Small intracerebral haemorrhage: a study of clinical manifestations and CT findings on 31 cases

T P Hung, K Y Lee
Annals of the Academy of Medicine, Singapore 1985, 14 (1): 22-31
The clinical manifestations and computed tomographic (CT) findings of small intracerebral haematomas (ICHs) were studied in 31 consecutive cases which comprised 6% of 520 cases of non-traumatic, non-neoplastic ICH confirmed by CT in a 3-year period. A small ICH was defined by CT as a sharply demarcated high density area with the maximum dimension not exceeding 20 mm and on no more than two contiguous 10-mm scan sections. The ages ranged from 50 to 85 years, being between 50 and 69 in about two thirds. Twenty-nine patients (93%) were hypertensive. The haematoma was in the capsulothalamus (9 cases), thalamus (6 cases), capsuloputamen (6 cases), subthalmus (2 cases), internal capsule (2 cases) pons (4 cases), midbrain (1 case), and cerebellum (1 case). Headache (4 cases) and vomiting (3 cases) were rare, whereas dizziness was rather frequent (16 cases). None had loss of consciousness. The essential clinical manifestations were sensorimotor deficits in 13 cases, pure motor hemiparesis in 6, pure sensory disturbance in 4, and involuntary movements in 2. Five patients with haemorrhage in the brain stem presented with various syndromes. None of the 31 cases had a fatal outcome directly due to the small haemorrhagic stroke. Two patients had recurrent stroke; a small, deep infarct in 1 and a large haemorrhage in the other. Full neurological and functional recovery was made in 17 cases (56.7%), recovery with mild sequelae in 7 (23.3%) and little recovery in 6. Poor recovery was related to the location (pons), the age (above 75 years), and the presence of involuntary movements. Some clinical features common to lacunar infarcts and small ICHs were discussed, and the possibility of a combination of these two conditions in a same hypertensive patient was raised. Small ICH as a type of benign, non-fatal stroke is not infrequent in communities where the incidence of hypertensive ICH is relatively high. CT scanning in the early stage of stroke even for patients with mild neurological symptoms may enhance the detection rate of such small ICHs.

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