Two types of spontaneous intracerebral hemorrhage due to hypertension

1972 ◽  
Vol 37 (5) ◽  
pp. 509-513 ◽  
Author(s):  
Vladimír Beneš ◽  
František Koukolík ◽  
Dagmar Obrovsk´
Keyword(s):  
Intracranial Pressure ◽  
Conservative Treatment ◽  
Intracerebral Hemorrhage ◽  
Surrounding Tissue ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Hypertensive Patients ◽  
Content Type ◽  
Initial Shock ◽  
Postmortem Examinations ◽  
Fine Print

✓ Analysis of 150 postmortem examinations indicates that spontaneous intracerebral hemorrhage in hypertensive patients develops in two ways. In the first, hemorrhage crushes the surrounding tissue, tamponades the ventricles, and produces a fatal increase in intracranial pressure. Operation on such patients does not improve the results obtained by conservative treatment. In the second type, the hemorrhage is self-limited; the hematoma that frequently develops behaves as an expanding lesion, and operative treatment can be helpful after the initial shock interval has passed. Diagnostic differentiation of the two types is not possible immediately after the stroke.

CT infusion scanning for the detection of cerebral aneurysms

1989 ◽  
Vol 71 (2) ◽  
pp. 175-179 ◽  
Author(s):  
David W. Newell ◽  
Peter D. LeRoux ◽  
Ralph G. Dacey ◽  
Gary K. Stimac ◽  
H. Richard Winn
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Computerized Tomography ◽  
Cerebral Aneurysms ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Content Type ◽  
Spontaneous Hemorrhage ◽  
Fine Print

✓ Computerized tomography (CT) infusion scanning can confirm the presence or absence of an aneurysm as a cause of spontaneous intracerebral hemorrhage. Eight patients who presented with spontaneous hemorrhage were examined using this technique. In five patients the CT scan showed an aneurysm which was later confirmed by angiography or surgery; angiography confirmed the absence of an aneurysm in the remaining three patients. This method is an easy effective way to detect whether an aneurysm is the cause of spontaneous intracerebral hemorrhage.

Surgical treatment of spontaneous intracerebral hemorrhage

1973 ◽  
Vol 39 (2) ◽  
pp. 145-151 ◽  
Author(s):  
Jean E. Paillas ◽  
Bernard Alliez
Keyword(s):  
Surgical Treatment ◽  
Intracerebral Hemorrhage ◽  
Cerebral Hemorrhage ◽  
Preoperative Diagnosis ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Content Type ◽  
Selection Of Patients ◽  
Selection Of ◽  
Fine Print

✓ The results of the surgical treatment of cerebral hemorrhage in 250 cases are reported. Preoperative diagnosis, the selection of patients, and the favorable moment to operate are discussed.

Hematoma enlargement in spontaneous intracerebral hemorrhage

1994 ◽  
Vol 80 (1) ◽  
pp. 51-57 ◽  
Author(s):  
Yukihiko Fujii ◽  
Ryuichi Tanaka ◽  
Shigekazu Takeuchi ◽  
Tetsuo Koike ◽  
Takashi Minakawa ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Liver Dysfunction ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Content Type ◽  
Hematoma Enlargement ◽  
Coagulation Abnormalities ◽  
Hematoma Growth ◽  
Low Levels ◽  
Fine Print

✓ In order to evaluate the incidence and risk factors of hematoma enlargement in spontaneous intracerebral hemorrhage (ICH), 419 cases of ICH were reviewed. The first computerized tomography (CT) scan was performed within 24 hours of onset and the second within 24 hours of admission; a blood sample was taken for laboratory examination within 1 hour of admission. In 60 patients (14.3%) the second CT scan showed an enlarged hematoma. The incidence of enlargement significantly decreased with time (p < 0.05) and significantly increased with the severity of liver dysfunction and the volume of the hematoma on the first CT scan. Patients with an irregularly shaped hematoma had a higher risk of hematoma growth than those with a round hematoma. In addition, patients with hematoma enlargement were more likely to have coagulation abnormalities (low platelet counts and low levels of fibrinogen, α2-antiplasmin activity and platelet aggregation). Moreover, hematoma growth was associated with a poor clinical outcome. It is concluded that patients admitted to a hospital within 6 hours of onset of ICH, especially those admitted within 2 hours, and patients with liver dysfunction or irregularly shaped large hematomas should be closely observed for at least 6 hours after onset in preparation for emergency surgery, since the risk of hematoma growth in these circumstances is high.

Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage

1993 ◽  
Vol 78 (2) ◽  
pp. 188-191 ◽  
Author(s):  
Joseph P. Broderick ◽  
Thomas Brott ◽  
Thomas Tomsick ◽  
Rosemary Miller ◽  
Gertrude Huster
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Confidence Interval ◽  
Intracerebral Hemorrhage ◽  
Annual Incidence ◽  
Laboratory Research ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Content Type ◽  
Fine Print

✓ The authors report a study of all instances of spontaneous intracerebral hemorrhage (ICH) (188 cases) and subarachnoid hemorrhage (SAH) (80 cases) that occurred in the Greater Cincinnati area during 1988. Adjusted for age, sex, and race, the annual incidence of ICH was 15 per 100,000 population (95% confidence interval 13 to 17) versus six per 100,000 for SAH (95% confidence interval 5 to 8). The incidence of ICH was at least double that of SAH for women, men, and whites and approximately 1½ times that for blacks. The 30-day mortality rate of 44% for ICH was not significantly different from the 46% mortality rate for SAH. Despite the evidence that ICH is more than twice as common and the disorder just as deadly as SAH, clinical and laboratory research continues to focus primarily on SAH.

Measurements of brain-stem auditory evoked potentials in patients with spontaneous intracerebral hemorrhage

1984 ◽  
Vol 60 (3) ◽  
pp. 548-552 ◽  
Author(s):  
Christianto B. Lumenta
Keyword(s):  
Glasgow Coma Scale ◽  
Intracerebral Hemorrhage ◽  
Evoked Potentials ◽  
Brain Stem ◽  
Auditory Evoked Potentials ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Content Type ◽  
Different Types ◽  
The Brain ◽  
Fine Print

✓ Brain-stem auditory evoked potentials (BAEP's) were recorded in 19 patients with spontaneous intracerebral hemorrhage. More than half of the patients were deeply comatose. There was no correlation between BAEP changes and different types of spontaneous intracerebral hemorrhage or between BAEP's and coma grading by the Glasgow Coma Scale. However, BAEP's were a significant prognostic aid in these cases and useful in indicating the level of the brain-stem lesion.

Comparative study of traumatic and spontaneous intracerebral hemorrhage

2002 ◽  
Vol 96 (1) ◽  
pp. 86-89 ◽  
Author(s):  
M. Shahid Siddique ◽  
Barbara A. Gregson ◽  
Helen M. Fernandes ◽  
Jane Barnes ◽  
Lynne Treadwell ◽  
...  
Keyword(s):  
Head Injury ◽  
Intracerebral Hemorrhage ◽  
Surgical Intervention ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Content Type ◽  
Younger Age ◽  
Severity Of Injury ◽  
Significant Difference ◽  
Gcs Score ◽  
Fine Print

Object. Spontaneous intracerebral hemorrhage (SICH) and traumatic intracerebral hemorrhage (TICH) are common disorders. The authors planned to study how these two types of hemorrhage behave pathologically and clinically to gain further insight into their causes, pathogeneses, indications for surgical intervention, and prognoses. Methods. Prospectively filled databases of demographic, clinical, radiological, and outcome details have been maintained for all patients admitted to the Regional Neurosciences Centre with head injury since 1987 and with SICH since 1993. Of the 5686 patients whose case information was included in the head-injury database, 90 were found to suffer from an isolated intracerebral hemorrhage (ICH) as the only major abnormality observed on computerized tomography scans (subdural and extradural hematomas were excluded). Case details on these 90 patients and the 440 patients from the SICH database were extracted and analyzed using a statistical software program. The median age of patients with TICH was lower than the median age of patients with SICH (51 years compared with 65 years, respectively), but it was much higher than the median age of the entire head-injury group (21 years). Among patients younger than 45 years of age, 0.8% of patients who experienced trauma suffered from an ICH compared with 4.3% of patients older than 45 years of age. Irrespective of intervention, much better outcomes were achieved by patients with TICH compared with those with SICH (67% favorable outcomes compared with 24% in patients with SICH). Following trauma, there was no significant relationship between the severity of injury and the development of ICH. At presentation the median Glasgow Coma Scale (GCS) score for both groups was 13. Younger age and higher GCS score at presentation were strongly related to a favorable outcome for both types of hemorrhage. There was no significant difference in patient age, presenting GCS score, or outcomes of patients who underwent surgery compared with those who did not for either type of hemorrhage. No conclusions can be drawn about the efficacy of surgery from such observational studies. Conclusions. On the basis of these data the authors suggest that TICH and SICH have different features: TICH affects a slightly younger age group and carries a much better prognosis compared with SICH. In addition, indications for surgical intervention are not well defined for either type of hemorrhage. Practice is subjective and inconsistent. The International Surgical Trial in Intracerebral Haemorrhage may resolve the dilemma for SICH. A similar trial in which surgery is compared with conservative management should be considered for cases of TICH.

Matrix metalloproteinase—9 concentration after spontaneous intracerebral hemorrhage

2003 ◽  
Vol 99 (1) ◽  
pp. 65-70 ◽  
Author(s):  
Sònia Abilleira ◽  
Joan Montaner ◽  
Carlos A. Molina ◽  
Jasone Monasterio ◽  
José Castillo ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Neurological Diseases ◽  
Neurological Status ◽  
Acute Stage ◽  
Ct Scans ◽  
Enzyme Linked Immunosorbent Assay ◽  
Content Type ◽  
Blood Brain Barrier Disruption ◽  
Brain Barrier Disruption ◽  
Fine Print

Object. Matrix metalloproteinases (MMPs) are overexpressed in the presence of some neurological diseases in which blood—brain barrier disruption exists. The authors investigated the MMP-9 concentration in patients after acute intracerebral hemorrhage (ICH) and its relation to perihematomal edema (PHE). Methods. Concentrations of MMP-9 and related proteins were determined in plasma by performing an enzyme-linked immunosorbent assay of samples drawn after hospital admission (< 24 hours after stroke) from 57 patients with ICH. The diagnosis of ICH was made on the basis of findings on computerized tomography (CT) scans. The volumes of ICH and PHE were measured on baseline and follow-up CT scans at the same time that the patient's neurological status was assessed using the Canadian Stroke Scale and the Glasgow Coma Scale. Increased expression of MMP-9 was found among patients with ICH. In cases of deep ICH, MMP-9 was significantly associated with PHE volume (r = 0.53; p = 0.01) and neurological worsening (237.4 compared with 111.3 ng/ml MMP-9; p = 0.04). A logistic regression model focusing on the study of absolute PHE volume showed ICH volume as an independent predictor (odds ratio [OR] 3.37; 95% confidence interval [CI] 1.1–10.3; p = 0.03). A second analysis of relative PHE volume (absolute PHE volume/ICH volume) in patients with deep ICH demonstrated that the only factor related to it was MMP-9 concentration (OR 11.6; 95% CI 1.5–89.1; p = 0.018). Conclusions. Expression of MMP-9 is raised after acute spontaneous ICH. Among patients with deep ICH this increase is associated with PHE and the development of neurological worsening within the acute stage.

Flushing in relation to a possible rise in intracranial pressure: documentation of an unusual clinical sign

2000 ◽  
Vol 92 (6) ◽  
pp. 1040-1044 ◽  
Author(s):  
Gregory W. Hornig
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Intraventricular Hemorrhage ◽  
Pneumococcal Meningitis ◽  
Clinical Importance ◽  
Neurological Deterioration ◽  
Content Type ◽  
Transient Nature ◽  
Fine Print

✓ This report documents clinical features in five children who developed transient reddening of the skin (epidermal flushing) in association with acute elevations in intracranial pressure (ICP). Four boys and one girl (ages 9–15 years) deteriorated acutely secondary to intracranial hypertension ranging from 30 to 80 mm Hg in the four documented cases. Two patients suffered from ventriculoperitoneal shunt malfunctions, one had diffuse cerebral edema secondary to traumatic brain injury, one was found to have pneumococcal meningitis and hydrocephalus, and one suffered an intraventricular hemorrhage and hydrocephalus intraoperatively. All patients were noted to have developed epidermal flushing involving either the upper chest, face, or arms during their period of neurological deterioration. The response was transient, typically lasting 5 to 15 minutes, and dissipated quickly. The flushing reaction is postulated to be a centrally mediated response to sudden elevations in ICP. Several potential mechanisms are discussed. Flushing has clinical importance because it may indicate significant elevations in ICP when it is associated with neurological deterioration. Because of its transient nature, the importance of epidermal flushing is often unrecognized; its presence confirms the need for urgent treatment.

