Hemorragia cerebral lobar clínica, etiologia, evolução: revisão de 58 casos

Dourado, Mario E.T.; Freitas, Marcos L.; Marti-Vilalta, J.L.

doi:10.1590/S0004-282X1993000200006

Resumos

Os autores revisam 58 casos de hemorragia localizada nos lobos cerebrais, observados entre 264 pacientes com hemorragia intracerebral em período de 6 anos. Os fatores etiológicos foram hipertensão em 29 pacientes, outras etiologias em 9; em 20 pacientes não se determinou a causa. Dentre os sintomas mais importantes observaram-se cefaléia em 56% e convulsão em 12% dos casos. Coma foi infrequente. Os sinais clínicos dependiam da localização do hematoma. O lobo parietal foi o mais afetado. A mortalidade foi de 8,6%. A evolução correlacionava-se ao tamanho do hematoma e ao nível de consciência à internação.

hemoragia lobar cerebral; clínica; etiologia; evolução

Fifty eight patients with spontaneous lobar hemorrhage of a 264 patients series with intracerebral hemorrhage seen during a six years period are reviewed. Twenty nine had arterial hypertension, 9 had other etiologies, and in the remaining 20 cases no apparent etiology was detected. Headache was a prominent symptom and occurred in 56%. Seizures occurred in 12%. Coma was infrequent. Clinical findings on admission depended on the location of the hematoma. Lobar hemorrhage occurred most commonly in the parietal region. Mortality rate was 8.6%. Size of hematoma (larger than 4 cm) on CT and altered consciousness on admission correlated with poor outcome.

lobar cerebral hemorrhage; clinics; etiology; follow-up

Mario E.T. Dourado^I; Marcos L. Freitas^I; J.L. Marti-Vilalta^II

^IMédico Residente (formado pela Universidade Federal do Rio Grande do Norte UFRN)

^IIProfessor de Neurologia da UAB e Chefe de Clínica do Serviço de Neurologia

RESUMO

Os autores revisam 58 casos de hemorragia localizada nos lobos cerebrais, observados entre 264 pacientes com hemorragia intracerebral em período de 6 anos. Os fatores etiológicos foram hipertensão em 29 pacientes, outras etiologias em 9; em 20 pacientes não se determinou a causa. Dentre os sintomas mais importantes observaram-se cefaléia em 56% e convulsão em 12% dos casos. Coma foi infrequente. Os sinais clínicos dependiam da localização do hematoma. O lobo parietal foi o mais afetado. A mortalidade foi de 8,6%. A evolução correlacionava-se ao tamanho do hematoma e ao nível de consciência à internação.

Palavras-chave: hemoragia lobar cerebral, clínica, etiologia, evolução.

SUMMARY

Fifty eight patients with spontaneous lobar hemorrhage of a 264 patients series with intracerebral hemorrhage seen during a six years period are reviewed. Twenty nine had arterial hypertension, 9 had other etiologies, and in the remaining 20 cases no apparent etiology was detected. Headache was a prominent symptom and occurred in 56%. Seizures occurred in 12%. Coma was infrequent. Clinical findings on admission depended on the location of the hematoma. Lobar hemorrhage occurred most commonly in the parietal region. Mortality rate was 8.6%. Size of hematoma (larger than 4 cm) on CT and altered consciousness on admission correlated with poor outcome.

Key words: lobar cerebral hemorrhage, clinics, etiology, follow-up.

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Agradecimentos Ao Dr. E. Guardia (Neurorradiologia), ao Dr. B. Zurita (Neurocirurgia) e ao Dr. G. Mendonza (Neurologia).

Aceite: 06-setembro-1992.

Dr. Mario E.T. Dourado - Servicio de Neurología, Hospital de la Santa Creu i Sant Pau - Av. Maria Claret 167 - 08025 Barcelona - Espanha.

Estudo realizado no Serviço de Neurologia do Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona (UAB)

