Schuss Patrick, Bode Christian, Borger Valeri, Coch Christoph, Güresir Ági, Hadjiathanasiou Alexis, Hamed Motaz, Kuchelmeister Klaus, Lehmann Felix, Müller Marcus, Schneider Matthias, Solymosi László, Vatter Hartmut, Velten Markus, Güresir Erdem
Department of Neurosurgery, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany.
Diagnostics (Basel). 2021 Feb 22;11(2):368. doi: 10.3390/diagnostics11020368.
Intracerebral hemorrhage (ICH) is a frequently disabling or fatal disease. The localization of ICH often allows an etiological association. However, in atypical/lobar ICH, the cause of bleeding is less obvious. Therefore, we present prospective histopathological and radiological studies which were conducted within the diagnostic workup to identify causes for lobar ICH other than hypertension. From 2016 to 2018, 198 patients with spontaneous, non-traumatic ICH requiring neurosurgical monitoring were enrolled in an institutional prospective patient registry. Patients with deep-seated ICH and/or hemorrhagically transformed cerebral infarcts were excluded from further analysis. Data to evaluate the source of bleeding based on histopathological and/or radiological workup were prospectively evaluated and analyzed. After applying the inclusion criteria and excluding patients with incomplete diagnostic workup, a total of 52 consecutive patients with lobar ICH were further analyzed. Macrovascular disease was detected in 14 patients with lobar ICH (27%). In 11 patients, diagnostic workup identified cerebral amyloid angiopathy-related ICH (21%). In addition, five patients with tumor-related ICH (10%) and six patients with ICH based on infectious pathologies (11%) were identified. In four patients, the cause of bleeding remained unknown despite extensive diagnostic workup (8%). The present prospective registry study demonstrates a higher probability to identify a cause of bleeding other than hypertension in patients with lobar ICH. Therefore, a thorough diagnostic work-up in patients with ICH is essential to accelerate treatment and further improve outcome or prevent rebleeding.
脑出血（ICH）是一种常导致残疾或致命的疾病。脑出血的定位往往有助于病因关联。然而，在非典型/脑叶性脑出血中，出血原因不太明显。因此，我们展示了在诊断检查过程中进行的前瞻性组织病理学和放射学研究，以确定除高血压外脑叶性脑出血的病因。2016年至2018年，198例需要神经外科监测的自发性、非创伤性脑出血患者被纳入机构前瞻性患者登记处。深部脑出血和/或出血性转化的脑梗死患者被排除在进一步分析之外。基于组织病理学和/或放射学检查来评估出血来源的数据进行了前瞻性评估和分析。应用纳入标准并排除诊断检查不完整的患者后，共对52例连续的脑叶性脑出血患者进行了进一步分析。在14例脑叶性脑出血患者中检测到大血管疾病（27%）。在11例患者中，诊断检查确定为脑淀粉样血管病相关性脑出血（21%）。此外，确定了5例肿瘤相关性脑出血患者（10%）和6例基于感染性病变的脑出血患者（11%）。在4例患者中，尽管进行了广泛的诊断检查，出血原因仍不明（8%）。本前瞻性登记研究表明，脑叶性脑出血患者中识别出除高血压外的出血原因的可能性更高。因此，对脑出血患者进行全面的诊断检查对于加快治疗并进一步改善预后或预防再出血至关重要。
