A case of bilateral hypertensive intracerebral hemorrhage which occurred simultaneously
Sugiura, M.; Himuro, H.; Tanikawa, T.; Beppu, T.
No Shinkei Geka. Neurological Surgery 10(2): 193-198
1982
ISSN/ISBN: 0301-2603 PMID: 7063100 Document Number: 194477
A case of bilateral hypertensive intracerebral hemorrhage (HICH) which occurred simultaneously, was reported. A 70-yr-old woman had a sudden onset of right hemiparesis, urinary incontinence and speech disturbance. She was stuporous and restless on admission. Neurological examination showed right hemiparesis and total aphasia, but failed to reveal bulbar palsy and left hemiparesis. CT scan revealed a high density mass in the left thalamic region extending to the left lateral ventricle and also a small high density mass in the right putaminal region. Angiogram showed mass effect in the left thalamic area and elongation of cerebral arteries without definite vascular anomaly. Although she had moderate right hemiparesis and motor dysphasia at discharge after 5 mo. of hospitalization, she was able to enjoy home life with help. As to the possible mechanism of simultaneously occurring bilateral HICH, the bilateral rupture of microaneurysms at one time or the primary rupture of a microaneurysm followed by the secondary hemorrahge from capillaries and veins due to circulatory disturbance in the contralateral hemisphere might be considered. The features of bilateral HICH, including simultaneously and nonsimultaneously occurring ones, were as follows. The predominant sites of hemorrhage were in the thalamus (80%) and putamen (20%). The clinical symptoms were characterized by severe consciousness disturbance (stupor to coma), bulbar palsy and bilateral paresis. The outcome in the majority of the cases was poor, especially as to morbidity. The cases with bilateral paresis took more unfavorable outcome than those with hemiparesis.