Multiple simultaneous intracerebral hemorrhages: Clinical presentations and risk factors

Yamaguchi, Yohei; Takeda, Ririko; Kikkawa, Yuichiro; Ikeda, Toshiki; Suzuki, Kaima; Shibata, Aoto; Tiezzi, Giacomo; Araki, Ryuichiro; Kurita, Hiroki

doi:10.1016/j.jns.2017.10.005

Cited by 6 publications

(9 citation statements)

References 27 publications

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“…Our study had cortical-cortical patterns of involvement in 60% of the patients and basal ganglion and thalamic involvement in 12.5% of cases. Putamen and thalamus patterns of involvement were the most common anatomical patterns of involvement in a study by Yamaguchi et al (2017) whereas bilateral thalamic hemorrhages variants were the most common in a study by Yen et al (2005).…”

Section: Discussionmentioning

confidence: 88%

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Demographical domains and clinico-radiological characteristics of study cohorts with simultaneous multiple intracerebral hemorrhages in a tertiary neurosurgical center in Nepal: a cross-sectional study

Munakomi

Chaulagain

2022

F1000Res

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Background: Simultaneous multiple intra-cerebral hemorrhages (SMICHs) and its occurrences in different territories of arterial disposition has been viewed as uncommon clinical occurrences, since the pathophysiological and predisposing factors as mechanisms aren’t vividly defined. This research primarily aims for demographic stratification and dichotomization pertaining to risk factors, etiological classifications, anatomical distributions and outcome analysis by focusing on management strategies and pertinent stroke care. Methods: 40 patients presenting to the College of Medical Sciences, Chitwan, Nepal in the last two years were included in the study. The patients with two-or-more SMICHs with affected arterial territories with similar tomographic density based profiling were chosen as samples. Regression analysis was chosen to test three hypotheses. Results: Among our study cohorts, cortical and cortical territory (60%) was the major anatomical patterns of involvement. A conservative approach was undertaken in nine patients (22.5%), whereas surgical intervention was needed in five others (12.5%). A total of 14(35%) patients leaving against medical advice and a further seven (17.5%) patients were referred for adjuvant oncologic care. Mortality was observed among five (12.5%) patients. Hypertension was seen as a significant variable in its pathogenesis. Male patients were more affected. Age groups comprising of 36-45years and 56-65 years were involved in 32.5% and 30% cases respectively. Conclusion: This study proves the need for a national stroke data bank pertaining to SMICH. This will help foster effective patient education during preoperative counselling; as well as formatting a management algorithm combating them.

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Section: Discussionmentioning

confidence: 88%

“…In a study by Yen et al (2005), the mean age of the patients presenting with SMICH was 60.6 ±7.9 years with a male: female ratio of 1.5:1.The mean age of similar cohorts in another study was 68.5 ± 12.8 years (Yamaguchi et al, 2017).…”

Section: Discussionmentioning

confidence: 93%

Demographical domains and clinico-radiological characteristics of study cohorts with simultaneous multiple intracerebral hemorrhages in a tertiary neurosurgical center in Nepal: a cross-sectional study

Munakomi

Chaulagain

2022

F1000Res

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“…Immune system abnormalities could lead not only to recurrent cerebrovascular and systemic vascular events – including hemorrhagic and ischemic strokes and DVT [14] – but also, along with hypercoagulability, to the development of occult cancer [15], which may not be immediately detectable on regular diagnostic imaging. An initial stroke could result in another lesion of the same or opposite nature within a short time, this phenomenon could be explained by “biphasic hypothetical mechanism” [16].…”

Section: Discussionmentioning

confidence: 99%

Mixed cerebrovascular disease in an elderly patient with mixed vascular risk factors: a case report

et al. 2019

BMC Neurol

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BackgroundMixed cerebrovascular disease is a diagnostic entity that presents with hemorrhagic and ischemic stroke clinically and/or subclinically. Here, we report a patient with mixed vascular risk factors, who presented with multiple intracerebral hemorrhages and a simultaneously occurring cerebral infarction with hemorrhagic transformation.Case presentationA 63-year-old male with no history of trauma or prior neurological disease presented with a sudden onset of weakness in his right limbs, followed by an episode of focal seizure without impaired awareness. The patient had a 4-year history of deep vein thrombosis in the lower limbs, and a 2-year history of Raynaud’s phenomenon in the hands. He also had a family history of hypertension and thrombophilia. Head computed tomography plain scans showed two high densities in the bilateral parietal lobes and one mixed density in the left frontal lobe. The patient was diagnosed with mixed cerebrovascular disease. In this report, we make a systematic clinical reasoning regarding the etiological diagnosis, and discuss the possible pathogenic mechanisms leading to mixed cerebrovascular disease. We exclude coagulopathy, endocarditis, atrial fibrillation, patent foramen ovale, brain tumor, cerebral venous thrombosis, cerebral vascular malformation, cerebral amyloid angiopathy and vasculitis as causative factors. We identify hypertension, hereditary protein S deficiency, hypercholesteremia and hyperhomocysteinemia as contributing etiologies in this case.ConclusionThis case presents complex underlying mechanisms of mixed cerebrovascular disease, in which hypertension and hyperhomocysteinemia are considered to play a central role.

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“…10 Sustained high blood pressure during hemorrhagic stroke can trigger another bleeding site as a result of acute vascular changes in perforating arteries that affect previously weakened intimal and medial layers. 18,19 Hematoma volume was also found to be a risk factor for multiple concurrent ICHs, suggesting that large hematomas can induce smaller ones. 19 MIS is relatively safe, although there are occasional complications such as bleeding, infection, and elevated ICP.…”

Section: Dovepressmentioning

confidence: 99%

“…18,19 Hematoma volume was also found to be a risk factor for multiple concurrent ICHs, suggesting that large hematomas can induce smaller ones. 19 MIS is relatively safe, although there are occasional complications such as bleeding, infection, and elevated ICP. We applied a stability protocol for MIS to prevent bleeding that included a time from onset to operation >6 h; repeated CT ≥6 h after the diagnostic CT showed that the hemorrhage had not expanded by >5 mL; slow and gentle aspiration during the operation; aspiration of not more than 70% of the hematoma volume; and stabilization of blood pressure.…”

Section: Dovepressmentioning

confidence: 99%

<p>Two Different Minimally Invasive Surgery Puncture Points with Thrombolysis in a Patient with Bilateral Basal Ganglia Hemorrhages</p>

Zhang¹,

Yu²,

Wang³

et al. 2020

IJGM

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Bilateral basal ganglia hemorrhages are extremely rare and have very poor prognosis. We describe the case of a 52-year-old woman with a history of hypertension who experienced bilateral basal ganglia hemorrhages. We performed bilateral hematoma aspiration by minimally invasive surgery via frontal and temporal puncture points. We discuss the surgical procedure and review relevant literature pertaining to the underlying causes and complications of similar cases.

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Multiple simultaneous intracerebral hemorrhages: Clinical presentations and risk factors

Cited by 6 publications

References 27 publications

Demographical domains and clinico-radiological characteristics of study cohorts with simultaneous multiple intracerebral hemorrhages in a tertiary neurosurgical center in Nepal: a cross-sectional study

Demographical domains and clinico-radiological characteristics of study cohorts with simultaneous multiple intracerebral hemorrhages in a tertiary neurosurgical center in Nepal: a cross-sectional study

Mixed cerebrovascular disease in an elderly patient with mixed vascular risk factors: a case report

<p>Two Different Minimally Invasive Surgery Puncture Points with Thrombolysis in a Patient with Bilateral Basal Ganglia Hemorrhages</p>

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