Abstract
For the purpose of investigaing how the hypertensive intracerebral hematoma increases in size, the author retrospectively reviewed angiograms and CT scans in 31 patients who showed extravasation on angiograms.
Of these patients, 28 patients (90.3%) had angiography and CT scannign within six hours after onset. Twenty seven patients (87.1%) showed extravasation on arterial phase of angiogram, 21 patients (67.7%) had multiple leakage of contrast medium, and 14 patients (45.2%) demonstrated two or more ruptured striate arteries.
Changeing the level and width of the CT window, the author found that a large hematoma consisted of several smaller hematomas, some of which had possible bleeding points in their corners.
The rationals for surgical treatment of hypertensive intracerebral hemorrhage was based on the assumption that the hemorrhage had a single bleeding point on a single striate artery and that the earliest possible hemostasis was mandatory.
The author's investigation, however, showed multiple extravasation and a close relationship between expanding form of hematoma and distribution of multiple extravasation of contrast medium. This proved that the hypertensive intracerebral hematoma increased in size with increase in number of ruptured striate arteries.
From these results, in order to prevent hematoma from rapidly increasing in size and to make Ruminant hemorrhage manageable, the author emphasizes the importance of intensive hypotension therapy that control bleeding from multiple ruptured arteries in the acute stage of hypertensive intracerebral hemorrhage.
