Recurrent Primary Cerebral Hemorrhage

González‐Duarte, Alejandra; Cantú, Carlos; Ruiz-Sandoval, José Luís; Barinagarrementería, Fernando

doi:10.1161/01.str.29.9.1802

Cited by 72 publications

(12 citation statements)

References 41 publications

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“…Additionally, because of the small sample size, we were unable to subdivide the patients into groups with or without preceding ICH. Although our study indicated that the presence of CMBs was a predictor of ICH independent of preceding ICH, preceding ICH is strongly correlated with both CMBs [9] and recurrent ICH [19]. Further studies are needed to clarify these correlations.…”

Section: Discussionmentioning

confidence: 85%

Cerebral Microbleeds Predict Impending Intracranial Hemorrhage in Infective Endocarditis

Okazaki

Sakaguchi²,

Hyun³

et al. 2011

Cerebrovasc Dis

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Background: Cerebral microbleeds (CMBs) detected by T2*-weighted MRI are a potential indicator of hypertension, microvascular disease and hemorrhagic stroke. An association between infective endocarditis (IE) and CMBs has been reported recently, but the clinical significance remains unclear. We hypothesized that CMBs in patients with IE are associated with vascular vulnerabilities such as mycotic aneurysm or pyogenic vasculitis. Methods: We retrospectively reviewed 26 consecutive patients with definite IE who underwent T2*-weighted MRI and were admitted to 2 medical centers in Osaka, Japan, between January 2006 and June 2010. We examined the incidence of symptomatic intracranial hemorrhage (ICH) occurring after initial MRI examination and investigated the association between ICH, CMBs and other clinical characteristics. Results: CMBs were identified in 14 patients (54%), and 72% of CMBs were found in the lobar region. Symptomatic ICH was observed in 8 patients (31%) during the 3-month follow-up period after initial MRI examination. In multiple logistic regression analyses, the presence of preceding ICH [odds ratio (OR) 40.0, 95% confidence interval (CI) 2.5–2,870] and the presence of CMBs (OR 34.0, 95% CI 1.3–17,300) were independent predictors of the development of ICH. Using cutoff values for CMBs of ≧2 and ≧3, the adjusted ORs for ICH increased (OR 42.1, 95% CI 1.9–24,300, and OR 70.1, 95% CI 2.5–105,000, respectively). Conclusions: In addition to prior ICH, the presence of CMBs was a strong predictor of impending ICH in patients with IE. CMBs might represent vascular vulnerability related to IE.

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Section: Discussionmentioning

confidence: 85%

Cerebral Microbleeds Predict Impending Intracranial Hemorrhage in Infective Endocarditis

Okazaki

Sakaguchi²,

Hyun³

et al. 2011

Cerebrovasc Dis

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“…Patient features associated with recurrent ICH were assessed in two studies. 3,7 No trends relating recurrence to age or gender were apparent. Diabetes was associated with recurrent ICH by univariate analysis in one study.…”

