Diagnosis and treatment of chronic expanding intracerebral hematoma: report on 37 cases

Abstract

Objective To improve the diagnosis and treatment level of chronic expanding intracerebral hematoma (CEICH). Methods The clinical data of 37 cases with CEICH were analyzed retrospectively with literature review, we wanted to find the evidence for diagnosis and the effective method for treatment. Results CEICH could involved in anywhere of brain, most of them were solitary, seldom seen multiple. 24 cases were misdiagnosed as CEICH before operation (65%). All the 37 cases were operatived, and small vascular malformation was detected in 13 cases in pathological examination. All cases were followed - up after operation, 29 patients recovered quite well, 7 patients suffered focal neurological deficit, 1 patient died of rebleeding of contralateral cerebral hemisphere. Conclusion We supposed the three points can be the evidence of diagnosis. (1) Developed slowly of the clinical presentation of increased intracranial pressure. (2) The radiological characteristics can include mass effect of encapsulated or liquefied lesion with unisodensity, low density, high density or isodensity (CT value 20 ～ 70 Hu). (3) Irregular ringed round or similar to round enhancement. We should think about CEICH if included two above points,and we should make a definite diagnosis of CEICH if three points were included. Surgery to evacuate the hematoma and remove the capsule should be the effective method to CEICH. Key words: Intracerebral hematoma; Cerebrovascular malformation; Diagnosis; Surgical procedures, operative