Massive Brain Hemorrhage: A Review of 144 Cases and an Examination of Their Causes

McCORMICK, Williams F.; Rosenfield, David B.

doi:10.1161/01.str.4.6.946

Cited by 232 publications

(75 citation statements)

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“…9,[16][17][18][19][20][21][22][23][24] Most FICH occurred soon after diagnosis, 27 within 7 days, and 13 patients presented with FICH at diagnosis. Because the median interval from FICH to death was 2 days, we estimate that 1.6% of patients with acute leukemia die from FICH without any opportunity for proper management.…”

Section: Discussionmentioning

confidence: 99%

Risk score model for fatal intracranial hemorrhage in acute leukemia

Kim

et al. 2006

Leukemia

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To build a risk score (RS) model of fatal intracranial hemorrhage (FICH) in patients with acute leukemia, we retrospectively assessed risk factors in 792 patients newly diagnosed with acute leukemia, 41 of whom had analyzable FICH. We found that female gender (relative risk (RR) ¼ 5.234, Po0.001), acute promyelocytic leukemia (RR ¼ 4.057, P ¼ 0.003), leukocytosis (RR ¼ 3.301, P ¼ 0.004), thrombocytopenia (RR ¼ 3.283, P ¼ 0.005) and prolonged prothrombin time (RR ¼ 3.291, P ¼ 0.016) were significantly associated with occurrence of FICH in multivariate analysis. To calculate RS for FICH, one point was assigned for each risk factor, making the RS between 0 and 5. The RS model segregated patients into three prognostic groups: a low-risk group (LRG) for RS of 0 or 1; an intermediate-risk group (IRG) for RS of 2 or 3; and a high-risk group (HRG) for RS of 4 or 5. Expectation of FICH was well correlated with risk groups (all P-values o0.001). Overall survival was significantly shorter in the HRG compared with the LRG. The RS model we constructed to predict the occurrence of FICH will be verified through prospective studies.

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Section: Discussionmentioning

confidence: 99%

Risk score model for fatal intracranial hemorrhage in acute leukemia

Kim

et al. 2006

Leukemia

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“…Prior studies of non-traumatic spontaneous subcortical lobar haematoma have emphasised two fea- (2) post-contrast enhancement on the scan performed within the initial week after the haemorrhage. The age predilection of these 50 patients with lobar haematomas is older than would have been expected for bleeding from a cerebral vascular malformation.…”

Section: Discussionmentioning

confidence: 99%

Subcortical lobar intracerebral haemorrhage: clinical-computed tomographic correlations.

