Abstract
The clinical features of intracranial hemorrhage were studied retrospectively in 645 cases of chronic renal failure with or without dialysis therapy admitted during the period, 1988 to 1994.
(1) Incidence : Cerebral hemorrhage occurred in 16 of 457 cases undergoing chronic intermittent dialysis (3.50%) and in 5 of 188 cases receiving conservative therapy (2.66%). (2) Risk factors and site of hemorrhage : All 21 cases of cerebral hemorrhage were statistically significant hypertensive (p <0.01) as compared to 574 cases of age-matched non-bleeders with chronic renal failure. The most common site of hemorrhage was the putamen, internal capsule and thalamus (13 cases) followed by the brain stem and cerebellum (6 cases) and occipital regions (2 cases). Among the cases of supratentorial cerebral hemorrhage, 4 manifested intraventricular hemorrhage and 3 died (75%). (3) Mode of dialysis : Among the 21 cases of cerebral hemorrhage, 13 were under chronic intermittent hemodialysis and 3 were under peritoneal dialysis (CAPD). Five cases were on conservative therapy. (4) Mortality : The overall mortality in cerebral hemorrhage was 9/12 (43%), comprising 8 on hemodialysis and 1 on CAPD. It is worthy of note that the mortality for brain stem and cerebellar hemorrhage was 4 out of 6 (66.7%). (5) Other details : Subarachnoid hemorrhage was found in 1 case and was successfully treated surgically. Subdural hematoma was noted in 5 cases, and 1 died. Conclusion : Intracebral hemorrhage was found in 21 of 645 cases with chronic renal failure. These 21 with intracerebral hemorrhage showed the highest mortality (43%) as a direct cause of death. In comparison with our previously reported series of autopsy-proven cases in 1976 and 1985, a tendency towards a decrease in mortality was noted, while there was a definite increase in brain stem hemorrhage. Of the risk factors hypertension and coagulation abnormalities involving the prothrombin time and thrombo test (p < 0.05) were factors of significance.
