Simultaneous, multiple hypertensive intracerebral hematomas: report of 5 cases and review of literature

Five cases of multiple hypertensive intracerebral hematomas which occurred simultaneously but in different locations were described in this report. The diagnoses of all five cases were established by computed tomography, and the location of the hematomas was as follows; case 1. bilateral putamen, case 2. bilateral thalamus and right parietal subcortex, case 3. cerebellum and left thalamus, cases 4 and 5. cerebellum and right putamen. These represented 0.7% of all the patients (679 cases) who suffered from hypertensive intracerebral hematoma and were admitted to our two institutions in the last five years. We also reviewed the other 11 cases which have been reported in literature, and the total 16 cases were analyzed with respect to clinical characteristics, pathogenesis of multiple hematomas, indication of operation and prognosis. 1. The age distribution had a peak in the 70's and was similar to that of single hematoma. 2. Sixteen cases had 34 intracerebral hematomas. Eleven cases had bilateral supratentorial lesions. Four cases had cerebellar and supratentorial lesions. The remaining had two supratentorial lesions ipsilaterally. The distribution of 34 hematomas (16 in cerebral basal ganglia, 10 in thalamus, 4 in cerebellum, 4 in cerebral subcortex and none in pons) was well correlated to the distribution of usual hypertensive intracerebral hematomas. 3. The clinical symptoms were characterized by severe consciousness disturbance and severe neurological deficits. Their outcome was poor. 4. As for the possible mechanism of simultaneous multiple hemorrhages, we suspected either that two or more primary bleedings occurred simultaneously in the different regions, or that a primary bleeding was followed a short time after by a secondary bleeding in the other site.(ABSTRACT TRUNCATED AT 250 WORDS)     

Traumatic intracranial hematomas in hemophiliac children

Three cases of traumatic acute subdural hematoma in hemophilia A children underwent surgical interventions. There were two functional survivors and one death. The management of intracranial hematoma in hemophiliac patients is discussed.     

Spontaneous bilateral extradural hematomas. Case report

Spontaneous extradural hematomas are rare and may be caused by pericranial infections, bleeding tendencies, or vascular abnormalities of the dura mater. The authors describe a case of spontaneous bilateral extradural hematomas assumed to be caused by a bleeding tendency with hypofibrinogenemia. A brief review of the literature is reported.     

Treatment of patients with spontaneous intracranial hematomas

Spontaneus intracerebral haemorrhage is a common cause of stroke especially in the young. The term "spontaneuos intracerebral haemorrhage" refers to bleeding without coincident trauma. About 80% of this haemorrhage occur supratentorial in the basal nuclei and they are associated with hypertension. Etiological factors range from congenital vascular malformations (aneurysmas, AVM, cavernomas) to acquired and degenerative vascular and brain conditions. In primary intracerebral hemorrhage arterial hypertension and consequent vascular changes are the major etiological factors. In secondary- nonhypertensive hemorrhage cause may be associated with aneurysms, AVM, tumors, coagulation disorders. Contemporary diagnosis imaging (CT, MRI) and neurological evaluation, allow early diagnosis and effective medical and/or surgical therapy in a majority patients. Without treatment, the risk of mortality and morbidity is high. Medical management involves normalization of blood pressure, reduction of intracranial pressure, control of brain edema and prevention of seizures. In design for operative treatment must be include age of the patient, hematoma size and location, clinical condition, the level of consciousness and patient outcome. The role of surgery remains contraversial.     

CT-guided stereotaxic evacuation of hypertensive intracerebral hematomas

Computerized tomography (CT) is now available for diagnosis and localization of intracerebral hematoma. Computerized tomography-guided stereotaxic evacuation of hypertensive intracerebral hematoma was performed in 51 cases: 34 basal ganglion hematomas with or without ventricular perforation, 11 subcortical hematomas, three thalamic hematomas, and three cerebellar hematomas. Three-dimensional CT images or biplane CT images were taken to determine the coordinates of the target point, which was the center of the hematoma. A silicone tube (3.5 mm in outer diameter and 2.1 mm in inner diameter) was then inserted into the center of the hematoma through a burr-hole under local anesthesia, and the liquefied or solid portion of the hematoma was aspirated with a syringe. Immediately after the first trial of hematoma aspiration, urokinase (6000 IU/5 ml saline) was administered through this silicone tube and the drain was clipped. Subsequently, aspiration and infusion of urokinase were repeated every 6 or 12 hours until the hematoma was completely evacuated. The silicone tube was removed when repeat CT scanning revealed no residual hematoma. The follow-up results indicate that this procedure is as good as conventional craniotomy and evacuation of hematoma under direct vision. This CT-guided stereotaxic approach for evacuation of the hematoma has the following advantages: 1) the procedure is simple and safe; 2) the operation can be performed under local anesthesia; and 3) the hematoma is completely drained with the aid of urokinase. This procedure seems indicated as an emergency treatment for elderly or high-risk patients who show no signs of cerebral herniation.     

Subacute bilateral epidural hematomas in an infant.

