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Annals of Indian Academy of Neurology
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IMAGES IN NEUROLOGY
Year : 2007  |  Volume : 10  |  Issue : 4  |  Page : 272-273
 

Bilateral simultaneous hypertensive intracerebral hemorrhage in both putamen


Department of Neurology, Sheri Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir - 190011, India

Correspondence Address:
Ravouf Parvez Asimi
19 Rajbagh Extension, Srinagar, Jammu and Kashmir - 190 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-2327.37824

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How to cite this article:
Asimi RP, Wani MA, Ahmad F. Bilateral simultaneous hypertensive intracerebral hemorrhage in both putamen. Ann Indian Acad Neurol 2007;10:272-3

How to cite this URL:
Asimi RP, Wani MA, Ahmad F. Bilateral simultaneous hypertensive intracerebral hemorrhage in both putamen. Ann Indian Acad Neurol [serial online] 2007 [cited 2020 Nov 28];10:272-3. Available from: https://www.annalsofian.org/text.asp?2007/10/4/272/37824


Recurrent intracerebral hemorrhage (ICH) occurring at different times is not uncommon; however, simultaneous hypertensive intracerebral hemorrhages are rare and have been recorded only in isolated cases in the literature. [1],[2]

A 65-year-old man presented to our emergency department with sudden onset of quadriplegia with bifacial weakness, slurring of speech and vomiting. His history revealed 20 years of hypertension, which was poorly controlled and smoking 1 to 2 packs of cigarettes per day for last 35 years. He was neither diabetic nor alcoholic. There was no apparent bleeding or coagulation disorder nor any history of drug intake.

At presentation, patient was drowsy with Glasgow coma scale of E3V3M5. A blood pressure of 190/110 mm Hg and a pulse rate of 56 beats/min were found; regular and both the carotids were normal. His systemic examination was unremarkable. Neurological examination revealed bilateral facial nerve palsy with bulbar dysarthria; optic fundi showed grade III hypertensive changes. His tone was decreased in all the four limbs and motor power revealed quadriparesis with bilateral extensor planter response. Considering the entire clinical profile, posterior circulation stroke was thought to occur. Brain CT [Figure - 1],[Figure - 2] showed bilateral putamenal hemorrhages. His coagulation profile was normal. MRI and DSA was not performed as patient was very sick. The patient was managed in an intensive stroke unit, but expired the next day.

A spontaneous intracerebral hemorrhage (ICH) is the cause of 5-16% of all the strokes in Europe and United States and 20-35% strokes in Asia. [2] Recurrent ICH is common in cases with hypertension, but simultaneous multiple ICHs are rare. [2] The outcome of bilateral ICH is dismal because there is very severe neurodeficit such as disturbances in consciousness, quadriparesis and pseudobulbar palsy, even if the hematomas are not so big. [3] The locations correspond to usual hypertensive bleeds, i.e., thalamus or putamen cerebellum. [4],[5] Even though the exact cause is not known, it thought to be related to long-standing hypertension that causes vascular changes. [6]

 
   References Top

1.Weisberg L. Multiple spontaneous intracerebral hematomas: Clinical and computed tomographic correlations. Neurology 1981;31:897-900.  Back to cited text no. 1  [PUBMED]  
2.Neau JP, Ingrand P, Couderq C, Rosier MP, Bailbe M, Dumas P, et al. Recurrent intracerebral haemorrhage. Neurology 1997;49:106-13.  Back to cited text no. 2  [PUBMED]  
3.Yen CP, Lin CL, Kwan AL, Lieu AS, Hwang SL, Lin CN, et al. Simultaneous multiple hypertensive intracerebral haemorrhages. Acta Neurochir (Wein) 2005;147:393-9.  Back to cited text no. 3    
4.Choi JW, Lee JK, Kim JH, Kim SH. Bilateral simultaneous hypertensive intracerebral haemorrhages in both Thalami. J Korean Neurosurg Soc 2005;38:468-70.  Back to cited text no. 4    
5.Srikanth B, Trimurti DN, Goel A. Simultaneous thalamic and cerebellar hypertensive haemorrhages. Neurol India 2007;55:183-4.  Back to cited text no. 5    
6.Hickey WF, King RP, Wang A, Samuels MA. Multiple simultaneous intracerebral hematomas: Clinical, radiologic, and pathologic findings in two patients. Arch Neurol 1983;40:519-22.  Back to cited text no. 6    


    Figures

  [Figure - 1], [Figure - 2]



 

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