Spontaneous intracerebral hemorrhage (ICH) accounts for up to 20% of all strokes. In older patients, these have a worse prognosis than do ischemic strokes. However, limited data exist for patients younger than 50 years of age. This study was designed to identify the clinical determinants of the short- and long-term prognosis after ICH in young adults.

Consecutive patients, ages 18 to 50 years, all with ICH and admitted to a Dutch medical center between 1980 and 2010, were studied. Patients were contacted for follow-up assessments. The Kaplan-Meier survival status was calculated until death or April of 2013. This result was compared with expected mortality of the Netherlands population, stratified by age, gender and calendar year.

Of the 98 patients the most common etiologic diagnosis among patients under 40 years of age was arteriovenous malformation, while that of patients ages 40 to 50 years was hypertension. Chance of survival up to 90 days after stroke differed significantly between those with Glasgow Coma Scale scores of three, four to nine and 10 - 15 (P<0.001). Among those who survived for at least 30 days, 51.3% had a poor functional outcome at discharge. The all-cause, 20-year, cumulative mortality in all patients was 31.4%. The long-term risk of death among 30-day survivors was greater than that of age and gender matched individuals for patients ages 40 to 50 years, but not for those less than 40 years of age. The five- and 10-year cumulative incidences of recurrent ICH were 8.4% and 12.2%, respectively. Recurrence was higher among those with structural vascular malformations.

This study of ICH in young adults found that, among the 30 day survivors under 40 years of age, these patients have a similar risk of dying compared with the general population.