Predisposing Factors, Pathologies, and Precipitating Factors Causing Intracerebral Hemorrhage
Most people with spontaneous intracerebral hemorrhage (ICH) have hypertension, which is the strongest modifiable predisposing (risk) factor. However, multiple long-term medical conditions and other known predisposing factors for ICH usually coexist with hypertension, indicating that the causal pathway is multifactorial, and the term hypertensive ICH is oversimplistic. In this review, we integrate the highest quality evidence and our clinical experience in a framework to attribute multiple predisposing factors, underlying pathologies, and precipitating factors as the cause of ICH. In clinical practice, this framework supports physicians to take a holistic approach to treatment and prevention of ICH. In research, this framework shows how existing classification systems for the cause of ICH include underlying macrovascular, microvascular, and other structural pathologies but few predisposing or precipitating factors. Furthermore, this framework can inform the development of a more holistic classification system and expose knowledge gaps, including how predisposing factors lead to underlying pathologies and why only some people with these pathologies experience ICH.
Authors
- Xin Cheng (ORCID: https://orcid.org/0000-0001-7816-0547)
- Craig S. Anderson (ORCID: https://orcid.org/0000-0002-7248-4863)
- Vega Pratiwi Putri (ORCID: https://orcid.org/0000-0002-5294-0884)
- Santosh B. Murthy (ORCID: https://orcid.org/0000-0002-4950-0992)
- David Gaist (ORCID: https://orcid.org/0000-0001-5205-7007)
- Rustam Al‐Shahi Salman (ORCID: https://orcid.org/0000-0002-2108-9222)
- Ashkan Shoamanesh (ORCID: https://orcid.org/0000-0002-2802-1626)
- Paula Muñoz Venturelli (ORCID: https://orcid.org/0000-0003-1869-2255)
- Mark Rodrigues (ORCID: https://orcid.org/0000-0002-4507-6872)
- Neshika Samarasekera (ORCID: https://orcid.org/0000-0001-6840-0199)
- William Whiteley (ORCID: https://orcid.org/0000-0002-4816-8991)
- Colin Smith (ORCID: https://orcid.org/0000-0002-4507-5132)
- Tom J. Moullaali (ORCID: https://orcid.org/0000-0002-6786-3623)
- Alice Hosking (ORCID: https://orcid.org/0000-0001-6900-7778)
Institutions
- Universidad del Desarrollo (CL)
- Universitas Gadjah Mada (ID)
- University of Southern Denmark (DK)
- Cornell University (US)
- Population Health Research Institute (CA)
- British Heart Foundation (GB)
- MIND Research Institute (US)
- The George Institute for Global Health (AU)
- MRC Centre for Reproductive Health (GB)
- Huashan Hospital (CN)
- Shanghai Center for Brain Science and Brain-Inspired Technology (CN)
- University of Edinburgh (GB)
Publication Details
- Journal
- Stroke
- Published
- 2025-12-03
- DOI
- https://doi.org/10.1161/strokeaha.125.051831
- Citations
- 1
- Primary Topic
- Intracerebral and Subarachnoid Hemorrhage Research
- Type
- article
- Field-Weighted Citation Impact
- 1.39