Twenty-six Cases of Recurrent Intracerebral Hemorrhage in Different Sites at Different Times

Abstract

A total of 347 patients who were hospitalized at the Department of Neurosurgery, Shizuoka Saiseikai General Hospital between September, 1980 and September, 1986 due to intracerebral hemorrhage, were used as subjects in this study, excepting those with subarachnoid hemorrhage caused by intracranial aneurysms and arteriovenous malformations, hemorrhagic infarction and ventricular hemorrhage of undeterminable origin. Out of the 347 patients, 26 had recurrent intracerebral hemorrhage at a different site from that found at the initial attack; seven who had a history of intracerebral hemorrhage were hospitalized due to recurrent hemorrhage; 19 who had been hospitalized due to the initial intracerebral hemorrhage suffered recurrent intracerebral hemorrhage. Among 13 patients having a history of putaminal hemorrhage, five, four, three and one had recurrent hemorrhage in the contralateral putamen, subcortex, thalamus and in the pons, respectively. Among seven patients with previous hemorrhage in the thalamus, four, two and one again developed hemorrhage in the contralateral thalamus, putamen and subcortex, respectively. Two each of four patients having had cerebellar hemorrhage were again attacked with hemorrhage in the putamen and thalamus, respectively. Recurrent hemorrhage occurred in the subcortex and putamen respectively in two patients with previous subcortical hemorrhage. Out of the 26 patients having intracerebral hemorrhage in different sites at different times, recurrent hemorrhage was found on the contralateral side in 19. These patients were 17 men and 9 women.
The mean age at the time of initial hemorrhage was 55.6 and that at the second time was 57.8. The duration between the first and second hemorrhage ranged from one month to 15 years, about 3 years on average. The complication which was most frequently seen was hypertension. Out of 15 patients with hypertension complications, 13 had been continuously treated from the time of the initial hemorrhage until the occurrence of second hemorrhage. Although only four of the 26 patients previously underwent cerebral angiography of the recurrent regions, no evidence indicating an anticipation of hemorrhage was found. As for surgical treatment, eight underwent hematoma removal through cerebrostomy and six underwent ventricular drainage at the time of initial hemorrhage. At the time of the recurrent hemorrhage, hematomas were removed in six cases, and ventricular drainage was applied to four; only one patient underwent the removal of hematomas at both times. Out of the 26 patients with recurrent hemorrhage, three were suffering their third hemorrhage, and hemorrhage had occurred four times in one patient, in a different site each time. As with those stated in previous reports, the prognosis of recurrent intracerebral hemorrhage is poor from the standpoints of both life and function.