1. Abbott RD, Yin Y, Reed DM, Yano K. Risk of stroke in male cigarette smokers. N Engl J Med 1986, 315:717-720.
2. Adams HP, Marsh EE. Intraparenchymal hemorrhage. Current Opinion Neurol Neurosurg 1989, 2:52-60.
3. Advisory council for the national institute of neurological and communicative disorders and stroke. A classification and outline of cerebrovtascular diseases II. Stroke 1975, 6: 564-616.
4. Arboix A, Marti-Vilalta JL. Ritmo nictemeral y patologia vascular cerebral: estudio clínico prospectivo de 206 pacientes. Med Clin (Barc) 1988, 30:358-361.
5. Berger AR, Lipton RB, Lesser ML, Lantos G, Portenoy RK. Early seizures following intracerebral hemorrhage: implications for therapy. Neurology 1988, 38:1363-1365.
6. Brott T, Thalinger K, Hertzberg V. Hypertension as a risk factor for spontaneous intracerebral hemorrhage. Stroke 1986, 17:1078-1083.
7. Calandre L, Arnal C, Ortega JF, Bermejo F, Felgeroso B, del Ser T, Vallejo A. Risk factors for spontaneous cerebral hematomas: case control study. Stroke 1986, 17:1126-1128.
8. Caplan L. Intracerebral hemorrhage revisited. Neurology 1988, 38:624-627.
9. Cosgrove GR, Leblanc R, Meagher-Villemure K, Ethier R. Cerebral amyloid angiopathy. Neurology 1985, 35:625-631.
10. Faught E, Peters D, Bartolucci A, Moore L, Miller PC. Seizures after primary intracerebral hemorrhage. Neurology 1989, 39:1089-1093.
11. Foulkes MA, Wolf PA, Mohr JP, Hier DB. The stroke data bank: design, methods, and baseline characteristic. Stroke 1988, 19:547-554.
12. Garcia-Ruiz PJ, Martinez NEG, Sola AG. Hemorragia intracerebral espontanea: epidemiologia, evolución y pronóstico en una série de 73 casos. Rev Clin Esp 1988, 182: 24-29.
13. Gärde A, Böhmer G, Seiden B, Neiman J. 100 cases of spontaneous intracerebral hematoma: diagnosis, treatment and prognosis. Eur Neurol 1983, 22:161-172.
14. Gorelick PB, Hier DB, Caplan LR, Langenberg P. Headache in acute cerebrovascular disease. Neurology 1966, 36:1445-1450.
15 Ishii N, Nisshihara Y, Horic A. Amyloid angiopathy and lobar cerebral hemorrhage. J Neurol Neurosurg Psychiatry 1984, 47:1203-1210.
16. Juvela S, Heikanen O, Poranen A, Altonen S, Kurrnet T, Kaste M, Troupp H. The treatment of spontaneous intracerebral hemorrhage: a prospective randomized trial of surgical and conservative treatment. J Neurosurg 1989, 70:755-758.
17. Kase CS, Williams JP, Wyatt DA, Mohr JP. Lobar intracerebral hematomas: clinical and CT analysis of 22 cases. Neurology 1982, 32:1146-1150.
18. Lipton RB, Berger AR, Lesser ML, Lantos G, Portenoy RK. Lobar VS thalamic and basal ganglion hemorrhage: clinical and radiographic features. J Neurol 1987, 234:86-90.
19. Masdeu JC, Rubino FA. Management of lobar intracerebral hemorrhage: medical or surgical. Neurology 1984, 34:381-383.
20. McKissock W, Richardson A, Taylor J. Primary intracerebral hemorrhage: a controlled trial of surgical and conservative treatment en 180 unselected cases. Lancet 1961, 2:221-226.
21. Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Pessin S, Bleich HL. The Harvard cooperative stroke registry: a prospective registry. Neurology 1978, 28:754-762.
22. Portenoy RK, Linpton RB, Berger AR, Lesser ML, Lantos G. Intracerebral hemorrhage: a model for the prediction of outcome. J Neurol Neurosurg Psychiatry 1987, 50:976-979.
23. Poungvarin N, Bhoopat W, Viriyavejakul A. Effects of dexamethasone in primary supratentorial intracerebral hemorrhage. N Engl J Med 1987, 316:1229-1233.
24. Ropper AH, Davis KR. Lobar cerebral hemorrhages: acute clinical syndromes in 26 cases. Ann Neurol 1980, 8:141-147.
25. Tanaka Y, Furuse M, Iwasa H, Masuzawa T, Saito K, Sato F, Mizuno Y. Lobar intracerebral hemorrhage: etiology and a long-term follow-up study of 32 patients. Stroke 1986, 17:51-57.
26. Toffol CJ, Biller J, Adams HP. Non traumatic intracerebral hemorrhage in young adults. Arch Neurol 1987, 44:483-485.
27. Tsementzis SA. Surgical management of intracerebral hematomas. Neurosurgery 1985, 16:562-572.
28. Tuhrim S, Dambrosia JM, Price TR, Mohr JP, Wolf PA, Heyman A, Kase CS. Prediction of intracranial hemorrhage survival. Ann Neurol 1988, 24:258-263.
29. Vinters HV. Cerebral amyloid angiopathy: a critical review. Stroke 1987, 18:311-324.
30. Weisberg LA. Computerized tomographic in intracerebral hemorrhage. Arch Neurol 1979, 36:422-426,
31. Weisberg LA. Subcortical lobar intracerebral hemorrhage clinical-computed tomographic correlations.. J Neurol Neurosurg Psychiatry 1985, 48:1078-1084.
32. Weisberg LA, Shamsnia M, Elliot D. Seizures caused by nontraumatic parenchymal brain hemorrhages. Neurology 1991, 41:1197-1199.
33. Weisberg LA, Stazio A, Shamsnia M, Elliot D. Non traumatic parenchymal brain hemorrhages. Medicine 1990, 69:277-295.