Tobacco Use: A Major Risk Factor of Intracerebral Hemorrhage

J Stroke. 2021 Jan;23(1):37-50. doi: 10.5853/jos.2020.04770. Epub 2021 Jan 31.


Spontaneous intracerebral hemorrhage (sICH) is one of the deadliest subtypes of stroke, and no treatment is currently available. One of the major risk factors is tobacco use. In this article, we review literature on how tobacco use affects the risk of sICH and also summarize the known effects of tobacco use on outcomes following sICH. Several studies demonstrate that the risk of sICH is higher in current cigarette smokers compared to non-smokers. The literature also establishes that cigarette smoking not only increases the risk of sICH but also increases hematoma growth, results in worse outcomes, and increases the risk of death from sICH. This review also discusses potential mechanisms activated by tobacco use which result in an increase in risk and severity of sICH. Exploring the underlying mechanisms may help alleviate the risk of sICH in tobacco users as well as may help better manage tobacco user sICH patients.

Keywords: Cerebral hemorrhage; Hematoma; Hemorrhagic stroke; Risk factors; Smoking; Tobacco.

Publication types

  • Review