The Clinical And Neuropathological Study In Patients With Cerebral Hemorrhage

Spontaneous intracerebral hemorrhage is the most common disease of cerebrovascular diseases and is associated with high mortality and morbidity. It is due predominantly to chronic hypertension and degenerative changes in cerebral arteries. In order of frequency, the most common sites of a primary cerebral hemorrhage are : the putamen and adjacent internal capsule (50%) ; the central white matter of the temporal, parietal, or frontal lobes(lobar hemorrhages); the thalamus; a cerebellar hemisphere and the pons.In cerebral hemorrhage, blood leaks from the vessel (usually a small artey) directly into the brain, forming a hematoma in the brain substance and spreading into the ventricles and then to the subarachnoid space. The mass of clotted blood causes physical disruption of the tissue and pressure on the surrounding brain. In the first hours and days following the hemorrhage, edama accumulates around the clot and adds to the mass effect. Intracranial hypertension with cerebral tissue displacements and herniation are also followed. Herniation is the most common direct cause of death of cerebral hemorrhage. After ICH, there are correlated with high concentrations of proinflammatory molecules in blood. Extravasated blood conclude hemoglobin , proteases and glutamate. Recent studies suggesting that neurotoxic mechanisms, such as induction of proteases, and inflammation associated with clotting proteins could be involved in the production of necrosis after cerebral hemorrhage. These findings suggest that excitotoxicity and inflammation may have an important role in causing secondary brain injury after cerebral hemorrhage. The study of biochemical changes after ICH may be useful for the design of future neuroprotective strategies in patients with ICH.Up to now, there are few domestic papers concerning on the clinical and pathological study on cerebral hemorrhage. The present study is consisited of the clinical and neuropathological data of ten patients with cerebral hemorrhage and is divided into two parts. The clinical autopsy data was obtained from the Department of Neurology, 1st cilincal medical college of Harbin medical university during 1996 to 1997. In the ten cases studied, there were nine males and one female, they were chosen from 40 total autopsied brains which were screened by HE and aged from 57 to 73 years old, their mean age was 62. 6 years old.Part one is focused on clinical material. There was history of moderated hypertension in ten cases. The predisposing causes of the ten patients included emotional agitations and emiction. They all did not have obvious prodromal symptoms before onset. Their presenting symtopms included distinct headache, vomiting, conscious disturbance, urine incontinence. All the patients went to coma after onset. Six patients vomitted coffee-like material. Two patient manifested as decerebration spasm. Two patients had speech disturbance. Crianial CT scans showed five patients with moderate type of right unilateral putaminal hemorrhage, one patient with left unilateral thalamic-occipito-temporal subcortical hemorrhage, and one patient with severe type of right unilateral thalamic hemorrhage. These patients were diagnosed as hypertonial cerebral hemorrhage and treated with mannitol, dexamethasone, pamba. Eight patients died of cerebral herniation, two patient died of stressive digestive ulcer. The patients all had obvious mass effect and secondary injuries of the brian stem because of their hematoma, thus their prognosis were poor.Part two is focused on neuropathological material. The cerebraltissue were fetched in 4 to 24 hours after death and were fixed in buffered 10% formalin for at least four weeks. The staining methods is Haematoxylin and Eosin. The neuropathological diagnosis were listed as the following: patient 1, right unilateral thalamic hemorrhage raptured into the lateral ventricle, secondary brain stem hemorrhage, subarchnoid hemorrhage. Patient 2, leftunilateral putaminal hemorrhage raptured into the lateral ventricle, subarchnoid hemorrhage, herniation of righ...