Multiple simultaneous intracerebral hemorrhages - Clinical features and outcome

Background: The simultaneous occurrence of intracerebral hemorrhages in dif ferent arterial territories is an uncommon clinical event. Its predisposing factors and pathophysiological mechanisms are not clearly defined. Objective: To analyze the frequency, risk factors, clinical features, neuro imaging findings, and outcome of multiple simultaneous intracerebral hemorr hages (SIHs). Patients and Methods: We studied all patients with acute stroke admitted to our hospital from July 18, 1997, through December 18, 1999. Multiple SIHs were defined as the presence of 2 or more intracerebral hemorrhages affecti ng different arterial territories with identical computed tomographic densi ty profiles. Patients with a history of traumatic brain injury were exclude d from this study. Diagnostic investigation included routine blood and urin e tests, coagulation studies, a chest radiograph, electrocardiogram, 2-dime nsional transthoracic echocardiography, and computed tomography of the head without contrast medium. Disability was assessed using the National Instit utes of Health Stroke Scale and Modified Rankin Scale. Results: Among 142 patients with hemorrhagic stroke, we found 4 (2.8%) with SIHs. All 4 patients had a history of uncontrolled arterial hypertension. We excluded other potential causes of multiple SIHs by using appropriate di agnostic tests. The most common clinical manifestations were headache and w eakness. Localization of hematomas was supratentorial, except for one patie nt who had both infratentorial and supratentorial hemorrhages. The mean Nat ional Institutes of Health score an admission was 15 and the Modified Ranki n Scale score was higher than 4 at 3 months. Conclusions: In our study, all patients with multiple SIHs had arterial hyp ertension and a poor outcome. Additional analytic studies, including new im aging techniques, can help to elucidate the association between arterial hy pertension and multiple SIHs, rick factors, and underlying mechanisms of th is clinical condition.