Subacute bilateral epidural hematomas in a two-year-old girl are presented. No similar case in this age group has been reported. CT scans may increase the detection of bilateral epidural hematomas in children in the future. The diagnostic and therapeutic characteristics of epidural hematoma in children are discussed.     

Transient global amnesia associated with bilateral subdural hematomas

An elderly man presenting with an episode of transient global amnesia was found to have bilateral subdural hematomas. The entity of transient global amnesia, its relationship to structural brain disease, and its possible pathogenesis are discussed.     

Spontaneous bilateral extradural hematomas: a case report

A rare case of spontaneous bilateral extradural hematomas probably due to hypofibrinogenemia is reported. On April 17, 1983, a 21-year-old woman was referred to our hospital because of her comatose state. She has complained of her longer duration of menstrual bleeding lasting 10 days to 2 weeks, but has had no history of hemorrhagic diseases. At the last night, she complained of headache and vomited several times, after drinking some beer but she went to bed without therapy. We cannot see a history of her head injury several days before admission. On admission, she was comatose with bilateral dilated pupils and flexed her upper extremities against painful stimuli. There was a tendency for subcutaneous hematomas to form immediately in places where the stimuli were applied. Skull fracture was not found on craniogram and CT scan showed bilateral extradural hematomas (60 ml on the right side and 130 ml on the left side). Laboratory data showed leukocytosis (14800), longer prothrombin time (15.2 seconds with a control of 11.9 seconds), markedly elongated activated partial thromboplastin time (90 seconds with a control of 15-45 seconds) and decreased fibrinogen concentration (114 mg/dl with a control of 200-400 mg/dl). At the bilateral decompressive craniectomies with infusion of 5 gram of fibrinogen and 300 ml of fresh blood, we found neither scalp hemorrhage nor skull fracture and after removal of coagulated hematomas no dural anomaly was found. After operation she improved gradually and laboratory re-examination was normal including bone marrow puncture. Now, 5 months after operation she is clear with slight tetraparesis on her rehabilitating course.(ABSTRACT TRUNCATED AT 250 WORDS)     

Surgical treatment for acute traumatic multiple intracranial hematomas

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Recurrent hematomas following craniotomy for traumatic intracranial mass

Of 850 patients who underwent craniotomy for evacuation of a traumatic intracranial mass, 59 (6.9%) developed a second hematoma at the operation site, which required a second operation. Compared to those who did not, patients who developed postcraniotomy hematoma (PCH) had a significantly higher incidence of evidence of alcohol intake and preoperative mannitol administration; a higher percentage had a bad outcome. Coagulopathy was frequent in PCH patients. Although three-quarters of the initial hematomas were intradural, 69% of the PCH's were predominantly extradural. The large potential space underlying a craniotomy bone flap may predispose to development of a PCH. Intracranial pressure (ICP) was monitored in 39 of the 59 PCH patients, which allowed earlier detection of the PCH in 22 (56%). In 17 patients, the ICP failed to rise despite clinical deterioration, and detection of the PCH was delayed, significantly worsening the outcome in this group.     

CT-guided stereotaxic evacuation of hypertensive intracerebral hematomas]

CT-guided stereotaxic evacuation of hypertensive intracerebral hematomas was performed in 50 patients. Hematoma was found in the basal ganglion in 36 cases in the internal capsule in 23, in external capsule in 6, in thalamus in 7, in subcortex in 6 in cerebellum, in 6 and in brain stem in 2. The volume of these hematomas was less than 10 ml in 2 patients, 20-50 ml in 21, 51-100 ml in 16 and over 100 ml in 11. The liquid hematoma was totally aspirated by stereotaxic technique in 9 patients. Similarly, more than 80% of clots of hematoma was evacuated in 28 patients and about 60-80% of clots was evacuated in 13. Good operative results were obtained in 14 patients (28%). Mild neurological disability was seen in 16 patients (32%) and marked disability in 15 (30%). Five patients (10%) died.     

Spontaneous bilateral perirenal hematomas in two patients with eclampsia

The purpose of this report is to provide two illustrative cases of spontaneous and bilateral perirenal hematomas that occurred during a pregnancy complicated by eclampsia. The sonographic and computed tomographic findings included bilateral perirenal hematoma with no evidence of an underlying malignancy. Since renal hematomas that occur in association with preeclampsia and eclampsia syndrome are extremely rare, but potentially life-threatening complications, prompt laboratory and radiologic evaluations are essential and can reduce the associated morbidity and mortality.     

开颅术后并发非手术区急性血肿的探讨

报告开颅术后并发非术区急性血肿14例。其中硬膜外血肿9例，硬膜下血肿3例，脑内血肿2例。分析认为，术中颅内压力的骤降，水后脑蹋陷，为发生硬膜外、硬膜下血肿的主要原因。高龄、高血压、糖尿病患者，手术易并发脑内血肿。术中平缓降颅压，平稳的麻醉，术后严密监护，及时头颅CT扫描是预防和早期诊断此类血肿至关重要的环节。及时再次手术清除血肿是成功救治的关键。文中特别讨论了国产头颅固定架的缺陷及改进措施。