gms | German Medical Science

Objective: Atypical intracerebral hemorrhage is a common form of primary manifestation of vascular malformations. Hematoma location (lobar, brain stem, cerebellar) can give a clue to the cause of the bleeding.

Methods: We retrospectively evaluated 279 consecutive patients with spontaneous intracerebral hemorrhage (ICH), who were admitted to our neurosurgical department between 2006 and 2016. Subarachnoid hemorrhage (SAH) bleeding pattern and basal ganglia hemorrhage were excluded from this study. We assessed image modality, location of hemorrhage, spot positivity, hematoma volumes and histological findings.

Results: We collected data of 279 patients. In 142 cases (50.9%) vascular malformations, such as AVMs, cavernomas, dural fistulas and aneurysms were the cause of bleeding. In 6 (2.2%) patients a tumor could be detected. 131 (47%) patients suffered from an intracerebral hemorrhage due to sinus vein thrombosis, amyloid angiopathy or long standing hypertension. In patients with infratentorial hemorrhage a malformation was more frequently detected as in patients with supratentorial hemorrhage (41.5% vs. 21.2%, p < 0.001, OR 2.65). Infratentorial location, brain stem, frontal and occipital regions were predicting locations for malformation -caused bleedings. Among the malformations AVMs were most common (78.2%). Hematoma expansion was less (< 50cm³) in hemorrhage due to a vascular malformation than non-malformation caused bleeding (80.3% vs. 48.2%, p < 0.001, OR 4.38). In 6 (2.2%) cases diagnosis remained unclear.

Conclusion: Localization and bleeding patterns are predictive factors for origin of the hemorrhage. These predictive factors should quickly lead to appropriate vascular diagnostic measures. CT-Angiography and MR-Angiography are suitable modalities but cannot replace interventional angiography in all cases.