[Simultaneous supra- and infratentorial hypertensive intracerebral hemorrhage]

Multiple intracerebral hemorrhage may occur as rebleeding at the site of the previous lesion or in other places. However, multiple intracerebral hemorrhage occurring simultaneously in the supra-and infratentorial regions is rare. We experienced 9 such cases between May 1976 and December 1989. The clinical symptoms, CT findings and outcome of our cases and of 4 cases which were previously reported in the literature are reviewed in this paper. Out of 13 cases, 11 patients had cerebellar hemorrhage, and the others had pontine hemorrhage in the infratentorium. Among the supratentorial lesions, 11 involved hemorrhage in the putamen or the thalamus, and the others were in the subcortical region. There were no characteristic initial symptoms or neurological signs which suggested that hemorrhage had occurred in both the supra-and infratentorial regions. The only methods by which we could recognize this exceptional situation were the CT scan and MRI scan. The outcome in those patients whose initial neurological grading (NG) was 1 to 3 was good with conservative therapy or surgical treatment. On the other hand, the outcome in patients whose initial NG was 4 or 5 was very poor no matter what treatment was used. As far as surgical treatment is concerned, we believe that hematoma evacuation is necessary when the cerebellar hematoma is bigger than the supratentorial hematoma.