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Pecs","award":["EGA-16"],"award-info":[{"award-number":["EGA-16"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Spontaneous intracerebral hemorrhage (ICH) is a devastating form of stroke, disproportionately affecting older adults and is associated with high rates of mortality, functional dependence, and long-term cognitive decline. Aging profoundly alters the structure and function of the cerebral vasculature, predisposing the brain to both covert hemorrhage and the development of cerebral microbleeds (CMBs), small, often subclinical lesions that share common pathophysiological mechanisms with ICH. These mechanisms include endothelial dysfunction, impaired cerebral autoregulation, blood\u2013brain barrier breakdown, vascular senescence, and chronic inflammation. Systemic factors such as age-related insulin-like growth factor 1 (IGF-1) deficiency further exacerbate microvascular vulnerability. CMBs and ICH represent distinct yet interconnected manifestations along a continuum of hemorrhagic small vessel disease, with growing recognition of their contribution to vascular cognitive impairment and dementia (VCID). Despite their increasing burden, older adults remain underrepresented in clinical trials, and few therapeutic approaches specifically target aging-related mechanisms. This review synthesizes current knowledge on the cellular, molecular, and systemic drivers of ICH and CMBs in aging, highlights diagnostic and therapeutic challenges, and outlines opportunities for age-sensitive prevention and individualized care strategies.<\/jats:p>","DOI":"10.3390\/life15101569","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T14:06:53Z","timestamp":1759932413000},"page":"1569","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Intracerebral Hemorrhage in Aging: Pathophysiology, Clinical Challenges, and Future Directions"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2715-995X","authenticated-orcid":false,"given":"Esra","family":"Zhubi","sequence":"first","affiliation":[{"name":"Department of Neurology, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Lehoczki","sequence":"additional","affiliation":[{"name":"Institute of Preventive Medicine and Public Health, Semmelweis University, 1089 Budapest, Hungary"},{"name":"Fodor Center for Prevention and Healthy Aging, Semmelweis University, 1085 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Toth","sequence":"additional","affiliation":[{"name":"Institute of Preventive Medicine and Public Health, Semmelweis University, 1089 Budapest, Hungary"},{"name":"Fodor Center for Prevention and Healthy Aging, Semmelweis University, 1085 Budapest, Hungary"},{"name":"Department of Neurosurgery, Medical School, University of Pecs, 7623 Pecs, Hungary"},{"name":"Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1439-6627","authenticated-orcid":false,"given":"Dominika","family":"Lendvai-Emmert","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical School, University of Pecs, 7623 Pecs, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1084-6195","authenticated-orcid":false,"given":"Levente","family":"Szalardy","sequence":"additional","affiliation":[{"name":"Department of Neurology, Albert Szent-Gy\u00f6rgyi Medical School, University of Szeged, 6725 Szeged, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2481-321X","authenticated-orcid":false,"given":"Bence","family":"Gunda","sequence":"additional","affiliation":[{"name":"Department of Neurology, Semmelweis University, 1083 Budapest, Hungary"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Watson, N., Bonsack, F., and Sukumari-Ramesh, S. 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