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Ongoing bleeding in acute intracerebral haemorrhage
Clinical Picture
Ongoing bleeding in acute intracerebral haemorrhage Dar Dowlatshahi, Matthew J Hogan, Mukul Sharma, Grant Stotts, Dylan Blacquiere, Santanu Chakraborty Lancet 2013; 381: 152 Published Online September 21, 2012 http://dx.doi.org/10.1016/ S0140-6736(12)60829-0 Division of Neurology, Department of Medicine (D Dowlatshahi MD, M J Hogan MD, M Sharma MD, G Stotts MD, D Blacquiere MD) and Division of Neuroradiology, Department of Medical Imaging (S Chakraborty MD) University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
A 49-year-old woman with recently diagnosed hypertension, developed sudden onset aphasia and right hemiplegia. A CT of her brain showed a large left subcortical haemorrhage. Dynamic CT-angiography showed dramatic contrast extravasation (see figure and webvideos) suggesting ongoing bleeding, and corresponding to rapid neurological deterioration. Our patient had urgent surgical evacuation of the haematoma. Her neurological symptoms subsequently stabilised. Surgical exploration, pathology, and postoperative conventional angiography did not show a vascular malformation. The
presumed cause of the haemorrhage was hypertension. One month later, she was transferred to a rehabilitation programme with ongoing expressive aphasia and right hemiplegia. Intracerebral haemorrhage is the most severe form of stroke. Mortality rates are approximately 40%, and up to 80% of survivors are disabled. A third of patients with acute intracerebral haemorrhage have ongoing bleeding and will have haematoma expansion, which is a major predictor of death and disability. Expanding haematomas are a target for ongoing treatment trials.
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Correspondence to: Dr Dar Dowlatshahi, Ottawa Hospital Civic Campus C2182, 1053 Carling Avenue, Ottawa, Canada [email protected]
See Online for videos
Figure: Dynamic CT-angiography with contrast extravasation representing ongoing bleeding (A) Axial CT showing haematoma; (B) and (C) sagittal dynamic CT-angiogram showing extravasation; (D), (E), and (F) three-dimensional reconstruction showing extravasation.
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Ongoing bleeding in acute intracerebral haemorrhage Dar Dowlatshahi, Matthew J Hogan, Mukul Sharma, Grant Stotts, Dylan Blacquiere, Santanu Chakraborty Lancet 2013; 381: 152 Published Online September 21, 2012 http://dx.doi.org/10.1016/ S0140-6736(12)60829-0 Division of Neurology, Department of Medicine (D Dowlatshahi MD, M J Hogan MD, M Sharma MD, G Stotts MD, D Blacquiere MD) and Division of Neuroradiology, Department of Medical Imaging (S Chakraborty MD) University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Canada
A 49-year-old woman with recently diagnosed hypertension, developed sudden onset aphasia and right hemiplegia. A CT of her brain showed a large left subcortical haemorrhage. Dynamic CT-angiography showed dramatic contrast extravasation (see figure and webvideos) suggesting ongoing bleeding, and corresponding to rapid neurological deterioration. Our patient had urgent surgical evacuation of the haematoma. Her neurological symptoms subsequently stabilised. Surgical exploration, pathology, and postoperative conventional angiography did not show a vascular malformation. The
presumed cause of the haemorrhage was hypertension. One month later, she was transferred to a rehabilitation programme with ongoing expressive aphasia and right hemiplegia. Intracerebral haemorrhage is the most severe form of stroke. Mortality rates are approximately 40%, and up to 80% of survivors are disabled. A third of patients with acute intracerebral haemorrhage have ongoing bleeding and will have haematoma expansion, which is a major predictor of death and disability. Expanding haematomas are a target for ongoing treatment trials.
A
B
C
D
E
F
Correspondence to: Dr Dar Dowlatshahi, Ottawa Hospital Civic Campus C2182, 1053 Carling Avenue, Ottawa, Canada [email protected]
See Online for videos
Figure: Dynamic CT-angiography with contrast extravasation representing ongoing bleeding (A) Axial CT showing haematoma; (B) and (C) sagittal dynamic CT-angiogram showing extravasation; (D), (E), and (F) three-dimensional reconstruction showing extravasation.
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www.thelancet.com Vol 381 January 12, 2013