Congenital astrocytoma presenting with intracerebral hematoma

1979 ◽  
Vol 51 (2) ◽  
pp. 237-239 ◽  
Author(s):  
Steven M. Rothman ◽  
James S. Nelson ◽  
Darryl C. DeVivo ◽  
William S. Coxe
Keyword(s):  
Intracerebral Hemorrhage ◽  
Vascular Malformation ◽  
Pathological Examination ◽  
Intracerebral Hematoma ◽  
Age Group ◽  
Bleeding Diathesis ◽  
Content Type ◽  
Congenital Tumor ◽  
Fibrillary Astrocytoma ◽  
Fine Print

✓ A massive left intracerebral hematoma was surgically evacuated from a 2-week-old infant. Pathological examination showed that the hemorrhage had developed within a fibrillary astrocytoma. Neonatal intracerebral hemorrhage should raise the question of congenital tumor because such a hemorrhage in this age group is rarely the result of trauma, bleeding diathesis, or vascular malformation.

The angiographically occult cerebrovascular malformation

1978 ◽  
Vol 48 (2) ◽  
pp. 292-296 ◽  
Author(s):  
James B. Golden ◽  
Richard A. Kramer
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Vascular Malformation ◽  
Ct Scans ◽  
Cerebral Lesions ◽  
Content Type ◽  
Surgical Exploration ◽  
Diagnostic Possibility ◽  
Cerebrovascular Malformation ◽  
Fine Print

✓ Three cases presenting with hemiparesis, headache, or seizures gave no history suggestive of subarachnoid or intracerebral hemorrhage. Carotid arteriograms were performed, and in each case failed to demonstrate a vascular malformation. In all three cases cerebral lesions were shown by either computerized tomographic (CT) scan, radionuclide scan, or both. Surgical exploration and biopsy revealed a vascular malformation in each case. The CT scans in two of the cases showed dense lesions that could suggest vascular malformation as a diagnostic possibility.

Encapsulated intracerebral hematomas: a defined entity

1993 ◽  
Vol 78 (5) ◽  
pp. 829-833 ◽  
Author(s):  
José M. Roda ◽  
Fernando Carceller ◽  
Antonio Pérez-Higueras ◽  
Carmen Morales
Keyword(s):  
Vascular Malformation ◽  
Vascular Malformations ◽  
Young Patients ◽  
Mass Effect ◽  
Magnetic Resonance Images ◽  
Intracerebral Hematoma ◽  
Content Type ◽  
Male Predominance ◽  
Perifocal Edema ◽  
Fine Print

✓ Encapsulated intracerebral hematoma is an interesting and not widely appreciated entity. It can be defined as an intraparenchymal hematoma found in normotensive patients, usually caused by histologically confirmed vascular malformations, characterized by a gradual clinical onset, and presenting a well-defined capsule at operation. One case is presented and 25 previously reported cases are reviewed, all reflecting the above-mentioned characteristics. The hematomas reviewed here occurred in relatively young patients with a mean age of 35 years and a clear male predominance (19 males, seven females). A ring of contrast enhancement around a lesion of variable density, usually with mass effect and perifocal edema, is the most relevant feature on computerized tomography. Findings on magnetic resonance images are described for the first time in the reported case. A vascular malformation was the most frequent cause found on histological examination (12 of the 26 total cases). No proven cause was found in the remaining 14 cases, although a small vascular malformation, destroyed or thrombosed after rupturing and bleeding, is the most likely etiology in these patients.

Low incidence of delayed intracerebral hemorrhage secondary to ventriculoperitoneal shunt insertion

1999 ◽  
Vol 91 (1) ◽  
pp. 32-34 ◽  
Author(s):  
Martin H. Savitz ◽  
Lewis M. Bobroff
Keyword(s):  
Intracerebral Hemorrhage ◽  
Brain Parenchyma ◽  
Adult Patients ◽  
Vascular Lesions ◽  
Intracerebral Hematoma ◽  
Shunt Insertion ◽  
Content Type ◽  
Vp Shunt ◽  
The Brain ◽  
Fine Print

Object. Bleeding into the brain parenchyma or ventricles is an infrequently reported complication in adults who undergo insertion of a ventriculoperitoneal (VP) shunt. The purpose of this study was to establish the incidence of delayed intracerebral hemorrhage secondary to ventricular cannulation during shunting procedures.Methods. Over a 24-year period, in a series of 125 adult patients with hydrocephalus, postoperative computerized tomography scans were obtained in every case within 48 hours of shunt surgery performed by the same neurosurgeon. The rate of delayed intracerebral hematoma or intraventricular hemorrhage after VP shunt placement was documented by routine neuroradiological follow up to be 4%.Conclusions. In adult patients with no coagulopathy or occult vascular lesions, the rate of bleeding after VP shunt insertion may be low if the procedure is uncomplicated by multiple attempts at perforation, puncture of the choroid plexus, or improper placement of the tubing within the parenchyma of the brain.

