(Stroke. 1997;28:2370-2375.)
© 1997 American Heart Association, Inc.
Articles |
Predisposing Factors to Enlargement of Spontaneous Intracerebral Hematoma
From the Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan.
Correspondence to Seiji Kazui, MD, Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, 5–7-1 Fujishirodai, Suita, Osaka 565, Japan. E mail skazui@hsp.ncvc.go.jp
Background and Purpose Enlargement of intracerebral hemorrhage is a major cause of clinical deterioration. Identification of factors that predispose to hematoma enlargement is important in managing patients.
Methods We selected 186 patients (71 women and 115 men; mean age, 64.8±12.5 years) with spontaneous intracerebral hemorrhage who had undergone an initial CT within 24 hours and a second scan within 120 hours of symptom onset. We compared patients with (n=41) and without (n=145) hematoma enlargement according to clinical characteristics and laboratory data.
Results By multiple logistic regression analysis (n=139),
interaction of long interval (>6 hours) from onset to first CT and
small hematoma (<25 cm3) strongly reduced risk of
enlargement. The analysis also demonstrated that the following
factors independently predisposed to enlargement: history of brain
infarction; liver disease; interaction of fasting plasma glucose 
141
mg/dL and systolic blood pressure on admission 200
mm Hg; and interaction of glycosylated hemoglobin A1c
5.1% and systolic blood pressure on admission 200
mm Hg.
Conclusions A patient examined >6 hours after ictus who has a
hematoma volume <25 cm3 is unlikely to experience further
hematoma growth. Prevention of brain infarction and premorbid
management of liver disease may serve to lower the risk of hematoma
enlargement. Although it remains controversial whether antihypertensive
drugs should be used in the acute phase of
intracerebral hemorrhage, poorly controlled
diabetics with high systolic blood pressure (200 mm
Hg) on admission also were at high risk of hematoma enlargement.
Key Words: hematoma • hypertension • intracerebral hemorrhage • diabetes mellitus
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