Abstract
Subcortical hemorrhage is observed in about 10%of intracerebral hemorrhage. Various causes of hemorrhage other than hypertensive should be taken into account. In this report, we identified that the relationship between the cause of subcortical hemorrhage and the angiographical findings. During the past four years, we experienced 41 subcortical hemorrhages. The average age was 59.6 years. Thirty-three angiogram were studied among 41 subcortical hemorrhages. Three patients (8%) showed arteriovenous malformation and one (3%) patient showed a small angiomatous malformation (SAM). The other 33 patients (89%) showed normal angiogram.
Removal of subcortical hemorrhage was performed in 26 cases. Three (11%) operative specimen showed arteriovenous malformation, five (19%) showed SAM, one (4%) demonstrated venous angioma and the others 17 (66%) revealed no vascular malformation. The pathology of angiographicaly positive cases showed the same diagnosis as diagnosed before the operation. Angiography of five cases (19%), which showed vascullar malformation after the operation, demonstrated negative angiography.
In all cases that were diagnosed by angiography as arteriovenous malformation, surgery proved the diagnosis to have been correct. One SAM demonstrated by angiography also proved to be SAM by surgical specimen.
Four of angiographycally occult vascular malformations proved to be SAM and one proved to be venous angioma on histological evaluation. 19% of operated cases revealed angiographycally occult vascular malformation. Unlike other reports, we did not experience rebleeding of subcortical hemorrhage in this series.
Various causes of angiographically occult vascular malformation such as SAM, cavernous angioma, venous angioma, thrombosed AVM, amyloid angiopathy and the capacity of the instrument has been reported.
But there is still a problem of the mortal history of small angiomatous malformations and subcortical hemorrhage. The indications for surgical treatment of intracerebral hemorrhage has not been determined yet.
Due to the sampling problem inherent in biopsy material, there was the possibility of operative false negative cases. But we are of the opinion that radical extirpation of the wall cavity should not be performed in the operation.
We recommend the minimum extirpation of the wall cavity and the total removal of the vascular malformation.
Intensive enlarged stereotaxic cerebral angiography should be performed on patients with subcortical hemorrhage and surgical removal of the vascular malformation and hematoma should be considered to prevent rebleeding from the vascular malformation.