Intracerebral hemorrhage due to ruptured venous aneurysm

1978 ◽  
Vol 49 (5) ◽  
pp. 739-743 ◽  
Author(s):  
George W. Tyson ◽  
John A. Jane ◽  
W. Ellis Strachan
Keyword(s):  
Intracerebral Hemorrhage ◽  
Arteriovenous Fistula ◽  
Spontaneous Rupture ◽  
Venous Aneurysm ◽  
Intracerebral Hematoma ◽  
Cerebral Vein ◽  
Traumatic Aneurysm ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Fine Print

✓ Documented rupture of venous aneurysms associated with arteriovenous fistulas is uncommon, and reports of the formation and rupture of venous aneurysms that are not associated with fistulas are distinctly rare. One case is presented in which spontaneous rupture of a saccular aneurysm on a vessel draining an arteriovenous fistula produced an intracerebral hematoma. A second case is described in which fatal intracerebral hemorrhage was produced by a traumatic aneurysm of an otherwise normal superficial cerebral vein.

Lobar intracerebral hemorrhage

1992 ◽  
Vol 76 (2) ◽  
pp. 231-238 ◽  
Author(s):  
Susumu Wakai ◽  
Nahomi Kumakura ◽  
Masakatsu Nagai
Keyword(s):  
Intracerebral Hemorrhage ◽  
Cerebral Amyloid Angiopathy ◽  
Vascular Malformation ◽  
Cavernous Malformation ◽  
Ct Scans ◽  
Amyloid Angiopathy ◽  
Content Type ◽  
Negative Angiography ◽  
Cerebral Amyloid ◽  
Fine Print

✓ The authors operated consecutively on 50 patients with lobar intracerebral hemorrhage during a prospectively designed study period from January, 1986, to March, 1990. They investigated the correlations between the underlying causes and the clinicoradiographic features in 29 patients who showed no angiographic vascular abnormalities, in order to elucidate the operative indication for such cases. Patients with ruptured saccular aneurysm or trauma were not included in this study. There were 15 males and 14 females, ranging in age from 7 to 76 years (mean 52.4 years). Histological diagnoses of the surgical specimens were as follows: vascular malformation in nine cases (arteriovenous malformation (AVM) in six and cavernous malformation in three), microaneurysm in 11, cerebral amyloid angiopathy in six, and brain tumor in two; in the remaining case the cause was not verified histologically. The underlying cause was determined in 96.5% of cases. The mean patient age was lowest in the cavernous malformation group (27.0 years), followed by the AVM (45.8 years), microaneurysm (59.8 years), and cerebral amyloid angiopathy (70.0 years) groups. Four patients with vascular malformation (three AVM's and one cavernous malformation) had previous episodes of bleeding at the same site, whereas none of those with microaneurysms or cerebral amyloid angiopathy had such episodes. On computerized tomography (CT) scans, the round to oval hematoma was related to the presence of an AVM or cavernous malformation in contrast to microaneurysms and cerebral amyloid angiopathy. Upon infusion of contrast material, variable enhancement was seen in five (two AVM's and three cavernous malformations) of the nine vascular malformations while no enhancement was noted in any patient with microaneurysm or cerebral amyloid angiopathy at the acute stage. Subarachnoid extension of the hematoma was associated with cerebral amyloid angiopathy significantly more frequently than with AVM's (p < 0.05) and microaneurysms (p < 0.01). The results suggest that clinicoradiographic pictures in cases with negative angiography are quite different among the three major pathological categories; namely, vascular malformation (AVM and cavernous malformation), microaneurysm, and cerebral amyloid angiopathy. It is suggested that the underlying etiology of a given lobar intracerebral hemorrhage with negative angiography may be predicted by a combination of patient age, history of previous bleeding at the same site, hematoma shape, and subarachnoid extension of the hematoma on CT scans. Based upon these findings, the authors discuss operative indications for such cases.

