The Clinical analysis of 130 spontaneous intracebral & cerebellar hematoma confirmed by brain CT & admitted to this neurosurgical clinic past years & 5 months were made with literature review. 1) The age incidence showed increase over fourth decade and male to female ratio was 56.1:43.9. 2) 50.4% of total patients showed hypertension but 40.3% did not checked their B.P. & 9.3% had normal B.P. before cerebral hemorrhage. Among 50.4% of hypertension cases, 72% received antihypertensive treatment intermittently, 2.9% regularly and the rest 24.3% did not. 3) 69.7% of hematoma located in basal ganglia & thalamus. In nonoperated patients, the morbidity & mortality showed no marked difference in their location except pontine & cerebellar hematomas. In operated patients the morbidity & mortality was prominent in putaminal hemorrhage than in thalamus and cerebellum. Most of putaminal hematoma had semicomatose or comatose mental state and ventricular hemorrhage in 87.5%. 4) The morbidity & mortality increased in proportion to size of hematomas, grade of unconsciousness in admisson and state of intraventricular hemorrhage. 5) About time interval from ictus to operation, the patients within first 24 hours are 29 cases(51.1%) and the next 24 hours are 13 cases(26.5%). The mortality rate of two groups were 55.1% & 53.8% respectively but no death in the patients with operation performed after 48 hours. 6) The morbidity & mortality rate were as follows. In the non operated patients (90 patients), no or mild neurological deficits:22.2% moderate:21.1% severe:20% and moribund or death:36.6%. In the operated patients no or mild neurological deficits:16.3% moderate:18.4% severe:18.4% and moribund or death:46.9%. The results of total patients showed no or mild neurological deficits:20.1%, moderate:20.1%, severe:19.4% and moribund or death:40.2%.
Basal Ganglia ; Brain ; Cerebellum ; Cerebral Hemorrhage ; Coma ; Female ; Hematoma* ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Male ; Mortality ; Putaminal Hemorrhage ; Thalamus ; Unconsciousness

The author analyzed 169 cases of spontaneous intracerebral hemorrhages at the basal ganglia and thalamus, who had been admitted to Jeonju Presbyterian Medical Center from 1975 to 1979. Intracerebral hematoma was confirmed by angiography and the amount of hematoma was divided as small, medium or large according to the angiographic evidence. Among the 169 cases, 145 cases underwent appropriate medical or surgical treatment. 63 cases were treated conservatively and 82 cases were operated ; 22 cases of frontal approach, 51 cases of temporal approach, and 9 cases of extraventricula diainage of clot. Results obtained are as follows : 1. The common pridiection age group was from the fifth to the seventh decades, which was 90.5% of all cases. The ratio of male to female was about 2 to 1. 2. putaminal hemorrhage was 65.1%, and thalamic hemorrhage was 16.6%. 3. Angiographic evidence of arteriosclerosis was seen in 86.4%. 4. The worse prognostic factors were related to age(over 65), site and size of hematoma, and mental state on admission. 5. With conservative management 49.2% were improved, 6.3% not improved, 44.4% moribund or dead. 6. With surgical treatment 58.5% were improved, 3.7% not improved, 37.8% moribund or dead. 7. Microsurgical temporal approach proved to have the following advantages over frontal approach. (1) Better outcome was found in this approach(64.7% vs 54.4%). (2) The distance to the hematoma was closer in temporal approach, and so total removal of hematoma and complete control of bleeding sources with less surrounding structural damages were possible. 8. Early operation seems to be more effective than delayed operation in the cases of large hematoma with deteriorating neurological signs.
Angiography ; Arteriosclerosis ; Basal Ganglia* ; Cerebral Hemorrhage* ; Female ; Hematoma ; Hemorrhage ; Humans ; Jeollabuk-do ; Male ; Protestantism ; Putamen ; Putaminal Hemorrhage ; Thalamus*

