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Progressing haemorrhagic stroke: categories, causes, mechanisms and managements.

Chen S, Zeng L, Hu Z - J. Neurol. (2014)

Bottom Line: Haematoma expansion, intraventricular haemorrhage, perihaematomal oedema, and inflammation, can all cause an acute progression of haemorrhagic stroke.Specific 'second peak' of perihaematomal oedema after intracerebral haemorrhage and 'tension haematoma' are the primary causes of subacute progression.For the chronic progressing haemorrhagic stroke, the occult vascular malformations, trauma, or radiologic brain surgeries can all cause a slowly expanding encapsulated haematoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Xiangya Second Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China.

ABSTRACT
Haemorrhagic stroke is a severe stroke subtype with high rates of morbidity and mortality. Although this condition has been recognised for a long time, the progressing haemorrhagic stroke has not received adequate attention, and it accounts for an even worse clinical outcome than the nonprogressing types of haemorrhagic stroke. In this review article, we categorised the progressing haemorrhagic stroke into acute progressing haemorrhagic stroke, subacute haemorrhagic stroke, and chronic progressing haemorrhagic stroke. Haematoma expansion, intraventricular haemorrhage, perihaematomal oedema, and inflammation, can all cause an acute progression of haemorrhagic stroke. Specific 'second peak' of perihaematomal oedema after intracerebral haemorrhage and 'tension haematoma' are the primary causes of subacute progression. For the chronic progressing haemorrhagic stroke, the occult vascular malformations, trauma, or radiologic brain surgeries can all cause a slowly expanding encapsulated haematoma. The mechanisms to each type of progressing haemorrhagic stroke is different, and the management of these three subtypes differs according to their causes and mechanisms. Conservative treatments are primarily considered in the acute progressing haemorrhagic stroke, whereas surgery is considered in the remaining two types.

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A case of subacute progressing stroke. The patient was admitted to our hospital because of dysphagia, hemiparalysis, and conscious disturbance. a CT on hospital admission showed left parietal and frontal intracerebral haemorrhage. After the initial treatment, the patient regained consciousness. b 10 days after hospital admission, the patient became lethargic, and repeated CT showed an increased mass effect and midline shift, with enlargement of the perihaematomal oedema. Stronger osmotic therapy was applied immediately and the patient’s consciousness improved. c Repeated CT at 17 days post hospital admission showed that the initial haematoma shrank further, the density of the brain oedema decreased, and the mass effect alleviated modestly. d An enhanced CT at 17 days showed no ring-enhancement, eliminating the tension haematoma
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Fig4: A case of subacute progressing stroke. The patient was admitted to our hospital because of dysphagia, hemiparalysis, and conscious disturbance. a CT on hospital admission showed left parietal and frontal intracerebral haemorrhage. After the initial treatment, the patient regained consciousness. b 10 days after hospital admission, the patient became lethargic, and repeated CT showed an increased mass effect and midline shift, with enlargement of the perihaematomal oedema. Stronger osmotic therapy was applied immediately and the patient’s consciousness improved. c Repeated CT at 17 days post hospital admission showed that the initial haematoma shrank further, the density of the brain oedema decreased, and the mass effect alleviated modestly. d An enhanced CT at 17 days showed no ring-enhancement, eliminating the tension haematoma

Mentions: A specific ‘tension haematoma’, reported by Chinese scholars, might also develop in this phase. The patients often have a history of hypertension. The main features of tension haematoma are as follows: a sudden increase of ICP after the initial alleviation during conservative therapy, with a CT scan showing large regions of low density, isodensity or mixed-density near the initial haemorrhage [75]. A contrast CT could be used to distinguish perihaematomal oedema from tension haematoma. The ring-enhancement [172] on contrast CT at that time indicated the formation of tension haematoma, with regions interior to the ring-enhancement demonstrated tension haematoma, whereas the regions exterior to the ring-enhancement demonstrated perihaematomal oedema [105] (Fig. 4).Fig. 4


Progressing haemorrhagic stroke: categories, causes, mechanisms and managements.

