Computed tomography of acute intratumoral hemorrhage

Analysis of the CT findings in 35 cases of tumoral hemorrhage (taken from 973 intracranial tumors) revealed three distinct patterns of bleeding: (a) hematoma, (b) central hemorrhage, and (c) hemorrhagic infarction. The location, multiplicity of lesions, and contrast enhancement are important in the diagnosis, and the clinical history and arteriography may also be helpful. The largest single group in this series consisted of 12 metastatic lesions: the others included glioblastoma (7), chromophobe adenoma (4), Grade I astrocytoma (3), medulloblastoma (3), central neuroblastoma (2), histiocytic lymphoma (2), and ependymoma (1). The relatively low mortality rate (21/35) despite marked neurological deterioration is attributed to prompt CT demonstration of hemorrhage followed by aggressive therapy (surgical evacuation, total resection, radiotherapy, and/or steroids or mannitol).