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David G. Piepgras, Michael K. Morgan, Thoralf M. Sundt Jr., Takehiko Yanagihara, and Lynn M. Mussman

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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Matthew E. Fewel, B. Gregory Thompson Jr., and Julian T. Hoff

intracerebral haemorrhage . J Neurol Neurosurg Psychiatry 55 : 1121 – 1124 , 1992 39 Fujii Y , Takeuchi S , Sasaki O , : Multivariate analysis of predictors of hematoma enlargement in spontaneous intracerebral hemorrhage . Stroke 29 : 1160 – 1166 , 1998 40 Gallerani M , Trappella G , Manfredini R , : Acute intracerebral haemorrhage: circadian and circannual patterns of onset . Acta Neurol Scand 89 : 280 – 286 , 1994 41 Guridi J , Gallego J , Mornzon F , : Intracerebral hemorrhage caused by transmural dissection of the anterior

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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

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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

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Emun Abdu, Daniel F. Hanley, and David W. Newell

with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial . Lancet 365 : 387 – 397 , 2005 22 Mendelow AD , Unterberg A : Surgical treatment of intracerebral haemorrhage . Curr Opin Crit Care 13 : 169 – 174 , 2007 23 Morgan T , Zuccarello M , Narayan R , Keyl P , Lane K , Hanley D : Preliminary findings of the minimally-invasive surgery plus rtPA for intracerebral hemorrhage evacuation (MISTIE) clinical trial . Acta Neurochir Suppl 105

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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

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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

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Satoru Takeuchi, Kojiro Wada, Kimihiro Nagatani, Naoki Otani, and Kentaro Mori

, Vekovischeva OY , Shekhar S , Durukan A , : Decompressive craniectomy for intracerebral hemorrhage . Neurosurgery 65 : 780 – 786 , 2009 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 24 Mendelow AD , Gregson BA , Mitchell PM , Murray GD , Rowan

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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

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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