The most common etiology of spontaneous, non-traumatic intracerebral hemorrhage is hypertension. One of the most decisive factors for the determination of etiology is location of the hemorrhage. Here, we report on a 53-year-old female patient who was admitted with left putaminal hemorrhage. She did not have prominent vascular risk factors other than fundoscopic signs of hypertensive retinopathy. Magnetic resonance imaging and angiography revealed arteriovenous malformation (AVM) in the basal ganglia, which was fed by the lateral lenticulostriate artery. This case suggests that we should consider an AVM-related hemorrhage in relatively young stroke patients, regardless of hematoma location or presence of accompanying hypertension.
Angiography ; Arteries ; Arteriovenous Malformations ; Basal Ganglia ; Cerebral Hemorrhage ; Female ; Hematoma ; Hemorrhage ; Humans ; Hypertension ; Hypertensive Retinopathy ; Magnetic Resonance Imaging ; Middle Aged ; Putaminal Hemorrhage ; Risk Factors ; Stroke

"Mirror-writing" is stript that runs in the direction opposite to normal with the individual letters also reversal. Several theories, including motor, visual dominance, spatial disorientation and supplementary motor hypotheses, have been proposed to explain "mirror-writng". With reviewing some of literatures, we present two cases of "mirror-writing" in association with bilateral basal ganglia hemorrhage and right frontal hematoma, respectively.
Basal Ganglia Hemorrhage ; Cerebral Hemorrhage* ; Hematoma ; Humans

In a study in 90 patients with primary hypertensive intracerebral hemorrhage in Friendship Hospital from August 1998 to May 2000. We found that white blood cell were 64.5% when the patients admitted to hospital. The increase of cholesterol is 53.4%; triglycerid is 63.3%. This is rich factor of primary hypertensive intracerebral hemorrhage. The author suggested the above mentioned clinic signs give the early diagnose, fast indication and blood test.
Cerebral Hemorrhage ; Hypertension ; Cerebral Hemorrhage, Traumatic

The preferred site of spontaneous intracerebral hemorrhage(SICH) is the supratentorial area, especially the basal ganglia. Large hematomas frequently spread into the ventricle, and in the case of intraventricular hematomas, varying degrees of fresh blood are found within the subarachnoid space. Cases in which SICH of the basal ganglia ruptures the insular cortex and causes thick subarachnoid hemorrhage(SAH) in the basal cisterns, are, however, rare. The authors report a rare case of putaminal SICH with intraventricular hemorrhage(IVH) and SAH in the basal cisterns. This 58-year-old female was stuporous on admission. Neurological examination revealed Glasgow coma scale score 7, left hemiparesis, positive Babinski's sign and neck stiffness. Brain CT showed a large intracerebral hematoma in the right basal ganglion and associated intraventricular hematoma and SAH in the basal cistern. Cerebral angiography demonstrated a small saccular aneurysm at the right M1. Right pterional and trans-sylvian approach revealed thick SAH in the sylvian fissure and a small unruptured aneurysm at the early bifurcation of the middle cerebral artery. The putaminal hematoma had ruptured into the sylvian fissure through a natural opening at the insular cortex between M2 branches. This case illustrates that hypertensive SICH should be included in the differential diagnosis of basal cistern SAH associated with SICH.
Aneurysm ; Basal Ganglia ; Brain ; Cerebral Angiography ; Diagnosis, Differential ; Female ; Ganglion Cysts ; Glasgow Coma Scale ; Hematoma ; Humans ; Middle Aged ; Middle Cerebral Artery ; Neck ; Neurologic Examination ; Paresis ; Putaminal Hemorrhage* ; Reflex, Babinski ; Rupture ; Stupor ; Subarachnoid Hemorrhage* ; Subarachnoid Space

Using diffusion tensor tractography (DTT), we demonstrated injury of the arcuate fasciculus (AF) in the nondominant hemisphere in two patients who showed subfalcine herniation after intracerebral hemorrhage (ICH) in the dominant hemisphere. Two patients (patient 1 and patient 2) with ICH and six age-matched control patients who have ICH on the left corona radiata and basal ganglia without subfalcine herniation were recruited for this study. DTT was performed at one month after onset in patient 1 and patient 2. AFs of both hemispheres in both patients were disrupted between Wernicke's and Broca's areas. The fractional anisotropy value and tract numbers of the right AFs in both patients were found to be more than two standard deviations lower than those of control patients. In contrast, the apparent diffusion coefficient value was more than two standard deviations higher than those of control patients. Using the configuration and parameters of DTT, we confirmed injury of the AF in the nondominant hemisphere in two patients with subfalcine herniation following ICH in the dominant hemisphere. Therefore, DTT would be a useful tool for detection of underlying injury of the AF in the nondominant hemisphere in patients with subfalcine herniation.
Anisotropy ; Basal Ganglia ; Cerebral Hemorrhage* ; Diffusion ; Humans