Chen S, Zeng L, Hu Z - J. Neurol. (2014)

A case of subacute progressing stroke. The patient was admitted to our hospital because of dysphagia, hemiparalysis, and conscious disturbance. a CT on hospital admission showed left parietal and frontal intracerebral haemorrhage. After the initial treatment, the patient regained consciousness. b 10 days after hospital admission, the patient became lethargic, and repeated CT showed an increased mass effect and midline shift, with enlargement of the perihaematomal oedema. Stronger osmotic therapy was applied immediately and the patient’s consciousness improved. c Repeated CT at 17 days post hospital admission showed that the initial haematoma shrank further, the density of the brain oedema decreased, and the mass effect alleviated modestly. d An enhanced CT at 17 days showed no ring-enhancement, eliminating the tension haematoma
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4221651&req=5

Fig4: A case of subacute progressing stroke. The patient was admitted to our hospital because of dysphagia, hemiparalysis, and conscious disturbance. a CT on hospital admission showed left parietal and frontal intracerebral haemorrhage. After the initial treatment, the patient regained consciousness. b 10 days after hospital admission, the patient became lethargic, and repeated CT showed an increased mass effect and midline shift, with enlargement of the perihaematomal oedema. Stronger osmotic therapy was applied immediately and the patient’s consciousness improved. c Repeated CT at 17 days post hospital admission showed that the initial haematoma shrank further, the density of the brain oedema decreased, and the mass effect alleviated modestly. d An enhanced CT at 17 days showed no ring-enhancement, eliminating the tension haematoma
Mentions: A specific ‘tension haematoma’, reported by Chinese scholars, might also develop in this phase. The patients often have a history of hypertension. The main features of tension haematoma are as follows: a sudden increase of ICP after the initial alleviation during conservative therapy, with a CT scan showing large regions of low density, isodensity or mixed-density near the initial haemorrhage [75]. A contrast CT could be used to distinguish perihaematomal oedema from tension haematoma. The ring-enhancement [172] on contrast CT at that time indicated the formation of tension haematoma, with regions interior to the ring-enhancement demonstrated tension haematoma, whereas the regions exterior to the ring-enhancement demonstrated perihaematomal oedema [105] (Fig. 4).Fig. 4

Bottom Line: Haematoma expansion, intraventricular haemorrhage, perihaematomal oedema, and inflammation, can all cause an acute progression of haemorrhagic stroke.Specific 'second peak' of perihaematomal oedema after intracerebral haemorrhage and 'tension haematoma' are the primary causes of subacute progression.For the chronic progressing haemorrhagic stroke, the occult vascular malformations, trauma, or radiologic brain surgeries can all cause a slowly expanding encapsulated haematoma.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Xiangya Second Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China.

ABSTRACT
Haemorrhagic stroke is a severe stroke subtype with high rates of morbidity and mortality. Although this condition has been recognised for a long time, the progressing haemorrhagic stroke has not received adequate attention, and it accounts for an even worse clinical outcome than the nonprogressing types of haemorrhagic stroke. In this review article, we categorised the progressing haemorrhagic stroke into acute progressing haemorrhagic stroke, subacute haemorrhagic stroke, and chronic progressing haemorrhagic stroke. Haematoma expansion, intraventricular haemorrhage, perihaematomal oedema, and inflammation, can all cause an acute progression of haemorrhagic stroke. Specific 'second peak' of perihaematomal oedema after intracerebral haemorrhage and 'tension haematoma' are the primary causes of subacute progression. For the chronic progressing haemorrhagic stroke, the occult vascular malformations, trauma, or radiologic brain surgeries can all cause a slowly expanding encapsulated haematoma. The mechanisms to each type of progressing haemorrhagic stroke is different, and the management of these three subtypes differs according to their causes and mechanisms. Conservative treatments are primarily considered in the acute progressing haemorrhagic stroke, whereas surgery is considered in the remaining two types.

Show MeSH
Related in: MedlinePlus