Schütz H, Bödeker R H, Damian M, Krack P, Dorndorf W
Department of Neurology, Justus-Liebig-University, Giessen, FRG.
Stroke. 1990 Oct;21(10):1412-8. doi: 10.1161/01.str.21.10.1412.
We investigated incidence, age distribution in relation to etiology, and localization of spontaneous intracerebral hematoma in 100 consecutive cases. Incidence in the total population of the Giessen area was estimated to be greater than 11/100,000 inhabitants/yr and increased with age. There was a trend toward higher incidence in males. Overall mortality was 27%, 22% of 58 patients aged less than 70 years and 33% of 42 patients aged greater than or equal to 70 years. Hypertensive putaminal hematoma showed the highest mortality rate (42%, 10 of 24 cases). Chronic alcoholism and anticoagulant medication influenced the mortality rate unfavourably. We found the following localizations and etiologies to have a specific relation with age: 1) lobar hematomas from vascular malformations, group aged less than 40 years; 2) hypertensive putaminal hematomas and hypertensive thalamic hematomas, group aged 40-69 years; and 3) lobar hematomas, group aged greater than or equal to 70 years. Alcoholism was an additional factor in 38% of the 13 middle-aged men with hypertensive putaminal hematomas. Fourteen cases of spontaneous intracerebral hematoma were possibly due to cerebral amyloid angiopathy. Six of these 14 patients had recurrent lobar hematomas, but only three of the six could be histologically investigated. In these three cases, cerebral amyloid angiopathy was proven.
我们对100例连续的自发性脑内血肿患者的发病率、与病因相关的年龄分布以及血肿部位进行了调查。吉森地区总人口中的发病率估计超过11/100,000居民/年，且随年龄增长而增加。男性发病率有上升趋势。总体死亡率为27%，58例年龄小于70岁的患者中死亡率为22%，42例年龄大于或等于70岁的患者中死亡率为33%。高血压性壳核血肿的死亡率最高（42%，24例中有10例）。慢性酒精中毒和抗凝药物治疗对死亡率有不利影响。我们发现以下血肿部位和病因与年龄有特定关系：1）血管畸形导致的脑叶血肿，年龄小于40岁的群体；2）高血压性壳核血肿和高血压性丘脑血肿，年龄40 - 69岁的群体；3）脑叶血肿，年龄大于或等于70岁的群体。在13例患有高血压性壳核血肿的中年男性中，38%的病例存在酒精中毒这一额外因素。14例自发性脑内血肿可能归因于脑淀粉样血管病。这14例患者中有6例出现复发性脑叶血肿，但6例中只有3例进行了组织学检查。在这3例中，证实存在脑淀粉样血管病。
