Spontaneous intracerebral hematomas from vascular causes

Abstract

The aim of the present study was to assess the diagnostic accuracy of CT in determining the underlying causes of brain hematomas with a state-of-the art CT. For this purpose, CT and angiographic data of 149 subjects with spontaneous intracerebral hematomas (ICH) were statistically compared in a blind, retrospective study, taking angiography, supported when possible by surgical findings, as providing the correct diagnoses. 5 groups were distinguished on the basis of CT data: 103 patients with isolated deep ICH had normal angiograms; 9 patients with isolated superficial ICH and 8 with deep ICH and intraventricular hemorrhage (IVH) had arteriovenous malformations (AVMs). 4 with this combination showed no angiographic abnormalities, one had an aneurysm. 14 subjects with ICH and subarachnoid hemorrhage (SAH) had a middle cerebral or carotid artery aneurysm; and 10 with ICH, SAH and IVH had also an aneurysm, in 7 on the anterior communicating artery. Sensitivity, specificity, positive and negative predictive values were respectively: for AVMs 100, 96, 77 and 100%; and for aneurysms 96, 100, 100 and 99%. Kendall coefficient was 0.95, indicating close correlation between the two modalities. This study confirms that CT can accurately predict the likelihood, nature and location of vascular ICHs. It indicates whether angiography is necessary or not, and if so, what vascular tree ought to be explored.

Surgical management for large hypertensive basal ganglionic hemorrhage: single center experience

“…In 15 patients with GCS 13-15, 13 (86.7%) had a favorable outcome while two (13.3%) had a poor outcome. This finding is in accordance to Schulmeyer et al [20] The value of CT scan measurements in prognostication with ICH is well known [19]. Volume of hematoma is one of the most important parameter to evaluate the severity of the condition.…”

“…Lampl et al [19] found a direct correlation between the size of the hematoma, depressed level of consciousness, and outcome. Patients with relatively normal consciousness (GCS Scores 13-15) rarely require surgery, whereas deeply comatose patients (GCS Scores 3-5) rarely benefit from surgery.…”

“…Early hematoma evacuation may decrease the toxic effects of blood and plasma products, diminish surrounding edema and ischemia, and prevent hematoma expansion [17,18]. Also, the early craniotomy surgery could lead to dramatic reduction of intracranial pressure (ICP) and improvement in local blood circulation [19]. Craniotomy had also some other advantages such as good view and clearance of hematoma completely, easy hemostasis, which could help in outcomes and a reduction in mortality and improve the prognosis.…”

Recommendations for the Management of Intracranial Haemorrhage – Part I: Spontaneous Intracerebral Haemorrhage

“…Haemorrhages that involve the putamen, globus pallidum, thalamus, internal capsule, periventricular white matter, pons and cerebellum, particularly in a patient with known hypertension, are often attributed to hypertensive small-vessel disease [77]. In these patients further imaging studies investigating the underlying vascular pathology are not necessary.…”

Retrospective analysis of surgical management for spontaneous basal ganglia haemorrhage and outcome: A tertiary institute experience

“…The value of CT scan measurements in prognostication of ICH is well known [18]. Volpin et al [19] observed that patients with a hematoma volume above 85 ml have poor outcomes.…”