Title : Spontaneous intracerebral hematomas in 48 cases
Abstract:
Introduction: Spontaneous intracerebral hematomas (SICH) or spontaneous intraparenchymal hematomas are defined as the occurrence of hemorrhage in the cerebral parenchyma without any vascular or parenchymal abnormality or any coagulation disorder that could explain the bleeding. HICS represent 9 to 14% of all cerebrovascular accidents (CVAs). The incidence varies from 10 to 75 new cases per 100,000 inhabitants, with an average age of 56 years and a male predominance. Several risk factors such as high blood pressure, amyloid angiopathy, toxic and drug induced angiopathy are responsible for different a clinical aspect whose imaging is specific and makes the definitive diagnosis.
Materials and Methods: This is a retrospective study of 48 cases of spontaneous intracerebral hematomas treated in the Neurosurgery Department of the Specialty Hospital Center (SHC) and at the Nouadhibou Hospital Center (HC NDB) between May 1, 2021, and April 30, 2024. The average age was 54 years, with clinical symptoms characterized by sudden headaches, dysarthria, intracranial hypertension syndrome, neurological deficits, and impaired consciousness. Brain CT and MRI were performed in the majority of our patients.
Results: The ICHs were located in different lobes, with a predominance of the thalamolenticular, temporal, and posterior cerebral fossa. The CT scan revealed a spontaneously hyperdense mass with a homogeneous irregular contour. CT angiography did not reveal any arteriovenous malformations. Magnetic resonance imaging (MRI) showed an intense or hyperintense T2-weighted image, hypointense depending on the age of the hematoma, without diffusion restriction. This was associated with biventricular or triventricular hydrocephalus and cerebral edema. All patients underwent hospitalization, 20% underwent surgical treatment with hematoma aspiration, and 30% underwent ventricular shunting. Postoperative outcomes were favorable in 20% of cases, with variable neurological sequelae. Follow-up was regular for approximately one year.
Conclusion: The management of intracerebral hematomas requires multidisciplinary collaboration to improve the prognosis, which depends on the volume of the hematoma and the patient's level of alertness. To treat ICHT in 29% of cases with decompressive craniotomy, to limit neurological sequelae to prevent severe disability, and to reduce mortality in this category of the active population.
Keywords: Spontaneous intracerebral hematoma, Intracranial bleeding, Stroke, Intracranial hypertension, Anticoagulant treatment, Flight, Decompression craniotomy
