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Acute fatal deterioration in putaminal hemorrhage
1Department of Neurology, Saint Mary's Hospital, Mayo Medical Center, Rochester, Minn. 55905, USA.
Stroke
|October 1, 1995
Summary
Sudden clinical deterioration in patients with spontaneous intracerebral hemorrhage can occur due to catastrophic hematoma enlargement or rebleeding. This highlights the potential for acute, fatal events hours to days after the initial stroke.
Area of Science:
- Neurology
- Neurosurgery
- Stroke Medicine
Background:
- Clinical deterioration in spontaneous intracerebral hemorrhage (ICH) is infrequently studied.
- Previously, intracranial hematomas were thought to bleed monotonically.
- Recent evidence suggests continuous bleeding and hematoma expansion within hours post-ICH.
Observation:
- Three cases of putaminal hemorrhage are presented, illustrating acute, fatal clinical deterioration.
- Deterioration included extensor posturing, fixed pupils, loss of brainstem reflexes, and hydrocephalus.
- CT scans revealed massive hematoma enlargement and ventricular extension.
Findings:
- Spontaneous intracerebral hemorrhage in the putamen can lead to acute, catastrophic enlargement.
- Fatal deterioration can occur hours to days after the initial ictus.
- Rebleeding is a potential mechanism for sudden clinical decline in ICH patients.
Implications:
- Clinicians should consider catastrophic hematoma expansion and rebleeding in patients with ICH experiencing acute deterioration.
- This underscores the dynamic nature of ICH and the need for close monitoring.
- Further research into the mechanisms and prediction of hematoma expansion is warranted.