Blood pressure surge precedes intracerebral hemorrhage

Most patients with acute intracerebral hemorrhage (ICH) have very high blood pressure (BP) on presentation, but it is unclear whether such pressure elevation is the cause or a consequence of the ICH. This controversy could be clarified by determining the exact temporal relationship between the BP elevation and the onset of the ICH. Several case reports have attributed ICH to specific situations in which the BP was inferred to be high. Unfortunately, those cases lacked continuous monitoring of BP and neurological exam.

Single case observation in a University-based tertiary medical center.

A neurologically intact 64-year-old woman whose BP and neurological status were monitored during admission to a medical intensive care unit. The patient suddenly developed a decreased level of consciousness and a right hemispheric syndrome 3.5 hours after demonstrating systolic BP values in the range 200 mmHg. An unenhanced computed tomography scan of the brain demonstrated a right ICH.

In this monitored case, the BP surge clearly preceded the onset of neurological symptoms by 3.5 hours, supporting the view that the acute BP elevation was the cause of ICH.