[The place of arteriography in the etiologic diagnosis of spontaneous intracerebral hematomas].

456 cases of spontaneous cerebral hemorrhage have been referred at the Neurosurgical Department of the University of Rennes since the CT scan is available, i.e. from 1979 till 1984. Sixteen passed away at the time of admission itself. Among the remaining 440 cases a diagnosis of cerebro-vascular malformation was suspected in 189 according to some atypical features in clinical and/or scanographic presentation, but only 101 patients were actually submitted to an angiographic evaluation, 88 others presenting with a very deep comatose state leading to death in a few hours. We found 14 vascular anomalies (14 p. cent) amongst them eight arterial aneurysms, five arteriovenous malformations and one combining cerebellar AVM and arterial aneurysm of the basilar artery. We couldn't perform an autopsy in all lethal cases but the necropsy findings lead to discover eight additional cases (4 aneurysms and 4 AVM). Statistically it means that a gross vascular lesion is responsible of 5% of cases of cerebral hematomas (22 out of 440). We didn't take in account the cavernomas discovered at the pathological examination of the walls of several hematomas. We may conclude that a careful angiographic study is justified in following cases: young age of the patient (under 65); lack of risk factors, especially cardio-vascular or hematologic; relatively satisfactory clinical status of the patient; topographic criteria related to the CT scan (hematomas located in the fronto-basal area and near sylvian fissure).