Chronic Encapsulated Intracerebral Hematoma : A Report of Two Cases and a Review of the Literature

Abstract

  Chronic encapsulated intracerebral hematoma (CEIH) is a rare clinicopathological entity. Two cases of putaminal hemorrhage with CEIH are presented. Case 1 : A 54-year-old man who had sudden onset of left hemiparesis, left hypoesthesia, and dysphasia was admitted to our hospital. Computed tomography (CT) scan showed a right putaminal hemorrhage. Delirium, disorientation, and left hemiparesis worsened with progressive enlargement of the hematoma and peripheral edema. There was ring-like enhancement with gadolinium-diethylenetriamine pentaacetic acid (Gd-DTPA). Despite aspiration of the hematoma liquid, marked peripheral edema continued. After a second operation, the hematoma and edema decreased gradually, and recurrence has not been observed for seven years after onset. Case 2 : A 36-year-old man who had a sudden onset of right hemiparesis and hypoesthesia was admitted to our hospital. CT scan showed a left putaminal hemorrhage. A left frontotemporal craniotomy was performed on the 27th day after admission. After thorough dissection of the sylvian fissure and a small corticotomy to the insula, a capsule was seen, containing. There was blood in various stages of organization in the capsule. A histological examination showed similarities to the membrane of chronic subdural hematoma. Postoperatively, the patient improved, and he was discharged ambulatory, and recurrence has not been observed as of three years from onset.

  The cause of CEIH is unknown. This unusual entity mimics brain tumors or abscess because of gradual growth and slowly progressive neurological deficits. The relevant literature was reviewed, and the pathogenesis of CEIH is discussed.