Rapid Expansion of Hypertensive Intracerebral Hemorrhage

Abstract

We report a series of 10 patients who had a rapid expansion of a hypertensive intracerebral hemorrhage (HICH). It occurred in approximately 3% of 320 patients who sought treatment for HICH during the past 2 years. The site of hemorrhage was the putamen in 6 patients and the thalamus in 4 patients. Neurological deterioration occurred in a mean time of 40 hours after the onset of symptoms (range, 5.5-109 h). Fifty percent of all patients deteriorated within 24 hours. Persistent hypertension was recorded in all patients. Repeat computed tomography showed an increase of hematoma volume that was twice as large in thalamic hemorrhage and about three times as large in putaminal hemorrhage. Six patients died, whereas 3 survived with severe disability and 1 survived with moderate disability. This study indicates that continued or subsequent bleeding can occur in HICH. If those lesions are not detected early and microsurgically evacuated, they are almost always fatal. Early stereotactic evacuation with urokinase irrigation is considered more dangerous than open craniotomy by microsurgical techniques. We stress the need for attention to this problem during the acute phase of HICH.

Transsylvian-Transinsular Approach for Deep-Seated Basal Ganglia Hemorrhage: An Experience at a Single Institution

“…Although a few methods are available for treatment of spontaneous cerebral hemorrhage, the treatment is generally classified according to 2 major groups: hematoma evacuation by craniotomy or drainage by burrhole. 1) …”

Blood pressure is not associated with haematoma enlargement in acute intracerebral haemorrhage

“…Even though high BP is a treatable condition, there is an unfortunate dearth of studies that have investigated the relevance of high BP to HE. Some previous reports [13–15] involving relatively small number of patients indicated that HE was associated with persistent hypertension. However, a prospective study [3] that included 103 patients with ICH within the first 3 h after the onset of symptoms, failed to find evidence that BP was associated with HE.…”

“…If high BP is a factor involved in the pathogenesis of HE, this would have important therapeutic implications. Small studies reported years ago and some retrospective studies more recently have reported that haematomas expand in patients with uncontrolled high BP [12–17]. However, there is no clear evidence of this association from prospective observational studies [3,18,19].…”

Rapid Spontaneous Reduction of a Huge Intracerebral Hematoma

“…The rapid expansion of a sICH has been frequently reported 1)14). However, we found limited reports describing the rapid spontaneous decrease in the volume of the hematoma observed in ICH 4).…”