Secondary Brain Stem Hemorrhages

Secondary brain stem hemorrhage in stroke.

“…The frequency of secondary brain stem hemorrhage in cases of infarction was 15%, which is comparable to 9% reported by Cohen 6 and 11.6% reported by Klintworth. 19 The finding that secondary brain stem hemorrhage had the highest frequency from day 1 to 5, with the maximum at day 4, is consistent with the prevailing clinical concept 20,21 and recent CT findings 22 indicating that cerebral edema becomes maximal at 2 to 7 days after infarction.…”

“…Some authors reported higher frequency in men 4,7> 24 and one author in women. 6 The present study does not demonstrate a significant difference between the two sexes. Our results indicate paucity of secondary brain stem hemorrhage in very young persons, a finding which is in agreement with earlier investigations 6,7 -25 The diminished frequency of secondary brain stem hemorrhages in young persons may be caused by a higher elasticity of the tissues.…”

“…Our finding that 45% of the patients with lethal cerebral hemorrhages had secondary brain stem hemorrhage, is comparable to 57% reported by Cohen,6 but higher than the frequency of 14% and 31 % reported by Poppen 15 and Klintworth, 19 respectively. Most patients died within 48 hours, which may indicate that in hemorrhage it is the expanding lesion and not reactive edema which is the primary cause of secondary brain stem hemorrhage.…”

“…6 The risk of secondary brain stem hemorrhage has been regarded as a function of the growth velocity of the primary space occupying lesion, as well as of the volume which the lesion ultimately achieves. 7,10 It is assumed that a quickly expanding lesion, such as cerebral hemorrhage, will produce a more rapid caudal displacement of the brain stem causing secondary brain stem hemorrhage, than a slower growing lesion such as infarction with concomitant edema.…”

“…7,10 It is assumed that a quickly expanding lesion, such as cerebral hemorrhage, will produce a more rapid caudal displacement of the brain stem causing secondary brain stem hemorrhage, than a slower growing lesion such as infarction with concomitant edema. 6 In early death following acute cerebrovascular lesions, symptoms of cerebral herniation are seen, and it is generally accepted that herniation often is a significant factor contributing to death. The aim of the present study was to evaluate these aspects by the analysis of a large autopsy material with recent cerebral hemorrhage, infarction or ruptured aneurysm and to assess the lesions frequency, time of occurrence, and age and sex distribution.…”