Abstract
From January, 1978 to December, 1990, a total of 382 patients with a ruptured cerebral aneurysm have been treated by means of neck clipping, and from this number, the cases of 5 patients who experienced a delayed intracerebral hematoma (DICH) that occurred months or years after receiving the aneurysmal neck clipping have been studied retrospectively. In each of these 5 patients, who ranged in age from 25 to 61 years (mean : 46 years) , the DICH had, occurred without any new and/or residual aneurysm, and the interval between the clipping and the development of the DICH ranged from 8 months to 5 years (mean : 2 years and 5 months). In 3 patients, the hematoma had developed ipsilaterally to the side that had undergone the craniotomy, and in the remaining 2 patients, it was in a contra-lateral side. The location of the DICH was in the subcortex in 2 patients, in the putamen in 2 other patients, and in the thalamus of the remaining patient. Of note, 2 of the patients subsequently showed a recurrence of the DICH : after a clinical stable interval of 1 year and I month, I patient (Case 2) suffered a right temporal subcortical hemorrhage, followed by a right putaminal hemorrhage, and after an interval of 3 months, the other patient (Case 4) suffered a right parietal subcortical hemorrhage that was followed by a right thalamic hemorrhage. As for the etiology of these cases, 2 patients had a history of hypertension for which they had received antihypertensive drugs, 3 had severe spasms and stenosis of the parent artery on postoperative angiography, and 1 (Case 5) had undergone surgery for coarctation of the aorta at the age of 14. In addition to the findings of their retrospective study, the pathogenesis of DICH is discussed.