To compare intrahematomal pressure(IH) with epidural pressure(EP), lumbar subarachnoid pressure(LP) and intraventricular pressure(IV), 34 intracerebral hemorrhage patients from Dec. 1986 to Aug. 1987 were selected. We measured IH via stereotacically placed catheter and at the same time, we measured EP with fiberoptic sensor, LP by lumbar puncture and IV via stereotactically placed catheter during communication between hematoma and ventricle. The results obtained were as follows : 1) IH was the highest in most cases and IH, IV, LP and EP in orders by mean values. 2) In distribuion of EP, LP and IV compared with IH, EP had wide range of distribution(17~500%) compared to LP and IV. 3) There was a tendency of increased rate of higher IH than EP according to increased size of hematoma. 4) There was a tendency of increased rate of higher IH than EP in thalamic hemorrhage than putaminal hemorrhage. 5) ICP curves showed abrupt increase or decrease in cases of rebleeding or communication between hematoma and ventricle. 6) In analysis of low IH compared with EP and LP, the causes were due to checking of IH just after aspiration of large amount of hematoma(3 cases) and normal variations(6 cases). 7) In analysis of failed monitoring, EP was 5 cases(19%) and IH was 3 cases(8.8%) so more failed monitoring were found in EP than IH and there was no failed cases in LP and IV. From above results, we concluded that IH was the highest in most cases and EP was less reliable than other pressures.
Catheters ; Cerebral Hemorrhage ; Hematoma ; Hemorrhage ; Humans ; Intracranial Pressure* ; Putaminal Hemorrhage ; Spinal Puncture ; Ventricular Pressure

To evaluate the current status of cerebrovascular disease in Korea, we performed a retrospective study on 1260 cases of stroke who had been admitted to or had visited Seoul National University Hospital, Choongnam National University Hospital, Hanyang University Hosipital, and Chung Ang University Hospital in the period from Jul 1, 1986 to Jun 30, 1987. The incidence was highest in sixth and seventh decades. Ischemic stroke (51.1%) was more common thar, hemorrhagic stroke (47.6%), and thrombotic infarction was the leading type (37.7%) of all kinds of strokes. Middle cerebral arterial territory was the most commonly involved site in thrombotic and embolic stroke. Among intracerebral hemorrhage, basal ganglia hemorrhage was found in 47.7%, and was followed by thalamic(23.8%), lobar (15.3%) and pontine hemorrhage (9.4%). Primary intraventricular hemorrhage (IVH) was relatively rare (8 cases, 7.5% of all IVH), and hemorrhages in basal ganglia or thalamus frequently induced secondary IVH. 16 cases (10.7%) of subarachnoid hamorrhage were accompanied by secondary IVH. This study suggests changing trends of stroke in Korea, and multicenter prospective study using stroke registry is requird for confirmation.
Basal Ganglia ; Basal Ganglia Hemorrhage ; Cerebral Hemorrhage ; Hemorrhage ; Incidence ; Infarction ; Korea* ; Retrospective Studies ; Seoul ; Stroke ; Thalamus

The authors report here on a rare case of aneurysm involving the distal lenticulostriate artery (LSA) in a 66-year-old man who presented with intracerebral hemorrhage (ICH) in the right basal ganglia and also intraventricular hemorrhage (IVH). Three-dimensional computed tomography angiography (3D-CTA) and conventional cerebral angiography showed a 4 mm, round-shaped aneurysm in the right distal LSA and this was combined with moyamoya-like disease. We performed proximal clipping of the aneurysm using a microsurgical technique and we evacuated the hematoma. After the operation, there was recurrent bleeding around the operation site and hydrocephalus gradually developed, and we implanted a ventriculo-peritoneal (V-P) shunt. The patient did well after the final shunt surgery and rehabilitation. Presently, he has no motor weakness or significant neurologic deficit, but mild cognitive dysfunction remains. When spontaneous ICH occurs in an unusual site, a thorough investigation is important to rule out a structural vascular abnormality.
Aged ; Aneurysm ; Angiography ; Arteries ; Basal Ganglia ; Cerebral Angiography ; Cerebral Hemorrhage ; Hematoma ; Hemorrhage ; Humans ; Hydrocephalus ; Neurologic Manifestations