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Simultaneous multiple hypertensive intracerebral haemorrhages.
1Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Acta Neurochirurgica
|December 18, 2004
Summary
Hypertension is a key factor in simultaneous multiple intracerebral hemorrhages (ICHs), a rare condition. Patients with multiple ICHs, often linked to longer hypertension history and prior strokes, face worse outcomes than those with single ICH.
Area of Science:
- Neurology
- Neurosurgery
- Vascular Neurology
Background:
- Multiple intracerebral hemorrhages (ICHs) in distinct arterial territories are rare.
- Associated conditions include cerebral amyloid angiopathy, venous sinus thrombosis, coagulopathy, vasculitis, hemorrhagic transformation of infarcts, and intracranial pathologies.
- Hypertension's role in multiple ICHs is less understood than in single ICHs.
Purpose of the Study:
- To investigate the characteristics and outcomes of hypertensive patients with simultaneous multiple ICHs.
- To compare these patients with a control group of those experiencing solitary hypertensive ICH.
Main Methods:
- Retrospective review of non-traumatic ICH cases at Kaohsiung Medical University Hospital (1993-2002).
- Identified 10 patients with simultaneous multiple ICHs and compared them with 600 patients with solitary hypertensive ICH.
- Analyzed CT scans and medical records for patient history, clinical presentation, hematoma location, risk factors, and outcomes.
Main Results:
- Bilateral putaminal or thalamic hemorrhages were most common; supratentorial locations predominated, especially the thalamus.
- Patients with multiple ICHs had longer hypertension duration and higher rates of previous stroke.
- Hypercholesterolemia was more frequent in the multiple ICH group, which also had significantly worse outcomes.
Conclusions:
- Hypertension remains the primary etiological factor for simultaneous multiple ICHs.
- Prolonged hypertension and prior strokes suggest widespread arteriolar degeneration contributes to multiple ICHs.
- While hypercholesterolemia showed association, the exact mechanisms remain unclear; poorer outcomes are linked to extensive brain tissue destruction and diaschisis.