Massive Intracerebral Hemorrhage Research Articles

Intracerebral hemorrhage in a patient with isolated abdominal stop-flow infusion chemotherapy

A case of unresectable liver metastases in a patient with breast cancer is reported. Isolated abdominal perfusion chemotherapy was performed in the patient, a 48-year old woman who complained of severe abdominal pain despite receiving analgetic treatment. The perfusion was uneventful, but 3h later the patient showed dilated and light-fixed pupils. A cranial computed tomography scan revealed a massive intracerebral hemorrhage and intracerebral metastasis. Brain death developed and the patient died 26h after stop-flow perfusion. Based on this experience, any intracerebral metastasis should be considered as a contraindication for abdominal and pelvic stop-flow chemoperfusion.

Noonan phenotype associated with intracerebral hemorrhage and cerebral vascular anomalies: Case report

A case of a 19-year-old man with multiple characteristics of the Noonan phenotype and a massive intracerebral hemorrhage in the left putaminal region is presented. The hemorrhage was removed surgically, and the patient made a good recovery and was finally able to walk unassisted. Postoperative cerebral angiograms revealed various vascular anomalies, including a small aneurysm. To the best of our knowledge, this is the second detailed case report of an association of the Noonan phenotype with cerebral vascular anomalies presenting intracerebral hemorrhage. The etiology of this syndrome remains unknown but the possible causes of this rare association are discussed.

Aneurysmal Intracerebral Hemorrhage

Approximately 20% of all massive nontraumatic intracerebral hemorrhages are caused by ruptured intracranial aneurysms. The possibility for repeated and catastrophic rebleeds, potentially reversible increased intracranial pressure effects, and the need for cerebral vasospasm treatment make the early identification of this cause of hematoma mandatory.

An unusual case of hairy cell leukemia: Death due to leukostasis and intracerebral hemorrhage

Hairy cell leukemia (HCL) was diagnosed in a 71-year-old Chinese man. His clinical presentation and the characteristics of the hairy cells were typical of classic HCL. However, extreme leukocytosis (195 to 323 × 10 9 cells/L) in peripheral blood was in striking contrast. This leukocytosis, which was much more pronounced than any of the reported cases of HCL with leukocytosis, was associated with leukostasis in the cerebral vasculature and was causally related to a massive intracerebral hemorrhage and death. This mode of death in HCL has not been reported previously.

Anticoagulant-related Intracerebral Hemorrhage in Patients with Prosthetic Heart Valves

Two cases of intracerebral hemorrhage in patients with prosthetic heart valves receiving anticoagulant therapy without preceding embolic cerebral infarction are reported. Phytonadione and fresh frozen plasma were immediately given, and the intracerebral hematoma evacuated successfully. In one case, intractable bleeding occurred perioperatively until the thrombotest value reached 40% or more. This patient later developed fatal massive multiple intracerebral hemorrhages.

Neonatal Congenital Factor X Deficiency

Four neonates with congenital Factor X deficiency presented soon after birth with bleeding episodes. Two of the newborns had intracranial hemorrhages; one of them also had antenatal ventricular dilatation and postnatal hydrocephalus and died of massive intracerebral hemorrhage at four months. One patient was lost for follow up. The two surviving infants were followed up for four years and two years respectively, while on replacement therapy with three injections of 40 units/kg prothrombin complex a month. In spite of markedly elevated prothrombin time and partial thromboplastin time, these two infants remain free of major bleeding manifestations except for troublesome petechiae and ecchymoses. A schedule for substitution therapy with Factor X is proposed for infants and children to prevent bleeding in severe Factor X deficiency.