Malignant transformation of a dysembryoplastic neuroepithelial tumor

2000 ◽  
Vol 92 (4) ◽  
pp. 722-725 ◽  
Author(s):  
Robert R. Hammond ◽  
Neil Duggal ◽  
John M. J. Woulfe ◽  
John P. Girvin
Keyword(s):  
Malignant Transformation ◽  
Complex Form ◽  
Ct Scanning ◽  
Subtotal Resection ◽  
Dysembryoplastic Neuroepithelial Tumor ◽  
Content Type ◽  
Recent Onset ◽  
Fibrillary Astrocytoma ◽  
Fine Print ◽  
Glial Nodules

✓ A 29-year-old man presented in 1984 with a recent onset of partial seizures marked by speech arrest. Electroencephalography identified a left frontotemporal dysrhythmia. Computerized tomography (CT) scanning revealed a superficial hypodense nonenhancing lesion in the midleft frontal convexity, with some remodeling of the overlying skull. The patient was transferred to the London Health Sciences Centre for subtotal resection of what was diagnosed as a “fibrillary astrocytoma (microcystic).” He received no chemotherapy or radiation therapy and remained well for 11 years.The patient presented again in late 1995 with progressive seizure activity. Both CT and magnetic resonance imaging demonstrated a recurrent enhancing partly cystic lesion. A Grade IV astrocytoma was resected, and within the malignant tumor was a superficial area reminiscent of a dysembryoplastic neuroepithelial tumor (DNT). Data on the lesion that had been resected in 1984 were reviewed, and in retrospect the lesion was identified as a DNT of the complex form. It was bordered by cortical dysplasia and contained glial nodules, in addition to the specific glioneuronal element. The glial nodules were significant for moderate pleomorphism and rare mitotic figures. The Ki67 labeling index averaged 0.3% in the glial nodules and up to 4% focally. Cells were rarely Ki67 positive within the glioneuronal component. This case is the first documented example of malignant transformation of a DNT. It serves as a warning of the potential for malignant transformation in this entity, which has been traditionally accepted as benign. This warning may be especially warranted when confronted with complex forms of DNT. The completeness of resection in the benign state is of paramount importance.

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.

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.

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.

Endoscopic surgery versus medical treatment for spontaneous intracerebral hematoma: a randomized study

1989 ◽  
Vol 70 (4) ◽  
pp. 530-535 ◽  
Author(s):  
Ludwig M. Auer ◽  
Wolfgang Deinsberger ◽  
Kurt Niederkorn ◽  
Günther Gell ◽  
Reinhold Kleinert ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Medical Treatment ◽  
Functional Recovery ◽  
Randomized Study ◽  
Treated Group ◽  
Surgical Patients ◽  
Lower Mortality ◽  
Intracerebral Hematoma ◽  
Content Type ◽  
Fine Print

✓ A controlled randomized study of endoscopic evacuation versus medical treatment was performed in 100 patients with spontaneous supratentorial intracerebral (subcortical, putaminal, and thalamic) hematomas. Patients with aneurysms, arteriovenous malformations, brain tumors, or head injuries were excluded. Criteria for inclusion were as follows: patients' age between 30 and 80 years; a hematoma volume of more than 10 cu cm; the presence of neurological or consciousness impairment; the appropriateness of surgery from a medical and anesthesiological point of view; and the initiation of treatment within 48 hours after hemorrhage. The criteria of randomization were the location, size, and side of the hematoma as well as the patient's age, state of consciousness, and history of hypertension. Evaluation of outcome was performed 6 months after hemorrhage. Surgical patients with subcortical hematomas showed a significantly lower mortality rate (30%) than their medically treated counterparts (70%, p < 0.05). Moreover, 40% of these patients had a good outcome with no or only a minimal deficit versus 25% in the medically treated group; the difference was statistically significant for operated patients with no postoperative deficit (p < 0.01). Surgical patients with hematomas smaller than 50 cu cm made a significantly better functional recovery than did patients of the medically treated group, but had a comparable mortality rate. By contrast, patients with larger hematomas showed significantly lower mortality rates after operation but had no better functional recovery than the medically treated group. This effect from surgery was limited to patients in a preoperatively alert or somnolent state; stuporous or comatose patients had no better outcome after surgery. The outcome of surgical patients with putaminal or thalamic hemorrhage was no better than for those with medical treatment; however, there was a trend toward better quality of survival and chance of survival in the operated group.

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