Multiple spontaneous intracerebral hematomas: clinical and computed tomographic correlations

Area of Science:

• Neurology
• Radiology
• Neurosurgery

Background:

• Multiple spontaneous intracerebral hemorrhages (ICH) without a clear cause are uncommon.
• These events constitute a small percentage (2%) of all intracranial hemorrhages.

Purpose of the Study:

• To analyze the clinical and radiological characteristics of patients with multiple spontaneous ICH.
• To evaluate the utility of computed tomography (CT) in diagnosing and characterizing these lesions.

Main Methods:

• Retrospective review of 12 patients diagnosed with multiple spontaneous ICH via CT.
• Analysis of lesion location, patient history (hypertension), neurological presentation, and CT findings (density, enhancement).
• Comparison of CT findings with other diagnostic studies like angiography.

Main Results:

• Eight supratentorial hemispheric, two hemispheric/ganglionic, one thalamic/cerebellar, and one bilateral cerebellar hemorrhage observed.
• Only two patients had a history of hypertension; five presented without lateralizing signs.
• CT confirmed multiple lesions in all cases, with identical density profiles in 11, suggesting similar age.
• Angiography suggested multiple lesions in only one case; other studies were often consistent with a single lesion.

Conclusions:

• CT is essential for diagnosing multiple spontaneous intracerebral hemorrhages, often revealing lesions missed by other modalities.
• The similar age of hematomas in most cases suggests a single underlying cause or event.
• Further investigation is warranted to determine the etiology of these idiopathic multiple hemorrhages.