Shaheed Tariq A, Glover Nicholas, Alboiny Safwan
Hospital Medicine / Internal Medicine, UC Davis Health, Lodi, USA.
Graduate Medical Education / Emergency Medicine, Desert Regional Medical Center, Palm Springs, USA.
Cureus. 2020 Nov 2;12(11):e11299. doi: 10.7759/cureus.11299.
A 62-year-old man with a past medical history of uncontrolled hypertension, tobacco abuse, and type 2 diabetes mellitus (DM) presented to the emergency department due to worsening confusion over the last 24 hours as reported by a friend. A CT brain without contrast was obtained, which demonstrated a bilateral intracerebral hemorrhage (ICH). Spontaneous bilateral intracerebral hemorrhage is an exceedingly rare condition with only 30-40 reported cases This patient had a non-traumatic ICH, without focal neurological deficits on presentation. The patient had no complications while hospitalized despite the imaging findings. Clinicians should keep a broad differential similar to causes of spontaneous non-traumatic unilateral ICH, including uncontrolled hypertension, tumor mass, coagulopathies, and vasculopathies. Although brain CT is the most appropriate study in the acute setting, MRI is the gold standard for definitive diagnosis and should be performed urgently to further characterize the lesions. Clinicians should be aware of non-traumatic ICH complications, which include aspiration pneumonia, quadriparesis, hemiparesis, and recurrent stroke. Management is supportive mainly by reducing risk factors for complications, including blood pressure control, aspiration precautions, reversing coagulopathies, frequent neurological checks, and consultation with multiple disciplines such as neurosurgery or neurointerventional radiology.
一名62岁男性，有高血压控制不佳、吸烟及2型糖尿病病史，据朋友报告，其在过去24小时内意识混乱加重，遂就诊于急诊科。行头颅非增强CT检查，结果显示双侧脑出血（ICH）。自发性双侧脑出血极为罕见，仅有30 - 40例报告病例。该患者为非创伤性脑出血，就诊时无局灶性神经功能缺损。尽管影像学检查有异常发现，但患者住院期间未出现并发症。临床医生应考虑与自发性非创伤性单侧脑出血病因相似的广泛鉴别诊断，包括高血压控制不佳、肿瘤、凝血功能障碍和血管病变。虽然脑部CT是急性情况下最适宜的检查，但MRI是明确诊断的金标准，应紧急进行以进一步明确病变特征。临床医生应知晓非创伤性脑出血的并发症，包括吸入性肺炎、四肢瘫、偏瘫和复发性卒中。治疗主要是支持性的，主要通过降低并发症的危险因素，包括控制血压、预防误吸、纠正凝血功能障碍、频繁进行神经检查以及多学科会诊，如神经外科或神经介入放射科会诊。