Section: Resultsmentioning

confidence: 99%

Primary cerebral amyloidoma

Blättler¹,

Siegel²,

Jochum³

et al. 2001

Neurology

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Article abstract-Objective: To characterize the rates of recurrent intracranial hemorrhage (ICH), ischemic stroke, and death in survivors of primary ICH. Methods: Systematic review of studies reporting recurrent stroke in survivors of primary ICH, identified at index ICH and followed forward. Studies were identified by computerized search of the literature and review of reference lists. Results: Ten studies published between 1982 and 2000 reporting 1,880 survivors of ICH, followed for a total of 6,326 patient-years (mean follow-up, 3.4 patient-years), were included. The aggregate rate of all stroke from five studies was 4.3% per patient-year (95% CI, 3.5% to 5.4%). The rate in the three population-based studies was higher than in the two hospital-based studies, 6.2% versus 4.0% per patient-year (p ϭ 0.04). About three fourths of recurrent strokes were ICH. Considering all 10 studies, a total of 147 patients had a recurrent ICH, an aggregate rate of 2.3% per patient-year (95% CI, 1.9% to 2.7%). Based on data from four studies, patients with a primary lobar ICH had a higher rate of recurrent ICH than those with a deep, hemispheric ICH (4.4% versus 2.1% per patientyear; p ϭ 0.002). The aggregate rates of subsequent ischemic stroke and mortality were 1.1% per patient-year (95% CI, 0.8% to 1.7%) and 8.8% per patient-year (95% CI, 5.2% to 11.0%). Conclusions: Recurrent stroke among survivors of primary ICH occurs at a rate of about 4% per patient-year, and most are recurrent ICH. Survivors of ICH have a higher risk of recurrent ICH than of ischemic stroke, and this has implications for the use of antithrombotic agents in these patients. NEUROLOGY 2001;56:773-777 Intracranial hemorrhage (ICH) accounts for 10% to 15% of all strokes and carries substantial associated mortality and often permanent disability for those affected.1 For the estimated 50,000 Americans who survive ICH each year, the risk of recurrent stroke and death are unclear. We undertook a systematic review of this issue, seeking to characterize the occurrence of recurrent ICH, ischemic stroke and death among survivors of primary ICH, as well as to identify predictors of recurrent stroke. We hypothesized a priori that recurrence of ICH would be infrequent and that subsequent stroke more often would be ischemic than hemorrhagic. Methods. Types of studies.Studies of patients identified at the time of a primary ICH, followed longitudinally, and evaluated for recurrent stroke were considered for inclusion. Minimum average follow-up required for a study to be included was 3 months.Types of participants. We included studies of patients of any age or gender surviving a primary ICH for at least 30 days. When possible, the studies confirmed ICH by CT or MRI and excluded those due to vascular malformation, coagulopathy, trauma, or neoplasm.Types of interventions. There were no restrictions as to the type of intervention.Types of outcome measures. The primary outcomes evaluated were recurrent intracranial hemorrhage (any hemorrhage confirmed by CT, MRI, or autopsy...

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“…On the other hand, patients are not likely to have a second bleed in another location. According to Gonzalez-Duarte and colleagues [16], recurrent hypertensive intra-cerebral hemorrhages do occur, but at a very low rate, and the main topographic pattern of re-bleeding is basal ganglionic-ganglionic. Non-hypertensive recurrent hemorrhages tend to be lobar in location, in contrast to the hypertensive ones.…”

Section: Discussionmentioning

confidence: 99%

“…The short-term mortality of recurrent hypertensive hemorrhages is considerably higher (32%) [16] than that of the first hemorrhages (20%) [18]. As for the long term functional outcome, Portenoy et al .…”

Section: Discussionmentioning

confidence: 99%

Recurrent, sequential, bilateral deep cerebellar hemorrhages: a case report

et al. 2011

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IntroductionHypertensive intra-cerebral hemorrhage is usually a one-time event and recurrences are rare. Most recurrences develop as part of long-term failure of blood pressure control. The site of the re-bleed is usually limited to the basal ganglia and thalami.Case presentationWe report the case of a 59-year-old hypertensive Caucasian woman who developed two sequential, right- and then left-sided, deep cerebellar hemorrhages. The second hemorrhage followed the first one by 57 days, at a time when her blood pressure was optimally controlled. In spite of these critical sites and short duration between the two bleeds, the patient achieved a relatively good functional recovery. Her brain magnetic resonance angiogram was unremarkable.ConclusionThe development of recurrent hypertensive hemorrhage is rare and usually occurs within two years of the first bleed. To the best of our knowledge, this is the first reported case of bilateral, sequential, right- and then left-sided deep cerebellar hemorrhages. These hemorrhages were separated by eight weeks and the patient had a relatively good functional recovery. We believe that hypertension was the etiology behind these hemorrhages.

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Recurrent Primary Cerebral Hemorrhage

Cited by 72 publications

References 41 publications

Cerebral Microbleeds Predict Impending Intracranial Hemorrhage in Infective Endocarditis

Cerebral Microbleeds Predict Impending Intracranial Hemorrhage in Infective Endocarditis

Primary cerebral amyloidoma

Recurrent, sequential, bilateral deep cerebellar hemorrhages: a case report

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