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  • Print publication year: 2012
  • Online publication date: August 2012

Chapter 44 - Basal ganglionic hemorrhages

from Section 2 - Vascular topographic syndromes


Severe ischemic stroke with progressive edema development is frequently life-threatening and associated with a poor prognosis due to limited expandability within the cranial cavity. This chapter describes the relevant aspects of supra- and infratentorial space-occupying strokes with particular emphasis on the role of decompressive surgery. Large ischemic infarction of the middle cerebral artery (MCA) territory can lead to a clinical syndrome called malignant MCA stroke. Cranial computed tomography (CT) is still the most widely used radiological modality to diagnose and monitor malignant MCA infarction. The only specific treatment option for this type of stroke with a solid base of evidence and major impact on the clinical course to date is decompressive surgery, that is, hemicraniectomy. Swelling of a large space-occupying cerebellar infarct appears within a few days from symptom onset and can lead to compression of the brainstem and midbrain or cause a hydrocephalus.
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Stroke Syndromes, 3ed
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1. ChungCS, CaplanLR, YamamotoY, et al. Striatocapsular haemorrhage. Brain 2000; 123: 1850–1862.
2. BrottT, ThalingerK, HertzbergV.Hypertension as a risk factor for spontaneous intracerebral hemorrhage. Stroke 1986; 17: 1078–1083.
3. DaveratP, CastelJP, DartiguesJF, et al. Death and functional outcome after spontaneous intracerebral hemorrhage. A prospective study of 166 cases using multivariate analysis. Stroke 1991; 22: 1–6.
4. GardeA, BohmerG, SeldenB, et al. 100 cases of spontaneous intracerebral haematoma. Diagnosis, treatment and prognosis. Eur Neurol 1983; 22: 161–172.
5. LamplY, GiladR, EshelY, et al. Neurological and functional outcome in patients with supratentorial hemorrhages. A prospective study. Stroke 1995; 26: 2249–2253.
6. MassaroAR, SaccoRL, MohrJP, et al. Clinical discriminators of lobar and deep hemorrhages: the Stroke Data Bank. Neurology 1991; 41: 1881–1885.
7. SuzukiK, KutsuzawaT, TakitaK, et al. Clinico-epidemiologic study of stroke in Akita, Japan. Stroke 1987; 18: 402–406.
8. SaccoS, MariniC, ToniD, et al. Incidence and 10-year survival of intracerebral hemorrhage in a population-based registry. Stroke 2009; 40: 394–399.
9. FisherCM.Clinical syndromes in cerebral hemorrhage. In: FieldsW, ed. Pathogenesis and Treatment of Cerebrovascular Disease. Springfield, IL: Charles C Thomas, 1961; 318–342.
10. BroderickJP, BrottTG, TomsickT, et al. Ultra-early evaluation of intracerebral hemorrhage. J Neurosurg 1990; 72: 195–199.
11. DruryI, WhisnantJP, GarrawayWM.Primary intracerebral hemorrhage: impact of CT on incidence. Neurology 1984; 34: 653–657.
12. HierDB, DavisKR, RichardsonEP Jr, et al. Hypertensive putaminal hemorrhage. Ann Neurol 1977; 1: 152–159.
13. MizukamiM, NishijimaM, KinH.Computed tomographic findings of good prognosis for hemiplegia in hypertensive putaminal hemorrhage. Stroke 1981; 12: 648–652.
14. ScottWR, NewPF, DavisKR, et al. Computerized axial tomography of intracerebral and intraventricular hemorrhage. Radiology 1974; 112: 73–80.
15. ZahuranecDB, GonzalesNR, BrownDL, et al. Presentation of intracerebral haemorrhage in a community. J Neurol Neurosurg Psychiatry 2006; 77: 340–344.
16. TapiaJF, KaseCS, SawyerRH, et al. Hypertensive putaminal hemorrhage presenting as pure motor hemiparesis. Stroke 1983; 14: 505–506.
17. WeisbergLA.Caudate hemorrhage. Arch Neurol 1984; 41: 971–974.
18. AlexanderGE, DeLongMR, StrickPL.Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Ann Rev Neurosci 1986; 9: 357–381.
19. GhikaJA, BogousslavskyJ, RegliF.Deep perforators from the carotid system. Template of the vascular territories. Arch Neurol 1990; 47: 1097–1100.
20. ChungCS, CaplanLR, HanW, et al. Thalamic haemorrhage. Brain 1996; 119: 1873–1886.
21. ChungCS, ParkCH.Primary pontine hemorrhage: a new CT classification. Neurology 1992; 42: 830–834.
22. WijdicksEF, St LouisE.Clinical profiles predictive of outcome in pontine hemorrhage. Neurology 1997; 49: 1342–1346.
23. HemphillJC 3rd, BonovichDC, BesmertisL, et al. The ICH score: a simple, reliable grading scale for intracerebral hemorrhage. Stroke 2001; 32: 891–897.
24. TuhrimS, HorowitzDR, SacherM, et al. Volume of ventricular blood is an important determinant of outcome in supratentorial intracerebral hemorrhage. Crit Care Med 1999; 27: 617–621.