Management of dural arteriovenous malformations of the anterior cranial fossa

Eight patients with dural arteriovenous malformations (AVM's) of the anterior cranial fossa are presented, and the pertinent literature is reviewed. Unlike cases of dural AVM's in other locations, sudden massive intracerebral hemorrhage was the most frequent reason for presentation. Other symptoms included tinnitus, retro-orbital headache, and a generalized seizure. The malformations were supplied consistently by the anterior ethmoidal artery, usually in combination with other less prominent feeding vessels. The lesion's venous drainage was through the superior sagittal sinus via a cortical vein; in addition, in two cases a subfrontal vein drained the AVM. A venous aneurysm was encountered near the site of anastomosis with the dural feeder in most cases, and was found in all patients who presented with hemorrhage. The AVM was obliterated surgically in six patients, with favorable results achieved in five. One patient died postoperatively from a pulmonary complication. Because of their anatomy and proclivity for hemorrhage, these vascular malformations represent a unique group of dural AVM's. Surgical management of anterior fossa dural AVM's carries low morbidity, and is indicated when the lesions have caused hemorrhage or when there is an associated venous aneurysm.

An unusual case of renal cancer showing mixed tumor response to interferon

A patient with renal cell carcinoma, recurrent in the renal bed and metastatic to the lung parenchyma, hilar lymph nodes, and ilium bone, showed a complete response to 12 months of treatment with human diploid fibroblast interferon. However, concurrently with clinical and pathologic resolution of the metastatic and recurrent tumor at known sites, a brain metastasis developed, which was not clinically or radiologically apparent during his lifetime. At autopsy, there was no evidence of metastatic renal cell carcinoma at the known sites of disease. In the brain, there was a massive fresh intracerebral hemorrhage originating in a small focus of metastatic renal cell carcinoma. Possible explanations for these mixed responses to interferon and this curious phenomenon are discussed.

Massive intracerebral hemorrhage following carotid endarterectomy.

To our knowledge, a particularly lethal complication of carotid endarterectomy, intracerebral hemorrhage, has not been given due consideration in the literature concerning carotid surgery. In the Atlanta area, massive intracranial hemorrhage developed in ten patients following routine carotid endarterectomies performed during a recent ten-year period. All ten of the patients in this series died despite a variety of therapeutic interventions. Risk factors may include the following: extreme arterial stenosis with resultant postoperative hyperperfusion, involvement of multiple extracranial cerebral vessels, postoperative systemic hypertension, and administration of anticoagulant or antiplatelet medications. Unfortunately, identification of the subset of patients potentially at risk for this complication is difficult, and, to date, therapy has been generally ineffective.

Meningiomas presenting as Massive Intracerebral Hemorrhage

Meningiomas presenting as Massive Intracerebral Hemorrhage

Cerebral amyloid angiopathy associated with massive intracerebral hemorrhage

Characteristic computed tomographic, clinical and pathologic features are discussed in two patients with cerebral amyloid angiopathy (CAA) associated with massive intracerebral hemorrhage. Amyloid angiopathy should be considered in any elderly patient in whom intracerebral hemorrhage occurs at an atypical site. Cortical involvement, multiplicity of hemorrhages, bilaterality, and repeated episodes should further arouse diagnostic suspicion. Clinical management is confined to prevention of systemic hypertension.

Cerebral neoplasms initially presenting with massive intracerebral hemorrhage

In three patients, clinically silent brain tumors led to massive intracerebral hemorrhage. These patients represented 0.6% of 497 consecutive patients with primary or secondary brain tumors and 2.5% of 119 patients with hypertensive or spontaneous intracerebral hemorrhage. Examination by computed tomography and angiography provided no evidence suggestive of the presence of neoplasms. All three patients were surgically treated and the lesions were histologically confirmed to be metastatic bronchogenic carcinoma, metastatic clear-cell carcinoma and low-grade astrocytoma, respectively.

Rupture of central canal with multisegmental haematomyelia: An unusual complication of rapidly fatal intracranial hypertension

Acute haematomyelia, an unrecognized sequela of sudden intracranial hypertension is described in 3 patients with massive intracerebral and intraventricular haemorrhage. The presence of a persistent central canal of the spinal cord in communication with the 4th ventricle and acute functional obstruction of the latter allows CSF and blood to pass down into the spinal cord with subsequent rupture into the cord parenchyma.

Intracranial hemorrhage caused by metastatic tumors.

Fifteen cases of metastatic brain tumors associated with massive subarachnoid, intracerebral, or intraventricular hemorrhage or a combination thereof are reported. Four patients had multiple bleeding cerebral metastasis. In 10 patients, stroke was the first manifestation of the neoplastic disease. It is concluded that metastases of choriocarcinoma, melanoma, and bronchogenic carcinoma are most prone to massive bleeding. The average survival from the beginning of neurologic symptoms was 65 days, but in seven patients, it was 11 days or less. Surgery seems to be beneficial in selected patients. Massive hemorrhage was a complication in 14 percent of our patients with metastases to brain versus 0.8 percent of those with gliomas.

Agenesis of internal carotid artery associated with aneurysm of contralateral middle cerebral artery.

SUMMARYAn autopsy case is reported of agenesis of the left internal carotid artery with rupture of a congenital aneurysm of the opposite middle cerebral artery. The patient was a 30-year-old Thai woman who died with massive subarachnoid and intracerebral hemorrhage. The diagnosis was rendered before death by arteriographic study and confirmed at autopsy.

Traumatic dissecting aneurysm of middle cerebral artery and carotid-cavernous fistula with massive intracerebral hemorrhage.

C AROTID-CAVERNOUS fistula poses no problem for diagnosis because of the impressive pulsating exophthalmos. In spite of a common belief that the lesion is usually easily and successfully treated by ligation of one or another artery leading to the fistula, the rate of cure is actually less than 50 %? Reasons for such poor results are not clear, since the complications of treatment are not frequently reported, but cerebral ischemia and hemorrhage appear to predominate. The former is easily understood, but the pathogenesis of cerebral hemorrhage is not clear? Postmortem analysis of the following case showed an interesting series of lesions which could have accounted for the terminal massive intracerebral hemorrhage.

HEMORRHAGE INTO MENINGIOMAS.

FOR many years, it was widely held that brain tumors not uncommonly presented acutely as a result of hemorrhage into the tumor. The 1930 edition of Osler's textbook of medicine contains the statement that gliomas of the brain, usually very vascular and the vessels are very liable to degenerate with resulting hemorrhage, thrombosis and edema. This often accounts for acute features appearing suddenly.1Over the years a sufficient body of information has accumulated which rather demolishes this view. Oldberg2in 1933 was among the first to correct this misapprehension. He reviewed Cushings series of 832 gliomas and found 31 instances of gross hemorrhage for a ratio of 1:27 or 3.7%. Various other series have corroborated this intelligence,3-6in studies primarily concerned with the etiology of massive intracerebral hemorrhage per se; other studies are devoted to the incidence of intracerebral hemorrhage secondary to tumor.7,8 As

Massive intracerebral hemorrhages of unusual etiology in young subjects

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

SURGICAL TREATMENT OF SPONTANEOUS NONTRAUMATIC HEMATOMAS

The symptomatology of massive intracerebral hemorrhage caused by hypertension is well known. The hopeless outcome in this condition following medical treatment prompted Cushing 1 in 1903 to report surgical therapy in 2 cases. He stated: In spite of the unfavorable result following operation in both cases, the temporary amelioration of the severe symptoms is a sufficient justification for future attempts to afford surgical relief to certain carefully selected cases of intracerebral hemorrhage. Since Cushing's article there have been many reports of successful removal of traumatic and spontaneous intracerebral hematomas from the cerebrum and cerebellum. This paper is limited to spontaneous, nontraumatic hematomas of the left temporal lobe, since these lesions produce a clear, easily recognized clinical syndrome and are amenable, because of their location, to successful evacuation by trephine or craniotomy. Russell and Sargent, 2 Bagley, 3 Penfield, 4 Craig and Adson, 5 Furlow, Carr and Wattenberg, 6 Pilcher 7

Sickle-cell anemia complicated by acuterheumatic heart disease and massive cerebral hemorrhage: Report of a case

Summary A case of sickle-cell anemia and acute rheumatic fever with carditis occurring simultaneously in a negro boy of 12 years is presented. The general necropsy findings were those typical of the two pathologic processes. Death was caused by a massive intracerebral hemorrhage, and associated evidences of chronic cerebral affection were present. The similarity in the clinical pictures of the two diseases is referred to, with special mention of the value of the fibrinolysin reaction as an aid in the diagnosis of rheumatic fever.