Intracerebral Hemorrhage in Young Adults (Aged 30–40) in Southeast Asia: A Systematic Review

A BSTRACT Spontaneous intracerebral hemorrhage (ICH) in young adults (30–40 years) is an escalating public health crisis in Southeast Asia (SEA), characterized by high mortality and decades of lived disability. Unlike in Western cohorts, the etiology in this region is a complex synergy of genetic variants and rapid epidemiological transitions. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, 30 studies from 2020 to 2025 were analyzed, covering cohorts from Indonesia, Malaysia, Thailand, Vietnam, Singapore, and the Philippines. The “Left-Shift” phenomenon is evident, with hypertension (84% prevalence) and RNF213 genetic variants being the primary drivers. Minimally invasive surgery (MIS) significantly improves functional outcomes compared to traditional craniotomy in this age group. ICH in young Southeast Asians is a preventable tragedy driven by early-onset hypertension and specific genetic markers. Regional protocols must prioritize aggressive primary prevention and MIS. Future policies should address the socioeconomic reintegration of young survivors.