25. RostNS, SmithEE, ChangY, et al. Prediction of functional outcome in patients with primary intracerebral hemorrhage: the FUNC score. Stroke 2008; 39: 2304–2309.
26. CheungRT, ZouLY.Use of the original, modified, or new intracerebral hemorrhage score to predict mortality and morbidity after intracerebral hemorrhage. Stroke 2003; 34: 1717–1722.
27. QureshiAI, EzzeddineMA, NasarA, et al. Prevalence of elevated blood pressure in 563,704 adult patients with stroke presenting to the ED in the United States. Am J Emerg Med 2007; 25: 32–38.
28. ZhangY, ReillyKH, TongW, et al. Blood pressure and clinical outcome among patients with acute stroke in Inner Mongolia, China. J Hypertens 2008; 26: 1446–1452.
29. WillmotM, Leonardi-BeeJ, BathPM.High blood pressure in acute stroke and subsequent outcome: a systematic review. Hypertension 2004; 43: 18–24.
30. BrottT, BroderickJ, KothariR, et al. Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 1997; 28: 1–5.
31. MoonJS, JanjuaN, AhmedS, et al. Prehospital neurologic deterioration in patients with intracerebral hemorrhage. Crit Care Med 2008; 36: 172–175.
32. DavisSM, BroderickJ, HennericiM, et al. Hematoma growth is a determinant of mortality and poor outcome after intracerebral hemorrhage. Neurology 2006; 66: 1175–1181.
33. MorgensternLB, HemphillJC 3rd, AndersonC, et al. Guidelines for the management of spontaneous intracerebral hemorrhage. A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2010; 41: 2108–2129.
34. QureshiAI, PaleschYY, MartinR, et al. Effect of systolic blood pressure reduction on hematoma expansion, perihematomal edema, and 3-month outcome among patients with intracerebral hemorrhage: results from the antihypertensive treatment of acute cerebral hemorrhage study. Arch Neurol 2010; 67: 570–576.
35. AndersonCS, HuangY, WangJG, et al. Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol 2008; 7: 391–399.
36. BroderickJP, AdamsHP Jr, BarsanW, et al. Guidelines for the management of spontaneous intracerebral hemorrhage: a statement for healthcare professionals from a special writing group of the stroke council, American Heart Association. Stroke 1999; 30: 905–915.
37. Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) investigators. Antihypertensive treatment of acute cerebral hemorrhage. Crit Care Med 38: 637–648.
38. QureshiAI.Antihypertensive treatment of acute cerebral hemorrhage (ATACH): rationale and design. Neurocrit Care 2007; 6: 56–66.
39. FogelholmR, MurrosK, RissanenA, et al. Admission blood glucose and short term survival in primary intracerebral haemorrhage: a population based study. J Neurol Neurosurg Psychiatry 2005; 76: 349–353.
40. KimuraK, IguchiY, InoueT, et al. Hyperglycemia independently increases the risk of early death in acute spontaneous intracerebral hemorrhage. J Neurol Sci 2007; 255: 90–94.
41. PasseroS, CiacciG, UlivelliM.The influence of diabetes and hyperglycemia on clinical course after intracerebral hemorrhage. Neurology 2003; 61: 1351–1356.
42. van den BergheG, WoutersP, WeekersF, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med 2001; 345: 1359–1367.
43. FinferS, ChittockDR, SuSY, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009; 360: 1283–1297.
44. ChambersIR, BanisterK, MendelowAD.Intracranial pressure within a developing intracerebral haemorrhage. Br J Neurosurg 2001; 15: 140–141.
45. FernandesHM, SiddiqueS, BanisterK, et al. Continuous monitoring of ICP and CPP following ICH and its relationship to clinical, radiological and surgical parameters. Acta Neurochir Suppl 2000; 76: 463–466.
46. ZiaiWC, TorbeyMT, NaffNJ, et al. Frequency of sustained intracranial pressure elevation during treatment of severe intraventricular hemorrhage. Cerebrovasc Dis 2009; 27: 403–410.
47. BrattonSL, ChestnutRM, GhajarJ, et al. Guidelines for the management of severe traumatic brain injury. IX. Cerebral perfusion thresholds. J Neurotrauma 2007; 24: S59–S64.
48. BhattathiriPS, GregsonB, PrasadKS, et al. Intraventricular hemorrhage and hydrocephalus after spontaneous intracerebral hemorrhage: results from the STICH trial. Acta Neurochir Suppl 2006; 96: 65–68.
49. HalleviH, AlbrightKC, AronowskiJ, et al. Intraventricular hemorrhage: anatomic relationships and clinical implications. Neurology 2008; 70: 848–852.
50. DiringerMN, EdwardsDF, ZazuliaAR.Hydrocephalus: a previously unrecognized predictor of poor outcome from supratentorial intracerebral hemorrhage. Stroke 1998; 29: 1352–1357.
51. MendelowAD, GregsonBA, FernandesHM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the international surgical trial in intracerebral haemorrhage (STICH): a randomised trial. Lancet 2005; 365: 387–397.