Predictors of Mortality of Primary Intracerebral Hemorrhage among the Sea Coast Population of South India

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Intracerebral hemorrhage (ICH) is the second most leading cause for stroke, followed by ischemic stroke, which leads to high rates of mortality and morbidity. Worldwide statistics reveal the incidence of ICH is nearly up to 10-15% of all strokes and its incidence vary from region to region globally. In Asian population ICH ranges from 4 to 14% of all strokes when compared to the west. Despite advances in medical and neurosurgical treatment modalities, prognosis of ICH carries poor outcome, with high rates of mortality projected worldwide up to 40% to 50%. Identification of major governing factors for outcome of ICH is essential and also important in analyzing the population.

vessels. The secondary ICH arises mostly due to vascular malformations, coagulopathies, vasculitis, head injury, tumors, drug induced effects and drug abuse. PICH occurs in the brain commonly in the region of putamen, thalamus, cortical followed by cerebellar and brain stem. However the majority of primary ICH will be seen in elderly people whereas the secondary ICH is common in the Young age group. In the elderly population cerebral amyloid angiopathy (CAA) was found to be the significant cause for the lobar ICH. Earlier studies also revealed various etiologies for intracerebral hemorrhage which include chronic arterial hypertension, consumption of alcohol, treatment with anti-coagulants and antiplatelets, therapies related to thrombolytics, amphetamines usage, cocaine abuse, and usage of statins. 

In India, HTN is a burning health problem. Nearly 20% of the population under 50 years is suffering with HTN. Several studies clearly stated that HTN is the most common independent risk factor for PICH [8]. The incidence of ICH varies in various regions of India. For instance, a study conducted in Kolkata revealed that majority of stroke cases had PICH, which was higher when compared to the western world. In another study conducted in northeastern parts of India it was found that tribals had more PICH. Studies related to south India population identified that ICH constitutes up to 12% of all the strokes. Moreover, very few studies on PICH demonstrated its impact and outcome. Since India represents its vastness and heterogeneity in population, systematic studies from different regions of the country are needed. So far most studies revealed the outcome of PICH in urban population, but very few studies have been done to show the incidence and impact of PICH along the sea coast population.