Chronic expanding intracerebral hematoma

Abstract

The cases of 10 normotensive patients with chronic intracerebral hematomas are reported. The patients' median age at diagnosis was 42 years. The median duration of symptoms was 22 days. Seizures were the presenting symptom in 50% of the cases. Computerized tomography almost consistently demonstrated ring-shaped lesions with mass effect and perifocal edema. Arteriography revealed that all but one of the lesions were avascular. All patients had superficial white matter lesions, mostly in the frontoparietal region. All patients were treated surgically. Most of the hematomas were encapsulated and contained blood in various stages of organization. The thick capsule consisted of an outer layer of collagenous tissue and an inner layer of granulation tissue. Occult cerebrovascular malformations were detected in two instances. There were two deaths, both related to recurrent postoperative hemorrhage. This entity can present much like a brain malignancy and should be considered in the differential diagnosis of ring-shaped lesions whatever the clinical presentation. Strategies of treatment are discussed.

De Novo Formation of Cavernoma After Radiosurgery for Adult Cerebral Arteriovenous Malformation -Case Report-

“…13) However, chronic encapsulated hematoma may be closely related to vascular malformations, including occult AVM, cavernoma, and venous angioma. 10,17,20,21) Therefore, the cause of chronic encapsulated hematoma is probably small vascular malformations that were destroyed or thrombosed during repetitive bleedings. 21) A similar hypothesis was suggested based on findings in 10 patients with chronic expanding hematoma.…”

“…21) A similar hypothesis was suggested based on findings in 10 patients with chronic expanding hematoma. 20) Furthermore, the capsule presumably originates from fibroblasts related to the abnormal vessels of an occult vascular malformation, so a careful search may be necessary for cryptic angioma in patients with chronic encapsulated hematoma. 10) In fact, the capsule of chronic encapsulated hematoma contains rich neovascularity with an attached cavernoma.…”

Serial Neuroimaging of Encapsulated Chronic Intracerebral Hematoma With Repeated Hemorrhage -Case Report-

“…Most reported cases of ECIH were followed up for less than several months before surgery, and only two cases including ours demonstrated expansion of the lesion with 14) Histological examinations demonstrated sinusoidal vessels in the capsule in most cases, and the two layer pattern in the capsule in nine cases. 1,3,7,11,12,14,16) Among these nine cases, sinusoidal vessels were located in the outer layer in five cases including ours, 3,11,14,16) and in the inner layer in the other four cases. 1,7,12) Thus, the clinicopathological characteristics of genuine ECIH may be summarized as the presence of a distinct fibrous capsule that may consist of two layers, sinusoidal vessels in the capsule, and expansion of the hematoma with repeated internal bleeding from the capsule.…”

“…Thirty cases of ECIH with histological evidence have been reported (Table 1). 1,[3][4][5][6][7][8][11][12][13][14][15][16][17]19) The mean age was 41.8 years old and the most frequent symptoms were headache and seizure. The male to female ratio is two to one, and the most frequent locations were the frontal, temporal, and parietal lobes.…”

Chronic Encapsulated Intracerebral Hematoma Associated With Cavernous Angioma -Case Report-

“…CEIH is a special type of intracerebral hematoma described for the first time in 1981, 10) with about 50 cases reported. [1][2][3][4][5][6][7][8][9][10][11][12]14,16,[18][19][20][21][22][23][24][25][26][27][28][29][31][32][33][34][35][36] Compared with normal intracerebral hemorrhage, CEIH is characterized by early age of onset and rare complication by hypertension, and almost all such lesions have developed beneath the cerebral cortex. 12) Headaches and seizures are the most common earliest symptoms.…”