Hypertensive intracerebral hemorrhage

Historical note and nomenclature
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By Te-Long Hwang MD

Intracerebral hemorrhage is the bleeding into the brain parenchyma resulting from rupture of a cerebral artery. It accounts for approximately 10% of strokes (Matsumoto et al 1973; Mohr et al 1978). Hypertension is the leading risk factor for intracerebral hemorrhage and is estimated to occur in 72% to 81% of victims (Mohr et al 1978; Furlan et al 1979).

Intracerebral hemorrhage was first verified at autopsy by Wepfer in 1658, long before blood pressure could be measured (Fields and Lemak 1989). In their landmark study in 1868, Charcot and Bouchard described an association between miliary aneurysms of intracerebral arteries and parenchymal hemorrhage (Charcot and Bouchard 1868). The concept of miliary aneurysm was later supported by other investigators (Russell 1963; Cole and Yates 1967; Fisher 1971). Fisher, as well as Takebayashi and Kaneko, proposed that hypertensive intracerebral hemorrhage results from rupture of lipohyalinotic arteries in the deep regions of the brain (Fisher 1971; Takebayashi and Kaneko 1983).

The introduction of CT in 1973 revolutionized the diagnosis of intracerebral hemorrhage. CT not only allows a precise localization of the hematoma and its effect but also provides rapid recognition of a small or clinically atypical hemorrhage that easily could be misdiagnosed as infarction, often the case in earlier days. MRI provides clinicians additional information, including more precise evolution of the hemorrhage and distinction between acute, subacute, and chronic hemorrhage.

Surgical treatment of hypertensive intracerebral hemorrhage was first reported by Cushing in 1903 (Cushing 1903). With advances in surgical techniques such as CT-guided stereotactic aspiration and clot dissolving, surgical evacuation has a more important role in the management of intracerebral hemorrhage.