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Multiple Simultaneous Intracerebral Hemorrhages
Clinical Features and Outcome
Jorge Mauriño, MD;
Gustavo Saposnik, MD;
Sandra Lepera, MD;
Raul C. Rey, MD;
Roberto E. Sica, MD
Arch Neurol. 2001;58:629-632.
Background The simultaneous occurrence of intracerebral hemorrhages in different
arterial territories is an uncommon clinical event. Its predisposing factors
and pathophysiological mechanisms are not clearly defined.
Objective To analyze the frequency, risk factors, clinical features, neuroimaging
findings, and outcome of multiple simultaneous intracerebral hemorrhages (SIHs).
Patients and Methods We studied all patients with acute stroke admitted to our hospital from
July 18, 1997, through December 18, 1999. Multiple SIHs were defined as the
presence of 2 or more intracerebral hemorrhages affecting different arterial
territories with identical computed tomographic density profiles. Patients
with a history of traumatic brain injury were excluded from this study. Diagnostic
investigation included routine blood and urine tests, coagulation studies,
a chest radiograph, electrocardiogram, 2-dimensional transthoracic echocardiography,
and computed tomography of the head without contrast medium. Disability was
assessed using the National Institutes of Health Stroke Scale and Modified
Rankin Scale.
Results Among 142 patients with hemorrhagic stroke, we found 4 (2.8%) with SIHs.
All 4 patients had a history of uncontrolled arterial hypertension. We excluded
other potential causes of multiple SIHs by using appropriate diagnostic tests.
The most common clinical manifestations were headache and weakness. Localization
of hematomas was supratentorial, except for one patient who had both infratentorial
and supratentorial hemorrhages. The mean National Institutes of Health score
on admission was 15 and the Modified Rankin Scale score was higher than 4
at 3 months.
Conclusions In our study, all patients with multiple SIHs had arterial hypertension
and a poor outcome. Additional analytic studies, including new imaging techniques,
can help to elucidate the association between arterial hypertension and multiple
SIHs, risk factors, and underlying mechanisms of this clinical condition.
From the Department of Neurology, Stroke Service, Hospital J. M. Ramos
Mejía, Universidad de Buenos Aires, Buenos Aires, Argentina.
Corresponding author: Jorge Mauriño, MD, Department of Neurology,
Hospital J. M. Ramos Mejía, Soler 4019, Sexto Piso, Buenos Aires 1425,
Argentina (e-mail: jorgemaurino{at}hotmail.com).
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