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(Stroke. 1998;29:2442-2443.)
© 1998 American Heart Association, Inc.

Letters to the Editor

Predictors of Hematoma Growth?

Raymond T.F. Cheung, MBBS, PhD, MRCP

Division of Neurology, Department of Medicine, Queen Mary Hospital, Hong Kong

To the Editor:

I read with much interest the article, "Multivariate Analysis of Predictors of Hematoma Enlargement in Spontaneous Intracerebral Hemorrhage," by Fujii and colleagues.¹ I fully agree with the authors on the importance of identifying factors responsible for the increase in volume of intracerebral hemorrhage, since the hematoma "growth" is common^{1 2} and because this is associated with neurological deterioration.² While their multivariate analyses revealed 5 independent "predictors" for hematoma enlargement, Fujii and colleagues pointed out in their Discussion section that 3 of the 5 factors (ie, a short time interval from onset, the presence of disturbed consciousness, and irregularly shaped hematoma) were related to the natural time course rather than acting as risk factors.¹ The authors further postulated that the stabilization of hematoma formation takes some time, that disturbed consciousness can be a consequence of hematoma enlargement rather than a cause, and that irregularly shaped hematomas may indicate bleeding from multiple arterioles.¹ Regarding their findings and interpretations, I would like to make the following comments.

First, the great majority of intracerebral hematomas are caused by bleeding from arteries or arterioles under systemic arterial pressure, and so hematomas will "grow" for some time, until the hematoma enlargement is counteracted by increasing regional intracranial pressure; eventually, bleeding ceases because of hemostasis.³ In a similar study, Brott and colleagues² performed baseline CT scans in patients with intracerebral hemorrhage within 3 hours of onset and repeated the scans at regular intervals after the first scans. Brott and colleagues reported 26% of substantial hematoma . . . [Full Text of this Article]

Yukihiko Fujii, MD, PhD

Department of Integrated Neuroscience

Ryuichi Tanaka, MD, PhD

Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan