To determine the clinical and radiological characteristics, etiology, and outcome of ICH among young adults in our center.

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.

This was an IRB-approved retrospective chart review from January 2016 to December 2020.  Descriptive analysis was presented as percentage and means±SD.  Our analysis was limited by the small sample size and disproportionate representation of the male gender. The level of significance was set at 0.05.

A total of 121 patients were included, of whom 111(91.7%) were males; mean age was 26.7±7.4 years.  Almost three-fourths (72.5%) were Saudis, 71 (68.9%) were single, and 22 (18.2%) were students.  Majority, 87 (73.7%) presented with loss of consciousness, 23 (19.5%) had seizures at presentation, 14 (13.1%) had headache and 13 (11.8%) had vomiting.  103 (85.1%) presented within 6 hours of onset.  Traditional vascular risk factors, hypertension (5.8%), diabetes mellitus (2.5%), thrombophilia (0.8%) were uncommon.  Mean GCS at presentation was 7.8+/-4.5. When documented, initial NIHSS was more than 25 in 41 (59.4%) patients.  The commonest cause was trauma in 102 (84.3%) overall, females had more hemorrhages of unknown etiology (p<0.001).  Lobar hemorrhage was the commonest, 99 (83.2%); 93 (81.6%) had ICH volume of <30 mL, ventricular involvement was seen in 43 (35.8%).  Mean ICH score was 1.9±1.3. Most patients, 104 (86.0%) required ICU admission, females were less frequently intubated (p=0.016) and 29 (24.0%) required surgical intervention.  Pneumonia (50.4%), urinary tract infection (18.3%), sepsis (18.3%), and seizures (18.3%) were common complications.  Twenty-six (24.3%) patients died, whereas 82 (69.8%) were discharged home.

Trauma was the most common cause of intracerebral hemorrhage among young adults and was associated with high morbidity and mortality.  Lobar hemorrhage was the commonest site of ICH.