Simultaneous multiple hypertensive intracerebral haemorrhages

Abstract

As with solitary ICH, hypertension is still the most important etiological factor for simultaneous multiple ICHs. The widespread and prolonged degeneration of intracerebral arterioles predispose patients to the development of multiple ICHs, which could be justified by the longer history of hypertension and higher incidence of former strokes. Only hypercholesterolemia was identified to be significantly associated with this unusual brain event in our study. The mechanism underlying the development of simultaneous multiple ICHs is not clear although structural and haemodynamic changes of first haemorrhage may be responsible for the second one. Poorer outcome in patients with multiple ICHs can be explained by the concomitant destruction of crossing and non-crossing fiber tracts and bilateral diaschisis phenomenon.

Multiple simultaneous hypertensive supratentorial and infratentorial hemorrhages: A rare kind of hypertensive bleed

“…Hypertension, previous strokes, hypercholesterolemia, diabetes mellitus, heart disease, and smoking are the commonly recognized risk factors in association with MISCHs. 2 Previously untreated hypertension and smoking were only risk factors present in our case consistent with the case reported by Cheng-Ta Hsieh. 4 Location and size of hemorrhages go against cerebral amyloid angiopathy.…”

Simultaneous bilateral hypertensive putaminal or thalamic hemorrhage: case report and systematic review of the literature

“…Hypertensive ICH commonly occurs at the putamen, thalamus, pons, and cerebellum. The putamen and thalamus are the most common sites of hypertensive ICH (29). Our review of 86 cases of simultaneous multiple hypertensive ICHs shows a similar trend on the distribution of location.…”

“…Symmetric bilateral ICH is likely to be reported rather than asymmetric bilateral ICH. When only complete surveys of consecutive ICHs were selected, there were 27 cases of simultaneous bilateral hypertensive putaminal or thalamic hemorrhage among 5334 cases of ICH in total (9,20,24,26,29). The same statistical analysis of hemorrhagic sites as described above showed p=0.050 (details not shown), and there was still a strong trend of deviation to symmetrical hemorrhage.…”

“…The locations of hemorrhage were the putamen (n=73), thalamus (n=49), subcortex (n=18), cerebellum (n=16), pons (n=14), and caudate nucleus (n=2). We selected cases of bilateral putaminal or thalamic hemorrhage because the putamen and thalamus are the two most frequent locations of hypertensive ICH (29). One case of unilateral thalamic and putaminal hemorrhage was excluded from this study.…”

The mysteries of Blaise Pascal’s sutures

“…If we ignore the chronicity of Blaise Pascal's illness, the presence of two symmetrical aneurysms in autosomal dominant polycystic kidney disease is a very rare condition [12] like simultaneous multiple intracerebral hemorrhages even in the case of hypertension (<1 %) [13].…”