Recently, there has been a gradual rise in the number of young patients suffering from intracerebral hemorrhage. This condition occurs unexpectedly, and even if patients recover, it often leaves them with significant long-term disabilities.
Let’s examine the causes, risk factors, and preventive measures for intracerebral hemorrhage.
Strokes typically affect individuals over 60, but there has been a rise in cases of intracerebral hemorrhage (ICH) among those in their 30s and 40s. This shift is largely attributed to lifestyle changes leading to increased rates of obesity, hyperlipidemia, and hypertension, starting in childhood and continuing into adulthood.
In South Korea, approximately 24.6 individuals per 100,000 experience ICH, where small blood vessels in the brain rupture, making up 10-20% of all stroke cases. Among the younger individuals, the rate is lower, with only about 1.9 cases per 100,000 for those under 45.
Researchers in South Korea have identified hypertension, obesity, alcohol consumption, smoking, hypertriglyceridemia, and cerebral small vessel disease (CSVD) as key factors contributing to ICH in the younger population.
Moreover, 70% of patients in their 30s and 40s suffered from bleeding deep within the brain, which significantly increases the risk of severe disabilities such as hemiplegia, aphasia, dementia, and psychiatric disorders.
A research team led by Park Yong Sook from Chung-Ang University Hospital and Professor Jang Joo Sung from Seoul National University studied 139 patients aged 30 to 49 hospitalized for ICH between 2011 and 2021. Their findings are based on an analysis of 73 patients who were admitted for “spontaneous intracerebral hemorrhage,” excluding those with preexisting brain conditions such as aneurysms, brain tumors, arteriovenous malformations, and cavernous malformations.
The study revealed that most 73 patients were male (83.6%). Additionally, 45.8% were classified as obese with a body mass index (BMI) over 25 kg/m², 47.2% were current smokers, 41.1% had hypertension, 30.6% reported excessive alcohol consumption (drinking more than 15 days a month), and 33.3% had hypertriglyceridemia (levels exceeding 150 mg/dL).
Notably, many young patients experienced hemorrhages deep within the brain. About 74% of the blood clots formed were concentrated in the thalamus and basal ganglia (55%), the brainstem (11%), and the cerebellum (8%).
The research team emphasized that conditions such as brain tumors or arteriovenous malformations are often predetermined and cannot be prevented through personal effort. However, they noted that spontaneous intracerebral hemorrhage (ICH) can largely be prevented or its risk reduced through individual efforts.
Park detailed that the brainstem, situated deep within the brain, houses densely packed nerve pathways that transmit information from the cerebral cortex. He further explained that regions like the basal ganglia and thalamus play crucial roles in coordinating motor and sensory functions with the cerebral cortex. While the cerebral cortex spans a broad area, these deep brain structures consolidate essential functions into a much smaller space. He pointed out that damage to these areas can result in neurological deficits as severe as those caused by widespread damage to the cortex.
The study revealed that 60% of the patients experienced poor outcomes, including death (19%), being in a vegetative state (19%), severe disabilities (14%), and significant mobility impairments (19%).
Among the 39 patients whose brain MRI scans were analyzed, 51.3% showed signs of micro bleeding and white matter degeneration, indicating that brain deterioration had likely begun before the ICH occurred. Hypertension was identified as the primary contributing factor.
Park described the brain’s micro-vessels as highly vulnerable to damage from hypertension, explaining that long-term high blood pressure can lead to blockages or small ruptures in these vessels or cause the vessel walls to harden under pressure. He noted that students identified with high blood pressure during high school physical exams or before military service should be considered at risk for intracerebral hemorrhage (ICH) and should begin managing their blood pressure and weight early.
He also pointed out a concerning trend among young men who are increasingly overweight or obese, along with rising rates of hypertension and hyperlipidemia. Park mentioned that many young individuals are complacent about their health, mistakenly believing that taking hypertension medication once means they won’t need it for life, which leads to neglect in proper health management.
Emphasizing prevention, Park stated that the most significant risk factors for ICH can be managed or prevented. He urged young individuals to take proactive steps to control their blood pressure and weight and to avoid smoking to prevent irreversible damage that could impact themselves and their families.
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