Recurrent Spontaneous Intracerebral Hemorrhage Yoshikatsu Seiki, Hideo Terao, Iekado Shibata, MasaruShishido, Mikiro Matsumoto, Kaoru Tsukahara and Shunichiro Tsutsumi Department of Neurosurgery, Toho University School ofmedicine, Tokyo, Japan Summary From 1981 to 1984, 13 cases of so-called spontaneous intracerebral hematoma were treated our hospital. Nine of these patients were male and four were female. They ranged in age from 27 to 67 years with a mean of 51. The location of the hematomas detected by CT was as follows : five in the frontal, four in the parietal, four in the occipital, three in the temporal and three in the parietal and occipital regions, respectively. One patient had an infratentorial hematoma. Twelve hematomas were located on the right side and seven on the left side. Headache was the most common symptom, and hemiparesis, aphasia, hemianopia and mental or psychic abnormality were manifested according to site and extent of the hematomas. Disturbance of consciousness was rather mild at the first attack of intracerebral hematoma. Angiographic examinations revealed a small angiomatous malformation in only two cases. Hematoma was removed surgically, and the wall of the lesion was carefully examined by surgical microscope to find any causative vascular abnormalities. Thus, three small arteriovenous malformations, one cavernous angioma and one small plexiform angioma were detected by pathological examination of specimens removed from the hematoma wall. Rebleeding occurred in five out of the 13 patients at one to 18 months after the initial hemorrhage, and one showed second and third hemorrhage at three and 10 months, respectively. Rebleeding occurred at the same site in two cases and at a different site in three. any small vascular malformations by arteriographic examinations in the rebleeding group. fine torturous in We could not detect Hewever, or tiny tangled arterioles around small arteries were demonstrated on the late arterial or precapillary phase of arteriography in three cases. Histopathological examination of specimens from the hematoma wall in these cases revealed marked arteriosclerotic changes with splitting and duplication of the internal elastic lamina. The prognosis of rebleeding cases was discouraging. Four patients died and one remained in a
vegetable state in our series. On the other hand, the clinical course of eight patients without rebleeding was uneventful. Table 1 Spontaneous intracerebral hemorrhage
Fig. 1 Rt CAG : Fine torturous, tangled arterioles around main arteries are demonstrated (arrows). Left: at a year before initial hemorrhage. Right: at a month after operation. Fig. 2 Plain CT Upper: at the first attack; Subcortical hematoma in the right parietooccipital lobe. Lower: at the second attack; Multiple intracerebral hematomas and ventricular perforation of hematoma in the right side.
Fig. 3 Photomicrograph showing splitting and duplication of the internal elastic lamina and narrowing of the lumen. Left: Case No. 4 EVG stain. ( ~200) Right: Case No. 13 EVG stain. ( ~200)
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