Subcortical Cerebral Hemorrhage with Reference to Vascular Malformations and Hypertension as Causes of Hemorrhage

Abstract

The authors have reviewed 80 cases of subcortical cerebral hemorrhage, in all of which intraoperative examinations during craniotomy or autopsies were performed. Cases involving trauma and aneurysm were excluded from the study. The diagnosis of subcortical hemorrhage was made by plain computed tomography in all cases. The most common cause of hemorrhage was vascular malformation (68%; 56 cases), in 20 (36%) of which angiographically occult vascular malformations were noted. Hypertension was present in 23 (29%) of 80 cases but was the cause of hemorrhage in only 9 cases (11%). Hypertension was present in 6 (30%) of 20 angiographically occult vascular malformations, all of which were in patients under 65 years. In 12 (75%) of 16 cases of angiographically occult vascular malformations, prolonged high-dose delayed-contrast computed tomography and magnetic resonance imaging were able to provide definite diagnostic information. We recommend that patients with subcortical cerebral hemorrhage, especially those under age 65, with or without hypertension, be carefully examined by prolonged high-dose delayed contrast computed tomography and magnetic resonance imaging for the presence of angiographically occult vascular malformations causing hemorrhage.

Value of Repeat Angiography in Patients With Spontaneous Subcortical Hemorrhage

“…The low incidence of AOVMs (12 cases; 9%) and amyloid angiopathy (2 cases; 1.5%) and the high frequency of "unknown etiology" may reflect the low rate of extensive surgical and/or histological inspection of the hematoma cavity in this series. 6,10,19 Previous studies have estimated that between 27% and 53% of patients with lobar hemorrhage have AOVMs. 5 Several authors recommended surgical exploration of the hematoma wall to detect occult vascular lesions.…”

Concepts and Hypotheses

“…cerebral cavernous malformation (CCM), which is also a significant cause of epilepsy (20,25,29,31,49). More than one million Americans are known to harbor CCM lesions, subjected to a 1 to 5% per year cumulative risk (estimated 50-70% lifetime risk) of hemorrhage, epilepsy, and other neurological sequelae (29,34,(42)(43)(44).…”

Spontaneous intracranial hematomas: role of dynamic CT and angiography

“…The various etiological factors include arterial hypertension, aneurysm, vascular malformation, neoplasm, coagulopathy, collagen vascular disease, cortical vein and/or dural sinus thrombosis (3). It has long been believed that the most common cause of ICH including subcortical hemorrhage is hypertension (4). However, recent publications have noted that an unknown etiology was more common than any single cause of subcortical hemorrhage and hypertension was the most common detected cause (3,5,6,7).…”