ELSEVIER Vascular PUTAMINAL AND THALAMIC HEMORRHAGE IN ETHNIC CHINESE LIVING IN HONG KONG John N.K. Hsiang, M.D., Ph.D., X.L. Zhu, FRCS@din), Lawrence K.S. Wong, MRCP (UK), Richard Kay, M.D., FRCP (UK), and Wai S. Poon, FRCS(Glasg) Department of Surgery (J.N.K.H., X.L.Z. and W.S.P.) and the Department of Medicine (L.K.S.W. and R.K.), Prince of Wales Hospital, The Chinese University of Hong Kong Hsiang JNK,Zhu XL, Wong LKS, Kay R, Poon WS.Putaminal and thalamic hemorrhage in ethnic Chineseliving in Hong Kong. Surg Neurol 1996;46:441-5. BACKGROUND Hemorrhagic stroke is very common in the Chinese pop- ulation, and it is one of the leading causes of mortality in Chinese communities. The risk factors to explain this high incidence are unknown. It is the purpose of this study to look into the features of hemorrhagic stroke in the Hong Kong Chinese. METHODS We conducted a prospective hospital-based study in which 60 consecutive Chinese patients with computed tomography diagnosis of putaminal or thalamic hemor- rhage were included. Their demographic and clinical data were collected and analyzed. RESULTS Two major findings evolved from the present study. (1) Unlike the Western studies, the majority of our patients were about a decade younger; (2) 50% of the patients had previously diagnosed hypertension, but only 20% of these patients were compliant with their antihypertensive med- ication. Our results also suggested that low admission Glasgow Coma Scale scores, large hematoma size, and the presence of intraventricular blood were associated with poor outcomes. CONCLUSIONS This study concludes that hemorrhagic stroke is indeed a serious health problem in Hong Kong. Simple measures, such as improvement of health education and the pri- mary care system in the management of hypertension, would help to reduce the incidence of hemorrhagic stroke. 0 I996 by Ekevier Science Inc. KEY WORDS Ethnic Chinese, hemorrhagic stroke, hypertension, putami- nal hemorrhage, primary intracerebral hemorrhage, tha- lamic hemorrhage. Address reprint requests to: John N.K. Hsiang, M.D., Ph.D., Neurosur- gery Unit, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong. Received April 6, 1995; accepted February 7, 1996. 0 1996 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010 C erebrovascular diseases are the most fre- quent causes of death in China [29] and are the third most common cause of mortality in Hong Kong [15]. Among all the subtypes of stroke, cere- bral hemorrhage is the one most likely to require neurosurgical services and carries the highest mor- tality rate [Z]. Several studies have demonstrated that primary intracerebral hemorrhage contributes about one third of all cerebrovascular diseases in the Chinese population living in China, Taiwan, and Hong Kong [ 17,18,24,29]. This figure is three times higher than that of the Caucasian population in Western coun- tries [4,13,16]. While there are studies to suggest risk factors for spontaneous cerebral hematomas [4,7,8,16], there are no known risk factors that can explain the higher incidence in ethnic Chinese. About 50% of all primary intracerebral hemor- rhages occur in the basal ganglion or the thalamus [4,19]. The cause of the hemorrhage is generally believed to be hypertensive angiopathy of the small penetrating vessels [ 121. ln this hospital-based study, we investigated the natural history of 60 Hong Kong Chinese who had computed tomogra- phy (CT)diagnosed putaminal or thalamic hemor- rhage. Based on the results of the present study, we also postulate the possible causes of the higher incidence of primary intracerebral hemorrhage in the Chinese population in Hong Kong. SUBJECTSANDMETHODS The population of Hong Kong is close to 6 million, of which 95% is ethnic Chinese. The neurosurgical service of the Prince of Wales Hospital (PWH) has a catchment population of 1.5 million. This series comprised 60 consecutive patients 0090-3019/96/$15.00 PI1 s0090-3019(96)00157-7