54-year old lady presented with left-sided hemiparesis and drowsiness of 6 hours duration. Her BP at admission was 220/160 mmHg. She was started on anti-hypertensive medications.
After 11 hours, her clinical condition worsened and she became comatose. Anisocoria was also noted. BP was 160/100 mmHg. CT scan of brain was repeated, which showed massive increase in the size of hematoma, with associated hydrocephalus. She was taken up for emergency surgery.
Hematoma expansion in hypertensive intracerebral hemorrhages (ICH) are common and can occur in about 40% of patients in the first 24-48 hours. High BP is the single most important factor, which is associated with increase in hematoma size. Bigger hematoma size predicts poorer outcome, and hence, BP lowering should be of utmost priority in patients with hypertensive ICH.
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