular hemorrages. Lobar hematomas were multiple in 3 patients. Eight patients had secondary intraventricular hemorrhage, and 5 patients had subarachnoid bleeding. Cerebral angiography was performed in 29 patients, and showed abnormal findings in 13 cases. The cause of bleeding was determined in 27 patients: 10 (24%) had arterial hypertension, 9 (21%) had arterio-venous malformations, 4 (10%) had intracranial aneurysms, one (2,5%) had idiopathic thrombocytopenic purpura, one (2,5%) had infectious endocarditis, one (2,5%) had venous thrombosis, and one (2,5%) had eclampsia. The cause of bleeding was not determined in 15 (36%) patients. Six patients died during the acute phase of the disease, and death was related to rebleeding in 5 cases (3 patients with aneurysms, one with arteriovenous malformation, and one with infectious endocarditis). The remaining patient died due to the primary bleeding (massive ventricular hemorrhage). Follow-up was possible in 20 of 36 survivors; of these, 4 experienced a rebleeding episode several months after the acute event (two patients with arterio-venous malformations, one with arterial hypertension, and one with idiopathic thrombocytopenic purpura). Such a rebleed was the cause of death in one patient. At the end of the follow-up, 13 patients were almost asymptomatic, and 6 were disabled. We conclude that young adults with intracerebral hemorrhage represent a heterogeneous group of patients with different bleeding sites, etiological factors, and prognosis. Every effort should be done to determine the cause of bleeding as specific therapy may reduce the incidence of rebleeding which is the single most important cause of morbidity and mortality in these cases.