The effect of intracerebral hematoma location on the risk of brain-stem compression and on clinical outcome

Abstract

The clinical findings and computerized tomography (CT) brain scans of 45 patients with supratentorial intracerebral hematomas were evaluated to determine the effect of hematoma location on the clinical course and outcome of the disease. The lesions were frontal in 18 patients, temporal or temporoparietal in 17, and parieto-occipital in 10. No patient with a frontal or parieto-occipital hematoma had clinical signs of transtentorial herniation at admission or subsequently, whereas seven (41%) of those with temporal or temporoparietal lesions had signs of herniation (p less than 0.05); three of these seven patients had an abnormal mental status, ipsilateral anisocoria, and lateralizing motor findings at admission, and four developed these signs within 12 hours after admission, necessitating urgent surgical intervention. The mean volume of the lesions estimated from the CT scans was similar in the three groups (frontal 47 +/- 28 cc; parieto-occipital 53 +/- 26 cc; temporal/temporoparietal 41 +/- 21 cc). None of the six patients with temporal or temporoparietal hematomas smaller than 30 cc had signs of tentorial herniation, compared with seven (64%) of 11 patients with larger hematomas (p less than 0.05); in six of these seven cases, the hematoma was caused by head injury. Patients with a temporal or temporoparietal hematoma had a worse outcome than those in the other two groups, and no patient with signs of tentorial herniation had a good outcome. Patients with temporal or temporoparietal hematomas appear to be at greater risk of brain-stem compression, especially if the lesion is larger than 30 cc and caused by head injury, than are those with hematomas in other sites. In such cases, prompt surgical intervention should be considered.

Computerized Tomography and Clinical Features of Large Cerebral Hemorrhages

“…Most of our patients had large deep clots that were more likely than lobar hematomas to distort centrally situated structures which maintain alertness. Another study of lobar hematomas [6] found that tempo ral or temporoparietal clots larger than 30 cm-' were more often than frontal or occipital clots associated with signs of brainstem compression. There was also a corre lation between maximal midline shift (structure not slated) and clot volume in patients with temporal hem orrhages.…”

Emergent Clipping without Prophylactic Decompressive Craniectomy in Patients with a Large Aneurysmal Intracerebral Hematoma

“…In evaluation of patients with supratentorial ICH, Andrews et al 1) noted that head injury was the cause of the hematoma in six of the seven patients who developed brain stem compression. They mentioned that this might simply reflect the predominance of head injuries in this group.…”

Management of Intracranial Hypertension

“…For the purpose of this article, normal adult ICP is defined as 5 to 15 mm Hg (7.5-20 cm H 2 O). ICP values of 20 to 30 mm Hg represent mild intracranial hypertension; however, when a temporal mass lesion is present, herniation can occur with ICP values less than 20 mm Hg [5]. ICP values greater than 20 to 25 mm Hg require treatment in most circumstances.…”