Kono Ryuhei, Ishii Norihiro, Takamatsu Kazuhiro, Shimoe Yutaka, Ota Shinzo, Kuriyama Masaru
Department of Neurology, Brain Attack Center Ota Memorial Hospital.
Rinsho Shinkeigaku. 2015;55(7):490-6. doi: 10.5692/clinicalneurol.cn-000709. Epub 2015 Jun 4.
Two patients presented with chronic intracerebral hemorrhage (CIH) in the basal ganglia. A 48-year-old man (Case 1) was admitted to our hospital because of hypertensive right putaminal hemorrhage. On day 14, his hematoma surrounding the edema had grown without re-bleeding as seen on head CT, which was then removed endoscopically on day 28. Biopsied specimen of the hematoma capsule showed granulomatous tissue with vascularity. A 54-year-old man (Case 2) was admitted to our hospital because of bilateral intracerebral hemorrhage in the basal ganglia of the right putamen and left thalamus. On head CT, both hematomas were found to be enlarged without change in his symptoms on the 11th day after onset. His symptoms and signs subsided with medical treatment for 4 weeks. Cerebral angiography showed no abnormality of cerebral vessels. The patient had intracerebral hemorrhage in the basal ganglia or cerebral lobes 5 times in the past 10 years. Although no arterial or venous abnormality was detected by cerebral angiography and MRI/MRA, the abnormality of vessels including capillaries was strongly suggested. CIH should be considered a possibility when the symptom or hematoma does not improve even 2 weeks after the onset. The prevalence of CIH in our hospital was 0.08% of total intracerebral hemorrhages and 0.15% of hemorrhages in the basal ganglia.
两名患者出现基底节区慢性脑出血(CIH)。一名48岁男性(病例1)因高血压性右侧壳核出血入住我院。第14天,其血肿周围水肿增大,头颅CT未见再出血,于第28天接受内镜下血肿清除术。血肿包膜活检标本显示有血管的肉芽肿组织。一名54岁男性(病例2)因右侧壳核和左侧丘脑基底节区双侧脑出血入住我院。发病后第11天头颅CT显示血肿均增大,但其症状无变化。经4周药物治疗,其症状和体征缓解。脑血管造影显示脑血管无异常。该患者在过去10年中基底节区或脑叶脑出血5次。尽管脑血管造影和MRI/MRA未检测到动脉或静脉异常,但强烈提示包括毛细血管在内的血管存在异常。当症状或血肿在发病后2周仍无改善时,应考虑慢性脑出血的可能性。我院慢性脑出血的患病率占脑出血总数的0.08%,占基底节区出血的0.15%。