Hematoma parenchymal

ECASS-II was designed to test a lower dose of rt-PA (0.9 mg/kg) during the same 0-6-hours time period after stroke onset, using similar inclusion criteria as in ECASS-I. ° The primary endpoint was the proportion with a favorable outcome on the mRS scale (defined as a score of 0 or 1). There was no difference in this outcome between rt-PA-treated and placebo controls (40% vs. 37%, p = 0.28). A separate analysis of the 158 subjects enrolled within 3 hours of stroke onset also showed no difference in the proportion with a favorable outcome (42% vs. 38%, p = 0.63) this result, however, must be treated with caution because in ECASS-II there was a substantially lower number of patients treated within 3 hours of stroke onset, compared to the 1995 NINDS rt-PA study. Parenchymal hematoma on post-treatment CT was seen in 12% of rt-PA-treated and 3% of placebo patients (p < 0.001). The 90-day mortality rate was 11 % for the rt-PA group and 11 % for the placebo group (p = 0.54). Protocol violations were much less frequent in ECASS-II compared to ECASS-I (9% vs. 18%), probably because of standardized training in CT interpretation at the study sites. 

In the previous sections we have, by part, already reviewed delayed effects after cerebral ischemia, such as the risk of hemorrhagic complications that may occur as petechial bleedings or parenchymal hematoma. We have seen that the blood-brain barrier opens to various degrees with a substantial time... 

Reperfusion hemorrhage associated with neurological decline or meeting ECASS criteria for parenchymal hematoma type 2 has been associated with significant morbidity and mortality... 

In fact, as was shown by Hillman (2001), the rupture of an AVM is as devastating as that of an aneurysm. While aneurysm rupture is more lethal than AVM rupture (21% vs 9%), a good outcome is obtained less frequently in AVM than in aneurysm ruptures (49% vs 56%), due to the high incidence of parenchymal hematoma. 

In this situation, the patient has the clinical presentation of a parenchymal hematoma or a subarachnoid hemorrhage or both. The first examination is the CT scan, which has a high sensibility to detect intracranial hemorrhage in the acute phase with a high specificity. 

In case of subarachnoid hemorrhage or parenchymal hematoma obviously related to FAA rupture, the aneurysm should be treated in emergency. 

In case the subarachnoid hemorrhage or parenchymal hematoma cannot be obviously ascribed to FAA or AVM rupture, the aneurysm should be treated in emergency (Pucheu). The treatment should indeed focus on the lesion presenting the more important risk of rebleeding and likely more severe clinical consequences. 

Fig. 5.60a,b. Multilobulated aneurysm of the pericallosal artery because of an associated intra-parenchymal hematoma surgery was performed... 

Hematoma Laceration Subcapsular, <10% surface area Capsular tear, < = 1 cm parenchymal depth... 

Hematoma Laceration Subcapsular, 10-50% surface area, intraparenchymal, <5 cm in diameter 1-3 cm parenchymal depth that does not Involve a trabecular vessel... 

Hematoma Laceration Subcapsular, >50% surface area or expanding ruptured subcapsular or parenchymal hematoma intraparenchymal, >5 cm or expanding >3 cm parenchymal depth or involving Trabecular vessels... 

Parenchymal laceration(s) 1-3 cm deep central or suhcapsular hematoma(s) 1-3 cm in diameter... 

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