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)