[Spontaneous non-hypertensive cerebral hematomas]

Abstract

A retrospective study of 35 non-hypertensive intraparenchymal brain hematomas (NHBH) is made to evaluate their etiopathogenesis and the therapeutic approaches employed. A comparison is made with the hypertensive hematomas seen during the same period. Among the NHBH there were 5 vascular malformations (VM (14%), 5 hematomas secondary to brain tumors (14%), 2 amyloid angiopathies (6%), 2 cases of coagulation dysfunction (6%), 3 hematomas secondary to anticoagulation therapy (9%), and one hematoma in an intravenous drug abuser (3%). No etiological diagnosis was established in the remaining 17 cases (48%). The NHBH were predominantly lobar (43%), and incidence was greater among young patients. Mortality was 20%. All cases were diagnosed by brain CT, the latter suggesting pathology underlying the hematoma in 3 tumoral hematomas, in 2 VM confirmed arteriographically, and in one patient with suspect VM not confirmed by angiography. A total of 22 angiographies were performed: the latter were diagnostic in all VMs and negative in the tumor hematomas, amyloid angiopathies and in those hematomas of unknown etiology where angiography was performed. Fifteen patients were operated on. We recommend that in patients with brain hematomas but without antecedents of arterial hypertension or with an atypically situated hematoma, a careful examination should be carried out to discard all possible causes of brain hemorrhage, together with the early performing of contrasted CT scans and posterior angiography. If the latter prove negative, the patient should undergo a clinico-radiological follow-up, together with an histological study of the blood clot if operated on.