Treatment of Intracerebral Hematomas in Young and Middle‐aged Patients

INTRACEREBRAL HEMATOMAS have been diagnosed with reasonable accuracy, particularly in older patients, for many years. Recent trends in neurosurgical practice indicate that a more aggressive attitude toward the perplexing problems associated with such lesions may, through early judicious surgical intervention, unexpectedly salvage many patients. Intracerebral hematomas are described most commonly as hemorrhagic mass lesions (blood clots) located within the substance of the cerebral hemispheres or adjacent cerebral ganglia. Those hematomas occurring in the cerebellum or brainstem usually are specifically so designated. By dissection through pressure, an intracerebral blood clot may extend to communicate with the cerebral subarachnoid spaces or the ventricular pathways; however, it may be completely contained within the substance of the brain, as is a tumor. Many underlying diseases are recorded as associated with cerebral hemorrhage, such as arteriosclerosis, hypertension, cerebral aneurysms, cardiovascular anomalies, brain tumors and abscesses, intracranial vascular occlusion, periarteritis nodosa, lupus erythematosus, tuberculosis, syphilis, eclampsia, trauma, blood dyscrasias, and SCUNY. Treatment with heparin or other anticoagulants also has been blamed. The average age of patients who have intracerebral hemorrhage was noted by Brown' to be 53 years. In general, most reports of surgical intervention in this disorder have been concerned with patients in the older age groups. Understandably, the results of neurosurgical intervention in older people who suffer from intracerebral hemorrhage are at times discouraging and have led to some pessimism as to the efficacy of operative intervention in patients who have intracerebra1 bleeding. A survey of the literature,2-1s however, reveals that relatively little attention has been paid to the surgical treatment of this disorder in younger patients. We recently have observed and treated surgically at the Mayo Clinic seven patients between 19 and 53 years of age who had intracerebral hematomas. It appeared