Spontaneous Intracerebral Hemorrhage

336

134

SUMMARY To better define the etiologic importance of hypertension for spontaneous intracerebral hemorrhage, hospital records were studied for all patients sustaining intracerebral hemorrhage during 1982 in the Cincinnati metropolitan area. Hypertension pre-dating the hemorrhage was present in 45% (69 of 154), as determined by history. A more inclusive definition of hypertension, combining those with a positive history with those found to have left ventricular hypertrophy by electrocardiogram or cardiomegaly by chest radiography, applied in 56% (87 of 154). The cases were compared to controls with and without hypertension derived from the NHANESII study of blood pressure (n = 16,204) to determine relative risk. For the presence of hypertension by history, the relative risk of intracerebral hemorrhage was 3.9 (95% confidence interval, 2.7 to 5.7). For the inclusive definition of hypertension, the relative risk was 5.4 (3.7 to 7.9). Relative risk was also determined for hypertension in blacks ( = 4.4), age > 70 ( = 7), prior cerebral infarction ( = 22), and diabetes ( = 3).We conclude that the term "hypertensive hemorrhage" should be used very selectively, particularly in whites, and propose that hypertension be viewed as one of several important risk factors for spontaneous intracerebral hemorrhage. Stroke Vol 17, No 6, 1986 THE TERM HYPERTENSIVE INTRACEREBRAL HEMORRHAGE is firmly imbedded in the medical literature.'" 3 When the characteristic high density lesion is seen in the computed tomographic scan (CT) critical differential diagnosis in the setting of acute stroke is too often truncated. Hypertension is quickly assumed to be causal, if present on the admission exam or if detected by history.We have been impressed at the bedside that an adequate history of hypertension is often lacking in patients with spontaneous intracerebral hemorrhage. When an adequate history for hypertension is established, other disorders of potential etiologic importance may be identified but are seldom given serious consideration. In prior studies of intracerebral hemorrhage, the blood pressure measurements (BP) were often those obtained during the acute event, 4 ' 5 or they were not provided. 6 Potential risk factors such as prior cerebral infarction or diabetes mellitus, were infrequently documented. 7 In 2 large studies of intracerebral hemorrhage in which criteria for the definition of hypertension were carefully specified, the results differed sharply regarding the importance of hypertension in pathogenesis. 89 A prospective epidemiologic study of intracerebral hemorrhage and potential risk factors is impractical. A ten-year study would require follow-up of approximately one million subjects to obtain 100 or more index cases. A longer study would require fewer subFrom the

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hypertension as a risk factor for spontaneous intracerebral hemorrhage.

Brott¹,

Thalinger

Hertzberg

1986

336

134

“…[8][9][10][11][12][13][14][15][16][17] The outcome of coma soon after the onset of the hemorrhage is associated with very poor prognosis in the great majority of patients, although there are some reports including satisfactory outcome of only a few patients. [21][22][23] Timing of surgery has also been controversial. Some recommended early surgery, [9][10][11][12][13][14][15][16][17] while others have indicated a preference for delay in evacuation for 2 to 7 days after the onset, and the patients who developed gradual onset of symptoms and gradually progressing neurological deficits have a better prognosis after surgery.…”

Section: Discussionmentioning

confidence: 99%

Hypertensive putaminal hemorrhage: treatment and results. Is surgical treatment superior to conservative one?

Waga¹,

Yamamoto²

1983

SUMMARY Seventy-four patients with hypertensive putaminal hemorrhage (HPH) were followed at least 6 months after treatment and estimated by ADL. They were graded according to the state of consciousness on admission. The grading consists of 6 grades: Grade 1, fully conscious; Grade 2, somnolent; Grade 3, stuporous; Grade 4, semi-comatose; and Grade 5, deeply comatose. Removal of HPH was performed in 18 patients and conservative treatment was done in 56 patients. The mortality in surgically treated group was 28% while that in conservatively treated group was 14%. The patients who returned to full work or independent life without disability and with minimal disability after surgical treatment were, 50% in Grade 1, 33% in Grade 2, and 50% in Grade 3. The patients without disability and with minimal disability after conservative treatment were; 87% in Grade 1,80% in Grade 2, and 22% in Grade 3. None below Grade 4 returned to full work or independent life in both groups. There was good correlation between the state of consciousness and CT findings on admission. There was no correlation between good recovery and the side of HPH. Our results do not support the view that the surgical treatment is superior to the conservative one in the management of HPH.

“…is an affliction of the older hypertensive patient, more frequent in males than in females." 7 More recently Ransohoff et al 2 were to claim that the " . .…”

Section: Mccormick Rosenfieldmentioning

confidence: 99%

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

McCORMICK

Rosenfield

1973

232

A detailed clinicopathological study of the causes and locations of massive nontraumatic brain hemorrhage in 144 patients is reported. A cause of the hemorrhage, such as an aneurysm, angioma, arteritis, neoplasm or a blood dyscrasia (leukemia, hemophilia), was proved in two-thirds (95) of these patients. Twelve normotensive patients had no cause found to explain their hemorrhage. Systemic hypertension, generally mild, defined as a pre-ictal pressure of > 140/90 or by excessive heart weight, was present in 58 of the 144 patients. Twenty-one of these 58 hypertensive patients had a clear discernible cause for their brain hemorrhage (i.e., leukemia, metastatic carcinoma, angioma, aneurysm), whereas no satisfactory morphological cause could be found in only 37. Thus, in only about one-fourth of our patients could any serious claim be made that hypertension was the cause of the hemorrhage. Our data would indicate the need for a critical study of the causes of intracranial hemorrhages, and re-evaluation of the true relationship of systemic hypertension to such strokes. The widespread dogma that hypertension is the outstanding cause of nontraumatic brain hemorrhage no longer seems warranted.