Rapid Expansion of Hypertensive INTRACEREBRAL HEMATOMA

Initial CT scan of brain showing right thalamic hematoma (yellow arrows) with normal sized ventricles (red arrows)
Repeat CT scan of brain after 11 hours showing massive increase in the size of hematoma (yellow arrows) and hydrocephalus (red arrows)

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.

Published by Dr Sudhir Kumar MD (Medicine) DM (Neurology)

I am a doctor with 25 years experience. I have worked as a neurologist for about 20 years. Educating public and healthcare professionals is very dear to me. This is possible due to my interactions with thousands of patients and their caregivers. I salute the patients who suffer and it is our duty to minimise suffering by preventing diseases and ensuring prompt diagnosis and treatment of those already affected.

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