Abstract
During the past 4 years we experienced 68 cases of subcortical hematoma, excluding one secondary to trauma or ruptured aneurysm. Among these we had 17 cases of hypertensive subcortical hematoma (hypertensive group) and 28 cases of so-called spontaneous subcotical hematoma. The so-called spontaneus hematoma was further subdivided into two groups; one (13 cases) is cryptic AVM group in which small angiomatous malformations were confirmed histologically (cryptic AVM group), the other (15 cases) is unknown group in which any clear etiology could not be found (unknown group). Three groups were clinically analyzed. Especially in cryptic AVM group, the age ranged from 3 months to 73 years with the mean age of 40 years and there were 2 males and 11 females. Initial symptoms of cryptic AVM group were mild onset with headache, nausea, vomiting, and delayed loss of consciousness and/or hemiparesis. On the other hand, initial symptoms of hypertensive group were sudden onset with hemiparesis and/or speech disturbance. The hematoma site was predominant in the parietal lobe in hypertensive and cryptic AVM group, and in the occipital lobe in unknown group.
CT scan was useful for diagnosis of subcortical hematoma, but there were no characteristic differences in shape and size of hematoma among 3 groups. Cryptic AVM showed no contrast enhancement in our cases. Angiographically, most cases with subcortical hematoma were demonstrated avascular mass with displacement of vessels. Only 5 cases of cryptic AVM showed abnormal findings such as early venous filling or extravasation. Since cryptic AVM is rarely found by angiography, it must be emphasized to search fully during surgery, even if considered to hypertensive hematoma preopeartively. And it is necessary to remove the cryptic AVM completely to prevent rebleeding. Microscopically, all cases of cryptic AVM showed arterio-venous malformations.
The outcome of subcortical hematoma was good even though the state of the consciousness were poor on admission. Out of the total 45 patients, 5 died of systemic complications postoperatively. Four of 5 dead cases were aged more than 70 years. Therefore, the outcome seemed to depend on the age of patient.
