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Early spontaneous hematoma in cerebral infarct

Is primary cerebral hemorrhage overdiagnosed?

Departments of Neurology (Drs. Bogousslavsky and Regli) and Radiology (Drs. Uské and Maeder), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

We identified 15 patients (63 ± 8 years) in whom CT showed no bleeding within 6 hours of stroke onset but showed ganglionic or lobar hemorrhage less than 18 hours later, without visible underlying infarct (early spontaneous intra-infarct hematoma [ESIH]). No patient had antithrombotic therapy or a coagulation disorder, but eight had hypertension. The second CT was prompted by rapid worsening (in 10) or because the first CT was not available (in five). Prior transient ischemic attacks, silent infarcts on CT, and a potential cardiac source of embolism were more common in patients with ESIH than in 200 patients with primary cerebral hemorrhage (PCH) admitted during the same period. Distal occlusions were present in four of five patients who underwent intracranial studies within the first 2 days. Most of these patients probably had embolism with early and extensive bleeding in the ischemic area. Our findings suggest that ESIH may be under-recognized, while PCH may be overdiagnosed.

Address correspondence and reprint requests to Dr. J. Bogousslavsky, CHUV, 1011 Lausanne, Switzerland.

Received October 12, 1990. Accepted for publication in final form November 30, 1990.

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