Spontaneous intracerebral hematomas expanding during the early stages of hemorrhage without rebleeding - Report of three cases

Department of Neurosurgery, School of Medicine, Tokyo Medical and Dental University, Japan.
Journal of Neurosurgery (Impact Factor: 3.74). 09/2002; 97(2):455-60. DOI: 10.3171/jns.2002.97.2.0455
Source: PubMed


Expansion of intracerebral hematoma usually occurs in the chronic phase because of repeated bleeding from pre-existing vascular anomalies or exudation of blood from capillaries of the capsule. In contrast, spontaneous intracerebral hematoma expanding during the acute phase of hemorrhage without rebleeding is seldom seen. Three such cases are reported, along with magnetic resonance (MR) and computerized tomography (CT) follow-up studies. The follow-up MR images and CT scans demonstrated no evidence of rebleeding, but revealed gradual expansion of a fluid component of the hematoma, beginning in the acute phase. Volume alterations posthemorrhage are carefully documented. There was a characteristic phenomenon of layering, with the red blood cell component of the clot settling by gravity and the serum separating as well as seen in a test tube, depending on whether a preservative was used. Examination of blood samples indicated a possible correlation between expansion of the hematoma and the activities of both the fibrinolytic system and coagulation factors.

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    • "The optimal treatment option for CEH is complete excision of the hematoma together with its fibrous capsule. Aspiration of the liquid or drainage could result in serious bleeding or recurrence [9,13]. However, hematomas are often difficult to remove because of adhesion to the surrounding tissue and abundant neovascularization beneath the capsule. "
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    ABSTRACT: Chronic expanding hematoma is a rare condition that develops after surgery, trauma, or injury. It can also develop at any location in the body in the absence of trauma. Clinical findings and various diagnostic imaging modalities can aid in the differential diagnosis of this condition. In general, hematomas are naturally reabsorbed and rarely cause serious problems. However, hematomas that develop slowly without a history of trauma, surgery, or bleeding disorders could be difficult to differentiate from soft tissue neoplasms. In the present case, we describe a patient, without any history or physical evidence of trauma, who exhibited a large chronic expanding hematoma in the retroperitoneal space that resulted in hydronephrosis because of the pressure exerted on the left ureter. A 69-year-old man presented to our hospital with a swollen lesion in the left flank. A mass, 19 cm in diameter, was detected in the retroperitoneal space by computed tomography. We suspected the presence of a chronic expanding hematoma, soft tissue tumor, or left renal artery aneurysm. Surgical treatment was performed. However, postoperative histopathological examination indicated that the mass was a nonmalignant chronic expanding hematoma. No recurrence was observed during a 2-year follow-up period. In patients without a history of trauma who present slowly growing masses, the differential diagnosis should include chronic expanding hematoma in addition to cysts and soft tissue tumors. Moreover, the use of magnetic resonance imaging and computed tomography is essential to differentiate between chronic expanding hematoma and soft tissue tumors.
    Full-text · Article · Nov 2013 · BMC Urology
    • "Enlargement of intracerebral hematoma without rebleeding in chronic phase is a rare but well-known clinical condition, and is well-described as chronic expanding intracerebral hematoma.[147814] The possible mechanism of hematoma enlargement is expansion due to serum exudation or repeated minor bleeding from capillaries of the hematoma capsule.[14] "
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    ABSTRACT: Enlargement of intracerebral hematoma without rebleeding in chronic phase is a rare but well-known clinical condition, and is well-described as chronic expanding intracerebral hematoma. However, chronic enlargement of pituitary hematoma without rebleeding after pituitary apoplexy is extremely rare. We report a case of chronic expanding pituitary hematoma without rebleeding after pituitary apoplexy. A 29-year-old male presented with sudden onset of headache and vomiting. Magnetic resonance imaging (MRI) demonstrated a pituitary mass lesion with hematoma, consistent with pituitary apoplexy. Neuro-ophthalmological examination revealed no visual field defect, and endocrinological evaluations showed an elevated prolactin level. Pituitary apoplexy due to a prolactinoma was the most likely diagnosis. He was conservatively treated because he exhibited no visual disturbance. Three weeks after the onset, he gradually began to complain of blurred vision and neuro-ophthalamological examination revealed bitemporal upper quadrant hemianopsia. MRI showed enlargement of the pituitary hematoma without any finding suggestive of rebleeding. This enlarged mass lesion compressed the chiasm. The patient was operated on via transsphenoidal approach. After dural opening, xanthochromic fluid spouted out, but no fresh clot could be detected within the cyst. After the operation, the visual field disturbance resolved completely. The possible mechanism of hematoma enlargement is considered to be expansion due to the serum exudation from capillaries of the hematoma capsule. This pathogenetic mechanism is common in enlargement of chronic subdural hematoma. This case is the first report of chronic expanding pituitary hematoma without rebleeding after pituitary apoplexy.
    No preview · Article · Mar 2013 · Surgical Neurology International
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    • "Aspiration of the liquid, drainage and curettage could result in serious bleeding and have a higher possibility for recurrence. Complete resection of the capsula and a meticulous suture of the subcutaneous tissue, with the underlying fascia in order to eliminate the dead space are highly recommended [5,6,9]. "
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    ABSTRACT: Chronic expanding haematoma (CEH) is a very infrequent event with imprecise developmental mechanism and is rarely reported in literature. We present a case of enormous and spontaneous chronic haematoma of the back, expanded from the lower thoracic area to the sacral area, in a young patient without any history of trauma or chronic coagulopathy. The MRI scan is very useful in preoperative diagnosis, however only the histopathological examination is able to perform the differential diagnosis with soft tissue tumors. Careful surgical treatment is important to minimize the haematoma recurrence.
    Full-text · Article · Dec 2009 · Cases Journal
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