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[Simultaneous multiple hypertensive intracerebral hematoma].
Naoto Shiomi1, Tomoya Miyagi, Satomi Koga
1Department of Neurosurgery, Kurume University School of Medicine, 67 Asahicho, Kurume-city, Fukuoka 830-0011, Japan. shiomi@med.kurume-u.ac.jp
No Shinkei Geka. Neurological Surgery
|May 20, 2004
Summary
Simultaneous hypertensive intracerebral hemorrhage (HIH) in multiple brain locations is rare. Outcomes for these patients were similar to those with single HIH, suggesting multiple lesions have minimal impact.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Hypertensive intracerebral hemorrhage (HIH) is a common cause of stroke.
- Simultaneous HIH in multiple locations is a rare clinical presentation.
Observation:
- Computed tomography (CT) diagnosed 11 cases of simultaneous HIH between 1990 and 2002.
- Common locations included cerebellum and basal ganglia, pons and basal ganglia, and subcortex and basal ganglia.
- 80% of patients had both supra- and infra-tentorial hematomas.
Findings:
- Multiple HIH cases represented 1% of all HIH patients.
- Hematoma size was generally proportional; cerebellar hematomas were mild, pontine were severe.
- Neurological outcomes for patients with mild to moderate deficits (grade 1-3) were favorable with conservative or surgical management.
Implications:
- The clinical severity, treatment, and outcomes of multiple HIH are comparable to single HIH.
- Possible mechanisms include simultaneous bleeding or secondary hemorrhage due to increased intracranial pressure.
- Surgical decisions for multiple hematomas should consider location and size, with cerebellar hematoma removal recommended if the supratentorial hematoma is small.