Cerebral Hemorrhage and Alcohol Exposure: A Review

Jialing Peng; Hongxuan Wang; Xiaoming Rong; Lei He; L Xiangpen; Qingy Shen; Ying Peng


Alcohol Alcohol. 2020;55(1):20-27. 

In This Article

Abstract and Introduction


Aims: To investigate the dose–response relationships between alcohol and intracerebral hemorrhage (ICH), the impact of alcohol on the outcome of ICH and possible mechanisms underlying hypertensive ICH (HICH) caused by heavy drinking.

Methods: Literature search from 1985 to August 2019 in the PubMed database.

Results: The relationship between low-middle alcohol consumption and ICH remains controversial for various reasons, whereas chronic heavy drinking increases the incidence of ICH and exerts worse outcome. More attention is needed to clarify the characteristics of chronic alcohol intake and binge drinking. Chronic alcohol abuse tends to elevates blood pressure, resulting in increased occurrence of HICH and exaggerated HICH-contributed brain injury.

Conclusion: It is important to develop strategies to promote reasonable intake categories, prevent alcoholism and thus reduce the risk of ICH.


Alcohol has been an integral part of cultures in human history and used generally for social purposes. With the rapid development of industrialization and popularization of alcohol, alcohol consumption along with alcohol-attributable diseases has increased rapidly worldwide (Rehm and Imtiaz, 2016). Alcohol has been identified as a significant contributor to the global burden of disease and mortality in the World Health Organization (WHO) Comparative Risk Assessment Study (George, 2006). Epidemiological studies demonstrated that alcohol is causally associated to diverse categories of diseases, such as cardiovascular disease categories (Rehm et al., 2016), cancer (Garaycoechea et al., 2018), cirrhosis of the liver, mental and behavioral disorders (Rehm J et al., 2010) and so on. Intracerebral hemorrhage (ICH), accounting for 10–15% strokes (Sudlow and Warlow, 1997), remains a devastating disease with an incidence of 10–30 per 100,000 population annually (Labovitz et al., 2005). Compared with ischemic stroke, ICH causes higher morbidity and mortality (Andersen et al., 2009). The ICH fatality rate is almost 40% at 1 month and 54% or so at 1 year. Furthermore, the rate of long-term functional independence ranges from 12 to 39% (An et al., 2017). Thus, ICH has been identified as public health burden with high morbidity and mortality (Feigin et al., 2009). Alcohol consumption has been consistently identified as an independent risk factor for ICH (O'Donnell et al., 2010; Zhang et al., 2011). Despite the consistent finding of a U-shaped relationship between alcohol consumption and ischemic stroke (Elkind et al., 2006; Larsson et al., 2016), conflicting dose–response relationships between alcohol consumption and ICH are found. However, for heavy drinking, the increase in occurrence of ICH and a worse outcome has been consistently reported.

We performed a literature search from 1985 to August 2019 in the PubMed database by combining the terms ('alcohol' OR 'ethanol' OR 'drink' OR 'alcohol abuse') AND ('stroke' OR 'hemorrhagic stroke' OR 'cerebral hemorrhage' OR 'intracranial hemorrhage' OR 'hypertensive intracerebral hemorrhage' OR 'ICH' OR 'HICH'). In this study, a summary on the main opinions of most studies with respect to ICH and alcohol exposure will be given, which may sketch out new developments as well as draw implications for policy and future research.