B J Byun

Recurrence of Bleeding in Patients with Hypertensive Intracerebral Hemorrhage

To characterize the recurrence of bleeding in patients who had hypertensive intracerebral hemorrhage (HICH), the authors reviewed 989 patients who underwent treatment for HICH between 1989 and 1995. Fifty-three patients (5.4%) had two episodes of HICH within a median interval of 22.9 ± 16.3 months (range 1.5–72 months), and of these 3 (5.7%) had three episodes of HICH. The recurrence of bleeding most commonly occurred within 2 years of the first hemorrhage: in 66% of the 53 patients the second hemorrhage occurred soon after the first (within 1 year in 34%, within 1–2 years in 32.1%). The site of the second hemorrhage was different from the initial site in all patients. Only 1 patient had a third hemorrhage in the same site as the second hemorrhage. The common patterns of recurrence were ‘ganglionic (putamen/caudate nucleus)-thalamic’ in 26.8% and ‘ganglionic-ganglionic’ in 21.4%. The ‘lobar-lobar’ pattern was noted in only 2 patients. The volume of the hematoma was increased at the second hemorrhage. The overall mortality was 28.3%. The risk of recurrent hemorrhage significantly increased in the patients who had antihypertensive therapy of less than 3 months after the initial attack compared to those with further long-term therapy (p < 0.005). Long-term regular control for hypertension is needed to prevent recurrent hemorrhage.

Clinical Factors for the Development of Posttraumatic Hydrocephalus after Decompressive Craniectomy.

OBJECTIVE Earlier reports have revealed that the incidence of posttraumatic hydrocephalus (PTH) is higher among patients who underwent decompressive craniectomy (DC). The aim of this study was to determine the influencing factors for the development of PTH after DC. METHODS A total of 693 head trauma patients admitted in our hospital between March 2004 and May 2007 were reviewed. Among thee, we analyzed 55 patients with severe traumatic brain injury who underwent DC. We excluded patients who had confounding variables. The 33 patients were finally enrolled in the study and data were collected retrospectively for these patients. The patients were divided into two groups: non-hydrocephalus group (Group I) and hydrocephalus group (Group II). Related factors assessed were individual Glasgow Coma Score (GCS), age, sex, radiological findings, type of operation, re-operation and outcome. RESULTS Of the 693 patients with head trauma, 28 (4.0%) developed PTH. Fifty-five patients underwent DC and 13 (23.6%) developed PTH. Eleven of the 33 study patients (30.3%) who had no confounding factors were diagnosed with PTH. Significant differences in the type of craniectomy and re-operation were found between Group I and II. CONCLUSION It is suggested that the size of DC and repeated operation may promote posttraumatic hydrocephalus in severe head trauma patients who underwent DC.

Ad hoc Reviewers in 1998

Accessible online at: http://BioMedNet.com/karger 73 H. Ackermann, Bad Urach R.G.A. Ackerstaff, Nimwegen J.M. Bamford, Leeds H. Barnett, London, Ont. R. Baumgartner, Zürich J. Biller, Indianapolis, Ind. S. Blecic, Brussels P. Burckhardt, Lausanne A. Carolei, L’Aquila M. Daffertshofer, Mannheim A. Davalos, Girona S. Demchuk, Houston, Tex. G. Devuyst, Brussels H.C. Diener, Essen P. Duchosal, Lausanne K. Einhäupl, Berlin G. Ertl, Mannheim K. Fassbender, Mannheim F. Fazekas, Graz H.J. Freund, Düsseldorf M. Giroud, Dijon A. Grau, Heidelberg R. Hart, San Antonio, Tex. M. Harrison, London P. Jallon, Geneva M. Kaps, Lübeck C. Kase, Boston, Mass. P. König, Bad Salzhausen P. Langhorne, Glasgow K. Leenders, Gruningen J. Lodder, Maastricht P. Magistretti, Lausanne H. Markus, London J. Mau, Düsseldorf L. Mayfrank, Aachen S. Meairs, Mannheim P. de Merloose, Geneva W.H. Mess, Maastricht P. Moore, Los Angeles, Calif. E. Mori, Himeji T. Moulin, Besançon P. Nicod, Lausanne J. de Reuck, Gent R. Sacco, New York, N.Y. P. Sandercock, Edinburgh P. Schmiedek, Mannheim S. Schwab, Heidelberg D. Seidel, München W. Steinke, Düsseldorf M. Sturzenegger, Bern A. Uské, Lausanne J.M. Valdueza, Berlin F. Vingerhoets, Lausanne J. Wade, London C.-W. Wallesch, Magdeburg C. Weiller, Jena B. Widder, Günzburg E. Wijdicks, Rochester, Minn.