Background and Aims

Intracerebral haemorrhage (ICH) in young stroke patients can have crippling effects on the patient, their family and society with high morbidity and mortality. This investigation seeks to clarify the SMASH-U aetiology and prevalence of risk factors in this cohort.

Methods

Retrospective analysis of medical records of patients under the age of 55 with ICH admitted to two acute stroke units in North West London over 5 years. These patients were identified by ICD-10 coding. Haemorrhagic transformation was excluded.

Results

63 patients were identified. The median age was 44 (ranging between 27-55). 46 (73%) patients were male and 37 (59%) patients were from ethnic minorities.

Analysing the patients using the SMASH-U aetiological classification: 39 (62%) had hypertension induced ICH, 1 (1.5%) medications, 1 (1.5%) amyloid angiopathy, 10 (16%) structural, 9 (14%) systemic and 6 (10%) were of unknown aetiology.

39 (62%) patients had uncontrolled hypertension on admission, 33 (52%) patients had previously diagnosed hypertension and 7 (11%) patients had newly diagnosed hypertension on admission.

6 (10%) patients had known diabetes and 4 (6%) had newly diagnosed diabetes on admission.

13 (21%) patients were smokers, 7 (11%) take recreational drugs and 9 (14%) have excessive alcohol consumption.

8 (13%) patients had diagnosed hypercholesterolaemia on treatment and LDL levels were >1.8mmol/L in 31 (49%) patients.

Conclusions

ICH in our cohort of young stroke patients is predominantly secondary to hypertension. A large proportion of these had known uncontrolled hypertension. This study suggests a significant proportion of young strokes are preventable with modifiable risk factors.