Weisberg¹

1985

Journal of Neurology, Neurosurgery & Psychiatry

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SUMMARY Fifty patients with spontaneous lobar haematomas were reviewed. Thirty-two were normotensive and eighteen were hypertensive. Vomiting, seizures, and altered consciousness were more common in hypertensive than in normotensive patients. Haematoma size (greater than 4-0 cm) and intraventricular extension occurred most commonly in hypertensive and rarely in normotensive patients. Twenty-eight per cent of hypertensive patients died, whereas none of the normotensive patients died.The majority of intracerebral haematomas are hypertensive in aetiology. These are usually located in the thalamic or basal ganglionic region; less commonly, they are in the cerebellum, brain stem, or subcortical white matter of the cerebral hemispheres (lobar haematomas). The finding of a lobar haematoma should initiate a thorough investigation for a specific neuropathological aetiology for the haemorrhage such as angioma, aneurysm, neoplasm, or an underlying medical condition (for example bleeding disorder, collagen vascular disease).The present report is an analysis of the clinicalcomputed tomographic correlations in 50 patients with non-traumatic acute lobar haematoma in whom a thorough clinical and laboratory investigation did not demonstrate a specific aetiology for the intracranial haematoma. Methods and patientsOf 489 consecutive patients who were studied prospectively with CT evidence of intracerebral haematoma, there were 68 patients with lobar haematomas. There were 18 patients in whom neurodiagnostic findings, laboratory studies and/or pathological findings showed a specific aetiology for the lobar haematomas ( There were 50 other patients with CT evidence of lobar haematoma in whom no aetiology was determined by CT findings, angiography, laboratory studies, and in some cases by surgical or necropsy studies. Patients with a history of trauma were excluded from this analysis. In an effort to ensure that patients with traumatic haemorrhagic contusions were not included, patients in whom trauma was even a remote consideration were excluded. The clinical and CT findings were reviewed by the author. The diagnostic criteria used by Kase et al' to support the diagnosis of lobar haematoma were used. These included: (1) absence of clinically detectable cardiac source of cerebral embolism; (2) CT evidence of a hyperdense lesion located in the subcortical white matter which extended beyond a specific arterial territory; (3) the haematoma was sometimes surrounded by an irregularly marginated hypodense region (representing oedema), but the irregular margination of the hypodense component excluded the diagnosis of infarction; (4) there was sometimes ventricular extension; (5) ring enhancement was sometimes seen if scan was performed 7 to 28 days after the haemorrhage; (6) when performed, angiogram showed evidence of an avascular mass and not a cortical branch occlusion (which would be consistent with cerebral embolism). Haematomas which appeared to originate in the ganglionic-thalamic region and then secondarily extended into the white m...

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“…8 However, most previous studies in this field are case-control studies 7,8 or studies that only include fatal cases. 9,10 Here, we have prospectively studied the effects of hypertension on the absolute and relative risks of ischemic stroke, PICH, and PICH with lobar and nonlobar location.…”

mentioning

confidence: 99%

Blood Pressure in Relation to the Incidence of Cerebral Infarction and Intracerebral Hemorrhage

Zia

Hedblad

Pessah‐Rasmussen

et al. 2007

Stroke

144

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Background and Purpose-Data regarding the association between blood pressure level and incidence of stroke subtype, especially primary intracerebral hemorrhage (PICH) subtypes, is sparse. This population-based study explored the relationship between blood pressure and the incidence of cerebral infarction, and PICH, with lobar and nonlobar location. Methods-Risk factors were assessed in 27 702 men and women without prior stroke from the city of Malmö, Sweden. Results-Mean age was 58.1 years. In all, 701 subjects had stroke (613 cerebral infarction and 88 PICH) during the follow-up period (mean, 7.5 years). The age-and sex-standardized incidences of cerebral infarction in subjects with hypertension grade 3 (Ն180/110 mm Hg) and normal blood pressure (Ͻ140/90 mm Hg) were 6.8 and 1.7 per 1000 person-years, respectively. Compared with the normotensive group, the adjusted relative risk of cerebral infarction was 3.4 (95% CI: 2.6 to 4.5) in subjects with hypertension grade 3. The corresponding incidences of lobar PICH were 0.5 versus 0.08 per 1000 person-years, respectively (adjusted relative risk: 9.2, 95% CI: 2.6 to 32.6) and for nonlobar PICH 1.6 versus 0.09 per 1000 person-years, respectively (adjusted relative risk: 25.9, 95% CI: 8.2 to 82.3). Conclusions-The incidence of hemorrhagic and ischemic stroke increased progressively with increasing blood pressure.Although hypertension was associated with substantially higher incidence rates and absolute numbers of cerebral infarction, which is most important in the public health perspective, the relationship with nonlobar PICH was strongest in terms of relative risks.

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Massive Brain Hemorrhage: A Review of 144 Cases and an Examination of Their Causes

Cited by 232 publications

References 6 publications

Risk score model for fatal intracranial hemorrhage in acute leukemia

Risk score model for fatal intracranial hemorrhage in acute leukemia

Subcortical lobar intracerebral haemorrhage: clinical-computed tomographic correlations.

Blood Pressure in Relation to the Incidence of Cerebral Infarction and Intracerebral Hemorrhage

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