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Subcortical cerebral hemorrhage with reference to vascular malformations and hypertension as causes of hemorrhage
A Kurata1, Y Miyasaka, T Kitahara
1Department of Neurosurgery, Kitasato University, School of Medicine, Kanagawa, Japan.
Insights
Subcortical cerebral hemorrhage is often caused by vascular malformations, not hypertension. Advanced imaging like MRI is crucial for diagnosing these occult vascular malformations, especially in patients under 65.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Subcortical cerebral hemorrhage (SCH) diagnosis relies on imaging.
- Common causes include vascular malformations and hypertension.
- Angiographically occult vascular malformations (AOVMS) present diagnostic challenges.
Purpose of the Study:
- To identify the primary causes of SCH in non-traumatic, non-aneurysmal cases.
- To evaluate the efficacy of advanced imaging in diagnosing AOVMS.
- To establish diagnostic recommendations for AOVMS in SCH patients.
Main Methods:
- Retrospective review of 80 SCH cases with intraoperative or autopsy confirmation.
- Diagnosis of SCH confirmed by plain computed tomography (CT).
- Utilized prolonged high-dose delayed-contrast CT and magnetic resonance imaging (MRI) for AOVMS detection.
Main Results:
- Vascular malformations were the most common cause (68%) of SCH.
- AOVMS accounted for 36% of vascular malformations.
- Hypertension was less frequently the cause (11%) but present in 30% of AOVMS cases, particularly in patients under 65.
- Advanced CT and MRI successfully diagnosed AOVMS in 75% of cases.
Conclusions:
- Vascular malformations are the leading cause of SCH, with AOVMS being a significant subset.
- Advanced imaging techniques (delayed-contrast CT, MRI) are essential for diagnosing AOVMS.
- Recommend advanced imaging for SCH patients under 65, irrespective of hypertension, to detect AOVMS.
Abstract:
The authors have reviewed 80 cases of subcortical cerebral hemorrhage, in all of which intraoperative examinations during craniotomy or autopsies were performed. Cases involving trauma and aneurysm were excluded from the study. The diagnosis of subcortical hemorrhage was made by plain computed tomography in all cases. The most common cause of hemorrhage was vascular malformation (68%; 56 cases), in 20 (36%) of which angiographically occult vascular malformations were noted. Hypertension was present in 23 (29%) of 80 cases but was the cause of hemorrhage in only 9 cases (11%). Hypertension was present in 6 (30%) of 20 angiographically occult vascular malformations, all of which were in patients under 65 years. In 12 (75%) of 16 cases of angiographically occult vascular malformations, prolonged high-dose delayed-contrast computed tomography and magnetic resonance imaging were able to provide definite diagnostic information. We recommend that patients with subcortical cerebral hemorrhage, especially those under age 65, with or without hypertension, be carefully examined by prolonged high-dose delayed contrast computed tomography and magnetic resonance imaging for the presence of angiographically occult vascular malformations causing hemorrhage.