Hypertensive intracerebral hemorrhage (HICH) is generally considered to be a monophasic event. Enlargement of the initial hematoma after several hours or days has rarely been documented. We describe the clinical and CT findings in 8 patients (5 men, 3 women, aged 39 to 68 years) with continued bleeding or rebleeding during the acute phase of HICH. The thalamus was the most frequent site of hemorrhage (6/8). The neurologic status deteriorated in all: 6 within 24 hours, and 2 after 5 and 7 days. Persistent hypertension was common (6/8) prior to extension of the hemorrhage. The 2nd CT revealed an obvious increase in hematoma size in all cases. Four patients died and 4 survived with severe neurologic disability. These serial studies indicate that active bleeding or rebleeding can occur in HICH and suggests that the risk is particularly high with thalamic hemorrhage. We conclude that meticulous control of hypertension after HICH may be justified in selected patients.

The clinical, MRI, and MRS findings suggest that the mechanisms responsible for NKHCB may be a reversible ischaemia insult potentiated by hyperglycemia.

We report a symptomatic case of unilateral hypoplasia of the internal carotid artery with an intercavernous anastomosis, a very rare developmental anomaly. The symptoms were caused by occlusion of the proximal middle cerebral artery which possibly related to the haemodynamic stress caused by the anomalous intercavernous anastomosis.

An unusual aneurysm arising from an extracranial lateral medullary segment of the posterior inferior cerebellar artery (PICA) is reported. The origin of the PICA was also extracranial, 10 mm below the foramen magnum. The aneurysm was not seen on three-vessel angiography. The literature is reviewed with regard to the clinical and radiological features of such aneurysms. Occipital and nuchal headache with an altered level of consciousness, intraventricular haemorrhage, and hydrocephalus are suggestive of such aneurysm. The need for four-vessel angiography is again stressed.

Klebsiella oxytoca meningitis is a rare condition. Nine patients were diagnosed between 1981 and 1993 at our institution. These accounted for 2.3% of 393 patients with blood and/or cerebrospinal fluid culture-proven bacterial meningitis. K. oxytoca was noted in both community-acquired meningitis and nosocomial meningitis. Eight of the nine cases were patients who had undergone neurosurgical procedures. Four were mixed bacterial meningitis. All K. oxytoca isolates were susceptible to third-generation cephalosporins and all but one to chloramphenicol. Antibiotic therapy was successful in eight patients but failed in one.