Recurrent hypertensive intracerebral hemorrhage: a case series from a single institution in Iraq

Hipertansif intraserebral kanama (HIK) genellikle yaşam boyunca bir kez görünür. Çalışmamızda ise tekrarlayan HIKın kanama özelliklerini ve prognozunu aydınlatmayı amaçladık. Haziran 2008 ile Nisan 2012 tarihleri arasında Süleymaniye Genel Eğitim ve Araştırma Hastanesi, Irakta çalışma prospektif, ardışık vaka serileri ile sürdürülmüştür. Primer HIK sonrası yaşayan hastalar değişken sürelerde izlendi; sadece 4 hastada tekrarlama görüldü. Tüm hastalara ilk ve ikinci başvurularında ve belirli zaman aralıklarında tarama testi olarak kontrastsız bilgisayarlı beyin tomografisi testi uygulandı. Klinik tabloları, prognozları ile beraber kanama bölgeleri kayıt edildi. Dört hastada kadın idi yaşları 58 ve 72 yıl arasında değişmekteydi. Hastaların hepsinde uzun süreli hipertansiyon ve hiperkolesterolemi öyküsü vardı. İlk kanama odakları beynin sol ve sağ yanlarına eşit dağılmışken, tekrarlayıcı olanlar daha çok sol yandaydı. Üçünün tekrarlayıcı atağı kontro-lateral iken sadece birinin ipsilateral kanama idi; putamenal-putamenal, talamik-talamik, serebellar-serebellar ve lobar-talamik. Tekrarlar arası süre 54 gün ile 3 yıl arasındaydı. Çoğu hastada ilk kanama sonrası fonksiyonel düzelme daha iyiydi ama ikinci inme belirgin nörolojik hasar ile sonuçlandı. Tekrarlayan HIK nadir olmasına rağmen belirgin nörolojik fonksiyonel bozulma ile sonuçlanır. Baskın olan şekil kontro-lateral olandır. Vakaların yarısında talamus hedef organdır.

Tekrarlayan hipertansif intraserebral kanama: Irak ta tek bir kurumdan vaka serisi

Hypertensive intracerebral hemorrhage (ICH) is usually once in a life event. We aimed to explore the pattern of hemorrhage and outcome of recurrent hypertensive ICH. This prospective, consecutive, case series was conducted at the Sulaimaniya general teaching hospital, Iraq, from June 2008 to April 2012. Survived patients with primary hypertensive ICH were followed-up for a variable time; 4 patients only developed a recurrence. All patients underwent serial non-contrast CT brain scanning on the first and second presentations and after variable intervals. The clinical presentations and their outcomes as well as the sites of the hemorrhages were noted. All patients (n=4) were females and their ages ranged from 58 to 72 years. All of the patients had long-standing hypertension and hypercholesterolemia. The first hemorrhages were distributed equally between the right and left sides of the brain while the recurrent ones were more common on the left side. Three out of 4 recurrences developed contra-laterally while only one was ipsilateral to the first hemorrhage; putamenal-putamenal; thalamic-thalamic; cerebellar-cerebellar; and lobar-thalamic. The interval between recurrences ranged from 54 days to 3 years, 8 months, and 2 days. The functional outcome after the first hemorrhage was relatively good in the majority but the second stroke resulted in prominent neurological dysfunction. Recurrent hypertensive ICH was rare among our patients but resulted in profound neurological functional impairment. Contralateral recurrences dominated the pattern. The thalamus was the target for recurrence in 50% of cases.

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