[Simultaneous, bilateral hypertensive intracranial hematomas]

Abstract

The reported incidences of bilateral intracerebral hemorrhages due to systemic arterial hypertension are exceptionally rare in Japan. Unilateral hemorrhages, on the other hand, are less uncommon. Recently, we have examined two patients with bilateral intracerebral hemorrhages due to hypertension. The first case involved bilateral thalamic hemorrhages; and in the other, a contralateral hemorrhage developed postoperatively, subsequent to the evacuation of a primary hematoma. The characteristic neurological manifestation of bilateral intracerebral hemorrhages include quadriparesis, bilateral Babinski's signs, stupor, and coma. Published information regarding the anatomy of intracerebral hemorrhages due to hypertension is inconclusive, but the bilateral basal ganglias are believed to be most frequently involved. One school of thought explains the pathomechanism of bilateral hemorrhages as a symmetrical rupture of cerebral microaneurysm. However, it is possible that an unilateral hematoma was formed by a ruptured microaneurysm, and subsequently, a contralateral hemorrhage developed in relatively short time due to circulatory disturbance. As in the case of general cerebral hemorrhage, a craniotomy is also indicated for hypertensive bilateral intracerebral hemorrhage.