Effect of stimulation of the medullary reticular formation on cerebral vasomotor tonus and intracranial pressure

1987 ◽  
Vol 66 (4) ◽  
pp. 548-554 ◽  
Author(s):  
Seigo Nagao ◽  
Tsukasa Nishiura ◽  
Hideyuki Kuyama ◽  
Masakazu Suga ◽  
Takenobu Murota
Keyword(s):  
Intracranial Pressure ◽  
Reticular Formation ◽  
Cerebral Blood Volume ◽  
Systemic Arterial Pressure ◽  
Brain Swelling ◽  
Dorsomedial Nucleus ◽  
Medullary Reticular Formation ◽  
Content Type ◽  
Fine Print ◽  
Stimulation Of

✓ The authors report the results of a study to evaluate the effect of stimulation of the medullary reticular formation on cerebral vasomotor tonus and intracranial pressure (ICP) after the hypothalamic dorsomedial nucleus and midbrain reticular formation were destroyed. Systemic arterial pressure (BP), ICP, and local cerebral blood volume (CBV) were continuously recorded in 32 cats. To assess the changes in the cerebral vasomotor tonus, the vasomotor index defined by the increase in ICP per unit change in BP was calculated. In 29 of the 32 animals, BP, ICP, and CBV increased simultaneously immediately after stimulation. The increase in ICP was not secondary to the increase in BP, because the vasomotor index during stimulation was significantly higher than the vasomotor index after administration of angiotensin II. The vasomotor index was high during stimulation of the area around the nucleus reticularis parvocellularis. In animals with the spinal cord transected at the C-2 vertebral level, ICP increased without a change in BP. These findings indicate that the areas stimulated in the medullary reticular formation play an important role in decreasing cerebral vasomotor tonus. This effect was not influenced by bilateral superior cervical ganglionectomy, indicating that there is an intrinsic neural pathway that regulates cerebral vasomotor tonus directly. In three animals, marked biphasic or progressive increases in ICP up to 100 mm Hg were evoked by stimulation. The reduction of cerebral vasomotor tonus and concomitant vasopressor response induced by stimulation of the medullary reticular formation may be one of the causes of acute brain swelling.

Early metabolic alterations in edematous perihematomal brain regions following experimental intracerebral hemorrhage

1998 ◽  
Vol 88 (6) ◽  
pp. 1058-1065 ◽  
Author(s):  
Kenneth R. Wagner ◽  
Guohua Xi ◽  
Ya Hua ◽  
Marla Kleinholz ◽  
Gabrielle M. de Courten-Myers ◽  
...  
Keyword(s):  
White Matter ◽  
Intracerebral Hemorrhage ◽  
Gray Matter ◽  
High Energy ◽  
Brain Regions ◽  
Large Animal ◽  
High Energy Phosphate ◽  
Content Type ◽  
Water Contents ◽  
Fine Print

Object. The authors previously demonstrated, in a large-animal intracerebral hemorrhage (ICH) model, that markedly edematous (“translucent”) white matter regions (> 10% increases in water contents) containing high levels of clotderived plasma proteins rapidly develop adjacent to hematomas. The goal of the present study was to determine the concentrations of high-energy phosphate, carbohydrate substrate, and lactate in these and other perihematomal white and gray matter regions during the early hours following experimental ICH. Methods. The authors infused autologous blood (1.7 ml) into frontal lobe white matter in a physiologically controlled model in pigs (weighing approximately 7 kg each) and froze their brains in situ at 1, 3, 5, or 8 hours postinfusion. Adenosine triphosphate (ATP), phosphocreatine (PCr), glycogen, glucose, lactate, and water contents were then measured in white and gray matter located ipsi- and contralateral to the hematomas, and metabolite concentrations in edematous brain regions were corrected for dilution. In markedly edematous white matter, glycogen and glucose concentrations increased two- to fivefold compared with control during 8 hours postinfusion. Similarly, PCr levels increased several-fold by 5 hours, whereas, except for a moderate decrease at 1 hour, ATP remained unchanged. Lactate was markedly increased (approximately 20 µmol/g) at all times. In gyral gray matter overlying the hematoma, water contents and glycogen levels were significantly increased at 5 and 8 hours, whereas lactate levels were increased two- to fourfold at all times. Conclusions. These results, which demonstrate normal to increased high-energy phosphate and carbohydrate substrate concentrations in edematous perihematomal regions during the early hours following ICH, are qualitatively similar to findings in other brain injury models in which a reduction in metabolic rate develops. Because an energy deficit is not present, lactate accumulation in edematous white matter is not caused by stimulated anaerobic glycolysis. Instead, because glutamate concentrations in the blood entering the brain's extracellular space during ICH are several-fold higher than normal levels, the authors speculate, on the basis of work reported by Pellerin and Magistretti, that glutamate uptake by astrocytes leads to enhanced aerobic glycolysis and lactate is generated at a rate that exceeds utilization.

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