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J Neurocrit Care 2010;3(Suppl 1): 15-18.
Secondary Intracerebral Hematoma
Eui Kyo Seo, MD
Department of Neurosurgery, Ewha Womans University School of Medicine, Seoul, Korea
Introduction: Intracerebral hemorrhage (ICH) accounts for 10 to 15% of all strokes. Although chronic hypertension accounts for the majority of ICH, other common causes include aneurysm rupture, AVM, moyamoya disease.
Summary: This article review the diseases which cause secondary ICH. Additional etiologies that predispose to ICH include vascular malformations, moyamoya disease, brain aneurismal rupture, tumor bleeding. It is well known that: 1) middle cerebral artery and posterior communicating artery aneurysms will predominantly cause intratemporal clots, with possible extension into the adjacent lobes; 2) anterior communicating artery aneurysms will most likely produce frontobasal hematomas; and 3) anterior cerebral artery aneurysms will mainly cause interhemispheric clots. Secondary ICH caused by bleeding of aneurysm directly into the brain parenchyma from the sac adhered to the pia mater was fundamentally a subcortical hemorrhage. Moyamoya disease (MMD) is a chronic, occlusive cerebrovascular disease involving bilateral stenosis or occlusion of the terminal portion of the ICAs and/or the proximal portions of the ACAs and MCAs. Certebral arteriovenous malformation (AVM) is defined the direct communication of arteries to abnormally tortuous and dilated veins without interposing capillaries. Dilated and tortuous draining vein which has high intravascular pressure is always the rupture site and cause secondary ICH. The risk of initial hemorrhage is approximately 2-3% per year. For the treatment of intracranial arteriovenous malformations (AVMs), one of three established methods or combinations of them-microsurgery, embolization, and stereotactic radiosurgery.
Conclusions: Aneurysm rupture, moyamoya disease, AVM rupture are the common cause of secondary ICH. The morbidity and mortality associated with secondary ICH remain high despite recent advances in our understanding of the clinical course and pathophysiology of these diseases which cause secondary ICH. Novel preventive and acute treatment therapies are needed and may be on the horizon.
Key Words: Secondary ICH·Aneurysm·Moyamoya disease·AVM
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