Study of recurrent hypertensive intracerebral hemorrhage.

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  • 高血圧性脳出血の再出血例に関する検討

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Patients with hypertensive intracerebral hemorrhage (ICH) who suffered recurrence at different sites were investigated. Overall, recurrence of ICH was noted in 29 (5.8%) of 500 patients with ICH who were admitted to our department of neurosurgery over a period of 10 years. These patients comprised 18 men and 11 women. The incidence of recurrence was slightly higher in men. The average age at the time of recurrence was about 64 years old. The site involved was the ipsilateral cerebral hemisphere in 7 patients, the contralateral cerebral hemisphere in 16 patients (56%), and the supratentorial and infratentorial regions in 6 patients. The recurrence of hypertensive intracerebral hemorrhage thus showed a tendency to occur in the contralateral cerebral hemisphere. The time interval between the initial hemorrhage and recurrence was 3 years or more in over half of the patients (52%). The grade of activities of daily living following recurrence became worse than after the initial hemorrhage, and the functional prognosis was very poor. Assessments of the risk factors for recurrence revealed that a medical history of hypertension, hypoalbuminemia and/or hypoproteinemia, and hypocholesterolemia were present a the time of recurrence or hospital admission in 22 patients (76%), 13 patients (45%), and 6 patients (21%), respectively. However, the incidence of recurrence showed no difference in relation to the performance of neurosurgery after the initial hemorrhage. Based on these results, it can be concluded that not only blood pressure control but also sufficient nutritional management and prolonged follow-up are required to prevent recurrence of ICH.

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