Recurrent hypertensive intracerebral hemorrhage: a case series from a single institution in Iraq

Tekrarlayan hipertansif intraserebral kanama: Irak’ta tek bir kurumdan vaka serisi

Abstract

Hypertensive intracerebral hemorrhage (ICH) is usually once in a life event. We aimed to explore the pattern of hemorrhage and outcome of recurrent hypertensive ICH. This prospective, consecutive, case series was conducted at the Sulaimaniya general teaching hospital, Iraq, from June 2008 to April 2012. Survived patients with primary hypertensive ICH were followed-up for a variable time; 4 patients only developed a recurrence. All patients underwent serial non-contrast CT brain scanning on the first and second presentations and after variable intervals. The clinical presentations and their outcomes as well as the sites of the hemorrhages were noted. All patients (n=4) were females and their ages ranged from 58 to 72 years. All of the patients had long-standing hypertension and hypercholesterolemia. The first hemorrhages were distributed equally between the right and left sides of the brain while the recurrent ones were more common on the left side. Three out of 4 recurrences developed contra-laterally while only one was ipsilateral to the first hemorrhage; putamenal-putamenal; thalamic-thalamic; cerebellar-cerebellar; and lobar-thalamic. The interval between recurrences ranged from 54 days to 3 years, 8 months, and 2 days. The functional outcome after the first hemorrhage was relatively good in the majority but the second stroke resulted in prominent neurological dysfunction. Recurrent hypertensive ICH was rare among our patients but resulted in profound neurological functional impairment. Contralateral recurrences dominated the pattern. The thalamus was the target for recurrence in 50% of cases.