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July2007 Vol.44 Issue:        2        Table of Contents
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Spontaneous Intracerebral Hematoma in Young People: Clinical and Radiological Magnetic Resonance Imaging Features by Diffusion-Weighted Images

Saleh Attia1, Mohamed G. El Khatib1, Maha Bilal2, Hoda Nassar1

Departments of Neurology1, Radiology2, Mansoura University



ABSTRACT

Background: Spontaneous intracerebral hematoma (ICH) accounts for 10% to 15% of all strokes and is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage. The etiologic spectrum of ICH in young people may be wider than in older individuals and includes vascular malformation, hypertension, and drug use. Objectives: The aim of this work is to study risk factors, causes, sites, and early prognosis of spontaneous intracerebral hematoma (ICH) in young people through determining the clinical and radiographic features of the cases selected at different stages using Diffusion-Weighted images (DW-I) in comparison with different conventional Magnetic resonance imaging (MRI) sequences. Patients and Methods: This study was carried out on 40 (16 males and 24 females) young patients (15-45 years old) with spontaneous ICH who were admitted to the neurology department in Mansura Emergency Hospital or Mansura University Hospital. They underwent thorough history taking, neurological examination, laboratory investigation and radiological imaging in the form of non-contrast axial Computed tomography (CT) scan of the brain in 38 patients, conventional MRI with multiple sequences including T1-, T2-, FLAIR-, GRE-WIs and D-WI & apparent diffusion coeffient (ADC) map in all patients. MR angiography and digital subtraction angiography were done in 27 and 9 patients respectively. According to the time interval between symptoms onset and MRI study, five stages were categorized, hyperacute (n=2), acute (n=5), early subacute (n=12), late subacute (n=14) and chronic (n=7). The signal intensity at different stages of ICH on D-WI and the ADC value were compared with those on the different conventional MRI sequences. Results: The frequency of risk factors among the studied groups showed that hypertension was the commonest risk factor (20 patients). The most common presenting feature of ICH young patients is focal neurological deficits 92.5%. The commonest cause was hypertension 42.5% followed by AVM 20%. Among the 40 patients 12 patients died within the first month with a mortality rate 30%. All hematomas were proved on CT and appeared as hyperdense lesions. Different MR signal intensities were identified on the D-WI and conventional MRI sequences. D-WI and ADC values identified different stages of ICH. Conclusion: ICH in young people needs more research studies. Hypertension is the most common risk factor for stroke in young adults. AVM, aneurysm, and cavernous angioma must be considered as possible cause in each case of ICH in young people even in presence of hypertension. The addition of D-WI and ADC map to conventional MRI study helps the differentiation of various stages of ICH from acute infarction as well as the characterization of intracranial hemorrhagic lesion.

(Egypt J. Neurol. Psychiat. Neurosurg., 2007, 44(2): 561-576)

 





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