Hematoma enlargement in spontaneous intracerebral hemorrhage

Abstract

In order to evaluate the incidence and risk factors of hematoma enlargement in spontaneous intracerebral hemorrhage (ICH), 419 cases of ICH were reviewed. The first computerized tomography (CT) scan was performed within 24 hours of onset and the second within 24 hours of admission; a blood sample was taken for laboratory examination within 1 hour of admission. In 60 patients (14.3%) the second CT scan showed an enlarged hematoma. The incidence of enlargement significantly decreased with time (p < 0.05) and significantly increased with the severity of liver dysfunction and the volume of the hematoma on the first CT scan. Patients with an irregularly shaped hematoma had a higher risk of hematoma growth than those with a round hematoma. In addition, patients with hematoma enlargement were more likely to have coagulation abnormalities (low platelet counts and low levels of fibrinogen, alpha 2-antiplasmin activity and platelet aggregation). Moreover, hematoma growth was associated with a poor clinical outcome. It is concluded that patients admitted to a hospital within 6 hours of onset of ICH, especially those admitted within 2 hours, and patients with liver dysfunction or irregularly shaped large hematomas should be closely observed for at least 6 hours after onset in preparation for emergency surgery, since the risk of hematoma growth in these circumstances is high.

Multivariate Analysis of Predictors of Hematoma Enlargement in Spontaneous Intracerebral Hemorrhage

“…As mentioned in our previous study, 12 irregularly shaped hematomas seem to indicate active bleeding from multiple arterioles. Hence, although an irregularly shaped hematoma on initial CT is an independent predictor of hematoma growth, it does not seem to be a risk factor for hematoma growth.…”

“…The time after onset was categorized according to that in our previous . 12 Ryan's method 17 was used to assess differences in the incidence of hematoma growth among categories. A 2 analysis was used to test the association between hematoma growth and hematoma site, hematoma shape, and intraventricular hematoma.…”

“…As previously reported, the incidence of hematoma growth decreases as the time interval from onset increases, and hematoma growth rarely occurs in patients admitted more than 6 hours after onset. [11][12][13]18 From the standpoint of hematoma formation, active bleeding seems to be mostly stabilized within 6 hours of onset. Thus, patients admitted early after onset have a high likelihood of undergoing a CT scan before the stabilization of hematoma formation.…”

“…[11][12][13] In our previous review 12 of 419 patients with ICH, we estimated the incidence of hematoma growth (14.3%) and noted the presence of predictors of hematoma growth (viz, a short time interval between admission and onset, an irregularly shaped and large hematoma revealed by an initial CT scan, and liver dysfunction associated with chronic alcohol consumption). However, in that report we did not examine the interrelationships among those predictors.…”

“…A n enlargement of a hematoma (hematoma growth) occurs not uncommonly in patients with spontaneous intracerebral hemorrhage (ICH) after their hospitalization [1][2][3][4][5][6][7][8][9][10][11][12][13] and worsens their clinical outcome. [11][12][13] In our previous review 12 of 419 patients with ICH, we estimated the incidence of hematoma growth (14.3%) and noted the presence of predictors of hematoma growth (viz, a short time interval between admission and onset, an irregularly shaped and large hematoma revealed by an initial CT scan, and liver dysfunction associated with chronic alcohol consumption).…”