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Published on: June 18, 2021
Multiple simultaneous intracerebral hemorrhages: Clinical presentations and risk factors
Yohei Yamaguchi1, Ririko Takeda1, Yuichiro Kikkawa1
1Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka City, Saitama 350-1298, Japan.
Objective:
Multiple simultaneous intracerebral hemorrhages (MSICH) are a rare clinical entity. The mechanism and risk factors have yet to be elucidated. The purpose of this study was to clarify clinical presentations and risk factors of MSICH compared with solitary intracerebral hemorrhages (ICH).
Patients And Methods:
Medical records of 313 consecutive patients with ICH admitted to our institution between April 2011 and September 2014 were retrospectively reviewed. Seventeen cases of MSICH were identified, and 10 clinical and neuroimaging variables were compared between MSICH cases and solitary ICH cases using the unpaired t-test, chi-square test, and multiple logistic regression analysis.
Results:
There were significant differences in size between larger hematomas (mean 59.2±69.1mL) and smaller hematomas (mean 1.7±2.1mL) in patients with MSICH (p=0.001). Larger hematoma volume was the only independent risk factor for MSICH in multiple logistic regression analysis (OR=1.012, 95%CI 1.004-1.021, p=0.004).
Conclusions:
Patients with MSICH have clinical characteristics and outcomes similar to patients with solitary ICH. They present with two significantly different hematoma sizes, both of which are significantly larger than patients with solitary ICH, suggesting that a larger hematoma can trigger smaller hematomas. A future prospective study with a larger number of patients will explore the precise mechanism of this rare entity.
Insights
Multiple simultaneous intracerebral hemorrhages (MSICH) are rare. Larger hematoma volume is the only identified risk factor for MSICH, suggesting it may trigger smaller hemorrhages.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Multiple simultaneous intracerebral hemorrhages (MSICH) represent a rare clinical occurrence.
- Understanding the underlying mechanisms and risk factors for MSICH is crucial for effective patient management.
Purpose of the Study:
- To investigate the clinical presentations and identify risk factors associated with MSICH.
- To compare these factors with those of solitary intracerebral hemorrhages (ICH).
Main Methods:
- Retrospective review of 313 patients with ICH.
- Identification of 17 MSICH cases for comparison with solitary ICH cases.
- Statistical analysis including t-tests, chi-square, and logistic regression.
Main Results:
- MSICH cases exhibited two distinct hematoma sizes, significantly larger than those in solitary ICH.
- Larger hematoma volume was the sole independent risk factor for MSICH (OR=1.012, p=0.004).
Conclusions:
- MSICH patients share clinical characteristics and outcomes with solitary ICH patients.
- The presence of significantly larger hematomas in MSICH suggests a potential causal link.
- Further prospective studies are needed to elucidate the precise mechanisms of MSICH.
