Ipsilateral intracranial hemorrhage with internal carotid artery occlusion: report of seven cases and a review of the literature

Abstract

Background and Purpose: The characteristics of cases with internal carotid occlusion and ipsilateral supratentorial cerebral hemorrhage were reviewed.Methods: Cases of internal carotid occlusion with an ipsilateral supratentorial cerebral hemorrhage over a 5-year period (2008–2012) were identified in our inpatient database and medical records.Results: Of 313 cases of supratentorial cerebral hemorrhage, 7 (2.3%) had internal carotid occlusion with an ipsilateral supratentorial cerebral hemorrhage. There were no cases of internal carotid occlusion with contralateral cerebral hemorrhage. There were 6 men and 1 woman with an average age of 79 years. The hemorrhagic location was the putamen in 3 and the thalamus in 4, with an average bleeding volume of 6 ml. CT perfusion studies showed decreased hemispheric blood flow on the affected side in 5 cases. One ¹²³I-IMP-SPECT study revealed misery perfusion. One case underwent bypass surgery 2 years and 8 months before the intracranial hemorrhage. Revascularization surgery (bypass 2, carotid endarterectomy 1) was performed at an average of 85 days from hemorrhage onset. Antithrombotic therapy was started or re-started after an average of 55 days after hemorrhage in 5 cases, but intracranial hemorrhage enlarged in one case. None of the 6 patients who could be followed-up showed recurrence during an average follow-up of 2 years and 3 months after hemorrhage.Conclusion: Decreased cerebral blood flow and vascular reserve capacity due to main trunk occlusion seemed to be risks for ipsilateral perforating branch area hemorrhage.