P ostoperative intracerebral hemorrhage is an infrequent complication of carotid endarterectomy, occurring with an incidence of less than 1%. 4, 13 Suggested predisposing factors for this complication include recent cerebral infarction, 4–6, 17, 20, 21 old cerebral infarction, 2 postoperative hypertension, 7, 10, 20 and the postoperative use of systemic anticoagulant agents. 15, 18 Recently, a mechanism for intracerebral hemorrhage has been proposed for patients in whom the above associations were not identified. 1, 13 This explanation is based on the
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David G. Piepgras, Michael K. Morgan, Thoralf M. Sundt Jr., Takehiko Yanagihara, and Lynn M. Mussman
Matthew E. Fewel, B. Gregory Thompson Jr., and Julian T. Hoff
Fogelholm R , Eskola K , Kiminkinen T , : Anticoagulant treatment as a risk factor for primary intracerebral haemorrhage . J Neurol Neurosurg Psychiatry 55 : 1121 – 1124 , 1992 10.1136/jnnp.55.12.1121 39 Fujii Y , Takeuchi S , Sasaki O , : Multivariate analysis of predictors of hematoma enlargement in spontaneous intracerebral hemorrhage . Stroke 29 : 1160 – 1166 , 1998 10.1161/01.STR.29.6.1160 40 Gallerani M , Trappella G , Manfredini R , : Acute intracerebral haemorrhage: circadian and circannual patterns of onset . Acta Neurol
Kenneth L. Tyler, Charles E. Poletti, and Roberto C. Heros
C erebral amyloid angiopathy (CAA) is being increasingly recognized as a cause of typical and atypical dementia in pre-senile and elderly patients. 4, 16, 21, 23, 30–32, 35, 37–39, 41 Recently, a number of cases of intracerebral hemorrhage in association with amyloid angiopathy have been reported. 9, 12, 14, 17, 20, 21, 26, 27, 31, 33–37, 39 Many of these patients were elderly, demented, or had associated diseases known to predispose to hemorrhage including hypertension, coagulopathy, trauma, or arteriovenous malformation (AVM). We present the unusual case
Gabriele Tedeschi, Francesco Paolo Bernini, and Adolfo Cerillo
of our data is that neither the patient's age, nor the site of the hemorrhage, nor its mode of onset decisively affects the prognosis. There is no doubt, however, that deferment of surgery where possible offers a better chance of a successful outcome, particularly in older patients. Survival and the quality of recovery in the total series of 71 patients is analyzed in Table 6 . In our experience the two most useful diagnostic aids were angiography and brain scanning. TABLE 6 Morbidity and mortality in 71 patients with intracerebral hemorrhage
Emun Abdu, Daniel F. Hanley, and David W. Newell
, Brun NC , Begtrup K , Broderick J , Davis S , Diringer MN , : Recombinant activated factor VII for acute intracerebral hemorrhage . N Engl J Med 352 : 777 – 785 , 2005 10.1056/NEJMoa042991 21 Mendelow AD , Gregson BA , Fernandes HM , Murray GD , Teasdale GM , Hope DT , : Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial . Lancet 365 : 387 – 397 , 2005 10.1016/S
Norbert Roosen, Jean-Jacques Martin, Christian De La Porte, and Michel Van Vyve
A lthough cerebral amyloid angiopathy has long been recognized as a distinctive pathological entity, 6, 28, 31, 32 its importance in cases of nontraumatic nonhypertensive intracerebral hemorrhage, especially in older patients, 18, 23 has only recently been recognized in the neurosurgical literature. 9, 10, 16, 17, 20, 30, 36 We report a patient treated in our hospital for this disease. Case Report This 59-year-old man was admitted to the Department of Neurosurgery at the University Hospital, Antwerp, on April 24, 1983, because of a sudden left
Xavier Morandi, Laurent Riffaud, Beatrice Carsin-Nicol, and Yvon Guegan
We report the case of a patient who developed infra- and supratentorial intracerebral hemorrhage after removal of a cervical hourglass schwannoma. To the best of our knowledge, this complication has never been reported in the medical literature. The possible pathogenesis of this unusual complication is discussed. Case Report Presentation This 34-year-old man presented with a 3-month history of right arm pain that radiated down the medial side of the hand and the fourth and fifth fingers, which was consistent with the C8—T1 nerve root territory. The onset
Satoru Takeuchi, Kojiro Wada, Kimihiro Nagatani, Naoki Otani, and Kentaro Mori
, Durukan A , : Decompressive craniectomy for intracerebral hemorrhage . Neurosurgery 65 : 780 – 786 , 2009 10.1227/01.NEU.0000351775.30702.A9 23 Mendelow AD , Gregson BA , Fernandes HM , Murray GD , Teasdale GM , Hope DT , : Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial . Lancet 365 : 387 – 397 , 2005 10.1016/S0140-6736(05)70233-6 24 Mendelow AD , Gregson BA
Joseph P. Broderick, Thomas G. Brott, Thomas Tomsick, William Barsan, and Judith Spilker
T he belief that active bleeding in spontaneous intracerebral hemorrhage (ICH) lasts less than 1 hour is widespread within the neurological and neurosurgical community, 7 yet little data have been collected during the early course of intracerebral bleeding in humans. Recent observations in eight patients during the first few hours post-ICH have prompted us to question when the bleeding does stop. Materials and Methods Seven Cincinnati hospitals have been involved in a dose-escalation trial of tissue plasminogen activator (t-PA) for treatment of acute
Yukihiko Fujii, Ryuichi Tanaka, Shigekazu Takeuchi, Tetsuo Koike, Takashi Minakawa, and Osamu Sasaki
S pontaneous intracerebral hemorrhage (ICH) is widely believed to be monophasic with only a brief period of active bleeding. 7, 16 However, several authors have reported that some ICH's continue to bleed even after hospitalization. 1, 3, 6, 8–13, 15 Continued bleeding in ICH leads to enlargement of the hematoma, which may result in progressive neurological deterioration or even death. 10, 12 It is not unusual for repeated computerized tomography (CT) scans to reveal hematoma growth in ICH. However, very few studies have statistically analyzed the incidence
