Chronic encapsulated intracerebral hematoma: Three case reports and a literature review

Abstract

Background:Chronic encapsulated intracerebral hematoma (CEIH) is one type of intracerebral hematoma that sometimes grows progressively while forming a capsule and presenting with neurological deficits. Although many cases of CEIH have been reported, correct preoperative diagnosis is very difficult. Only around 20% of cases are diagnosed preoperatively.Case Description:We encountered three cases of CEIH in which causes were unidentified and difficult to diagnose. All three cases were treated surgically. In the first case, a 59-year-old male was diagnosed preoperatively with metastatic brain tumor. In the second case, a 62-year-old female was diagnosed preoperatively with glioblastoma. The third case involved a 58-year-old female diagnosed preoperatively with CEIH.Conclusion:We should keep in mind that CEIH is a differential diagnosis for intracerebral space-occupying lesions. This report describes these three cases and discusses imaging findings and characteristics of CEIH.

Imaging Diagnosis of Chronic Encapsulated Intracerebral Hematoma, a Comparison of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) characteristics

“…As the disease progresses and the capillaries bleed continuously, the hematoma continues to expand, and the mass effect increases gradually. Patients become concerned only when irritating symptoms are noticed or neurological damage occurs [ 2 , 8 , 9 ]. At this point, CT has no typical features.…”

“…At this point, CT has no typical features. MRI features are also not conclusive but rather confusing, and cannot be recognized clearly, which often leads to misdiagnosis of glioma, metastasis, or brain abscess [ 2 ].…”

“…Brain imaging shows lesions of chronic scalability because of a slow clinical course and atypical clinical and imaging findings. CEICH is often misdiagnosed as glioma, metastasis, or brain abscess [ 2 ]. We retrospectively analyzed clinical and radiological data of 5 patients with CEICH that was confirmed by surgical pathology, and discuss the imaging characteristics of CEICH in order to improve the diagnosis of this disease.…”

A Case of Recurrent Hemorrhages due to a Chronic Expanding Encapsulated Intracranial Hematoma

“…EIH, a rare type of cerebral hemorrhage, was first reported in 1978 by Yashon and Konsik [ 1 ], and about 50 cases have been reported since then [ 2 ]. EIH is defined as an intracranial hematoma that sometimes grows progressively [ 3 ]. Compared with normal intracerebral hemorrhages, EIH has an early onset age and can be complicated by hypertension, and almost all of the lesions develop beneath the cerebral cortex [ 4 ].…”

“…Compared with normal intracerebral hemorrhages, EIH has an early onset age and can be complicated by hypertension, and almost all of the lesions develop beneath the cerebral cortex [ 4 ]. Although many theories concerning the etiology [ 5 , 6 ] and mechanisms [ 6 , 7 , 8 ] of the disease have been proposed, the details remain unclear; thus, only around 20% of cases are diagnosed preoperatively [ 3 ]. Most previous studies report on expanded encapsulated hematomas that were discovered after the manifestation of neurological symptoms, with only a few studies discussing the initial stage of the disease before encapsulated hematoma development.…”