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[Indications for surgery to determine the etiology of subcortical hemorrhage]
Y Nakayama1, A Tanaka, S Yoshinaga
1Department of Neurosurgery, Fukuoka University Chikushi Hospital, Japan.
Insights
Determining the cause of subcortical hemorrhage often requires advanced imaging. Surgery is not recommended if initial neuroradiological investigations do not reveal vascular or tumorous lesions.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Subcortical hemorrhage etiology investigation in 55 patients.
- Patient demographics: 30 males, 25 females, aged 19-83 years (mean 60).
Observation:
- Diagnostic tools included CT scans (35 with contrast), cerebral angiography (37), and MRI (22).
- 41 patients underwent surgery; 14 received conservative treatment.
- Pre-operative diagnosis identified 10 arteriovenous malformations and 2 brain tumors.
- Post-operative diagnosis revealed 7 cases of amyloid angiopathy.
- Etiology remained unknown in 22 surgical cases (11 suspected hypertensive angiopathy) and 10 conservative cases (8 suspected hypertensive angiopathy).
- Hemorrhagic diathesis (including Warfarin, DIC) caused bleeding in 4 conservatively treated patients.
Findings:
- Meticulous neuroradiological investigations are crucial for identifying vascular or tumorous causes.
- Surgery is not indicated for etiological diagnosis when initial imaging is inconclusive.
- No recurrence at the same location was observed in 32 patients with unknown etiology over a mean 40-month follow-up.
Implications:
- Non-invasive imaging should be prioritized for diagnosing subcortical hemorrhage.
- Surgical intervention is reserved for cases where conservative management fails or specific lesions are identified.
- Further research may elucidate the causes of idiopathic subcortical hemorrhage.
Abstract:
We studied the etiology of subcortical hemorrhage in 55 patients (30 males, 25 females), aged 19-83 years (mean 60 years). CT scan was made in all patients on admission, with the use of intravenous infusion of contrast agent in 35 patients. Cerebral angiography was performed in 37 patients and MRI was performed in 22 patients. Forty-one patients underwent surgery and the other fourteen patients were treated conservatively. The cause of bleeding had been discovered before surgery in 12 cases; 10 arteriovenous malformations and 2 brain tumors. They were discovered by meticulous neuroradiological investigations including cerebral angiography, MRI, dynamic MRI, MRA and enhancing CT. The cause of bleeding was newly discovered after surgery in 7 cases; all of amyloid angiopathy. It remained unknown in the other 22 surgical cases although hypertensive angiopathy was suspected in eleven of them. Among the 14 patients who received conservative therapy, hemorrhagic diathesis including the use of Warfarin and DIC was the cause of bleeding in four cases and the etiology remained unknown in other ten, although hypertensive angiopathy was suspected in eight of them. The 32 patients in whom the etiology remained unknown had been observed as long as 12-120 months (mean, 40 months) and although bleeding has occurred at different locations in two of these patients, there has been no recurrence of bleeding at the same location in any of them. In conclusion, surgery is not indicated to determine the etiology of subcortical hemorrhage when meticulous neuroradiological investigations fail to disclose any vascular or tumorous lesions.