Recurrent and Repeated Hypertensive Intracerebral Hemorrhage in Surgically Treated Cases

Kim, Young Jin; Kim, Gook Ki; Lim, Young Jin; Kim, Tae Sung; Rhee, Bong Arm; Leem, Won

Abstract

We describe our experience of recurrent or repeated bleeding episodes occurring during the immediate postoperative and follow-up period in patients who had undergone surgery for hypertensive intracerebral hemorrhage (ICH). A total of 224 such cases, treated between January 1988 and December 1995, were retrospectively studied for recurrence rate, possible factors related to rebleeding, the pattern of hemorrhages, and prognosis during the immediate postoperative and long term follow-up period. Recurrent bleeding was defined as postoperative bleeding within one week and repeated bleeding as that which recurred at any time during the long-term postoperative period. In seven patients, episodes of recurrent bleeding were observed at the site of the operation ; in three of these, blood pressure control during the peri-and posto-perative periods had been poor. In 18 patients, repeated bleeding occurred between one week and five years postoperatively ; eleven of these(61%) experienced this secondary bleeding within six months. The most common pattern of recurrent bleeding, seen in 38.9% of patients, may be expressed as'same site and same lesion'. In most patients with repeated bleeding, blood pressure control after discharge from hospital was inadequate ; the prognosis of patients with either recurrent or repeated hemorrhage was poorer than those who experienced only a single episode. It is concluded from these results that adequate blood pressure control during peri-and postoperative periods may play an important role in preventing rebleeding. This is especially true for the six-month postoperative period.