Hassan Mohamed Sheikh, Bakir Ahmet, Sidow Nor Osman, Erkok Umut, Ahmed Said Abdirahman, Abshir Maryan Dahir, Köksal Ayhan Ayhan
Department of Neurology, Mogadishu Somalia Turkish Training and Research Hospital, Mogadishu, Somalia.
Faculty of Medicine and Surgery, Mogadishu University, Mogadishu, Somalia.
Int J Gen Med. 2024 Jun 25;17:2865-2875. doi: 10.2147/IJGM.S470314. eCollection 2024.
Spontaneous Intracerebral hemorrhage (ICH) in young patients is less common and not well studied compared to ICH in older patients. The etiology, risk factors and outcome of ICH in young patients may have regional and ethnic differences. The study aims to investigate the clinical characteristics, risk factors, etiology and outcome of spontaneous intracerebral hemorrhage in young adults in Somalia.
The study enrolled 168 young patients with ICH (16-50 years) admitted to the neurology department of a tertiary hospital from 2019 to 2022. The information about the demographic details, documented ICH risk factors, etiology and patients' clinical status were retrieved. The etiology of ICH was determined based on clinical, laboratory and radiological findings. Intra-hospital survival status and associated factors were assessed.
The mean age of the patients was 35±8.6 years. 99 (59%) of patients were male while 69 (41%) were females. Hypertension 48 (29%) was the most common risk factor, followed by substance abuse. Hypertensive hemorrhage was the most common etiology of ICH 60 (35.7%), followed by cerebral venous thrombosis (CVT) 5(15%), substance abuse 23 (13.7%) and arteriovenous malformation (AVM) in 10 (6%). AVM, CVT, cavernoma, eclampsia, substance abuse and cryptogenic etiology were more common in the 2nd and 3rd decades whereas hypertension was more common in the 4th and 5th decade. Intrahospital mortality was 28% in this study. Factors predicting intrahospital mortality were hematoma volume of greater than 30mL, thrombolytic etiology, brainstem ICH location, substance abuse related etiology, presence of associated mass effect, low GCS score on admission, high systolic blood pressure on admission, and the presence of chronic renal failure.
In this study, hypertension, substance abuse, CVT and vascular malformation are the leading causes of ICH in young adults. Intracerebral hemorrhage in the young has different spectrum of etiologies and factors associated with short-term mortality compared to older patients.
与老年患者的脑出血相比，年轻患者的自发性脑出血较少见且研究不足。年轻患者脑出血的病因、危险因素和预后可能存在地区和种族差异。本研究旨在调查索马里年轻成年人自发性脑出血的临床特征、危险因素、病因和预后。
本研究纳入了2019年至2022年在一家三级医院神经科住院的168例年轻脑出血患者（16 - 50岁）。收集了人口统计学细节、记录的脑出血危险因素、病因和患者临床状况的信息。根据临床、实验室和影像学检查结果确定脑出血的病因。评估了院内生存状况及相关因素。
患者的平均年龄为35±8.6岁。99例（59%）患者为男性，69例（41%）为女性。高血压48例（29%）是最常见的危险因素，其次是药物滥用。高血压性脑出血是脑出血最常见的病因，共60例（35.7%），其次是脑静脉窦血栓形成（CVT）5例（15%）、药物滥用23例（13.7%）和动静脉畸形（AVM）10例（6%）。AVM、CVT、海绵状血管瘤、子痫、药物滥用和隐源性病因在第二和第三个十年更为常见，而高血压在第四和第五个十年更为常见。本研究中院内死亡率为28%。预测院内死亡率的因素包括血肿体积大于30mL、溶栓病因、脑干脑出血部位、药物滥用相关病因、存在相关占位效应、入院时格拉斯哥昏迷评分低、入院时收缩压高以及存在慢性肾衰竭。
在本研究中，高血压、药物滥用、CVT和血管畸形是年轻成年人脑出血的主要原因。与老年患者相比，年轻人脑出血的病因谱不同，且与短期死亡率相关的因素也不同。
