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Putaminal hemorrhage: clinical-computed tomographic correlations
L A Weisberg1, A Stazio, D Elliott
1Department of Neurology and Psychiatry, Tulane University Medical School, New Orleans.
Insights
Hypertension is common in putaminal hemorrhage patients. Contrast-enhanced CT offers limited value for diagnosing acute putaminal hemorrhage in hypertensive individuals.
Area of Science:
- Neurology
- Radiology
- Public Health
Background:
- Putaminal hemorrhage is a severe type of intracerebral hemorrhage.
- Hypertension is a major risk factor for spontaneous intracerebral hemorrhage.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of patients with putaminal hemorrhage.
- To evaluate the utility of contrast-enhanced computed tomography (CT) in diagnosing acute putaminal hemorrhage.
Main Methods:
- Retrospective analysis of 100 patients with putaminal hemorrhage.
- Review of patient demographics, medical history, hemorrhage location, and outcomes.
- Performance of contrast-enhanced CT in all patients.
Main Results:
- 92% of patients with putaminal hemorrhage were hypertensive.
- Hemorrhage extension to thalamus or cerebral hemispheres was associated with higher mortality (20%).
- Contrast-enhanced CT provided no additional diagnostic yield compared to nonenhanced CT.
Conclusions:
- Hypertension is a predominant comorbidity in putaminal hemorrhage.
- Nonenhanced CT is sufficient for diagnosing acute putaminal hemorrhage in hypertensive patients.
- Further research is needed to explore risk factors and outcomes in normotensive patients.
Abstract:
Ninety-two percent of 100 patients with putaminal hemorrhage were hypertensive. Of the eight normotensive patients, seven were substance abusers or had bilateral putaminal hemorrhages. The one other normotensive patient was less than 40 years old. The 100 hemorrhages had the following locations: 1. medial putaminal (17 cases; six were normotensive and less than 40 years old and five were substance abusers); 2. lateral putaminal extending through the external capsule (eleven cases); 3. putaminal-capsular and subcortical white matter (32 cases); 4. putaminal cerebral hemispheric (19 cases); 5. putaminal-thalamic (19 cases); 6. bilateral (two cases). A disproportionate number of black patients suffered hematoma extension to the cerebral hemispheres or thalamus (46%) compared to Caucasians (23%). Overall mortality was 20% (17 blacks and three Caucasians) and occurred in patients with hematoma extension to the thalamus or cerebral hemispheres. Contrast-enhanced CT was performed in all 100 patients and provided no additional diagnostic yield. This indicates limited use for enhanced CT in hypertensive patients with putaminal hemorrhage who have a characteristic appearance of the acute hemorrhage on the nonenhanced CT.