Histopathological analysis of intracerebral hemorrhage: implications for clinical management.
BACKGROUND
The clinical impact of routine neuropathologic examination of samples from patients with intracerebral hemorrhage (ICH) is unclear.


METHODS
Therefore, we evaluated a consecutive series of 378 surgical specimens from patients with ICH concerning demographic data, localization of hemorrhage, preoperative clinical diagnosis and neuropathological diagnosis.


RESULTS
Histological examination revealed the putative origin of ICH in 143 cases (37.8%). Vascular pathologies were detected in 127 patients (33.6%), while tumors were identified in 9 patients (2.4%), infarction in 6 patients (1.6%) and abscess in 1 patient (0.3%). Preoperatively, tumor was considered in 65 patients (17.2%), while vascular malformations were supposed in 94 patients (24.9%), infarction in 18 cases (4.8%) and abscess in 3 cases (0.8%). In 198 patients (52.4%) no specific assumption was made.


CONCLUSIONS
Comparing preoperative assumptions and histological diagnoses, tumor, vascular malformations and infarctions were clinically overestimated, while arteriolosclerosis and amyloid angiopathy were underestimated. In conclusion, we found that histological findings potentially affecting clinical management and prognosis were obtained in 37.8% of cases. Our data suggest that histopathological examination of intracerebral hemorrhage provides important information for patient management and should be routinely performed.
Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Straße 33, Münster, Germany. hollingm@ukmuenster.de
Markus
M
Holling
Astrid
A
Jeibmann
Bernhard R
BR
Fischer
Friedrich K
FK
Albert
Heinrich
H
Ebel
Werner
W
Paulus
Walter
W
Stummer
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001922:Brain Abscess / Q000453:epidemiology / Q000473:pathology*; D001932:Brain Neoplasms / Q000453:epidemiology / Q000473:pathology*; D020785:Central Nervous System Vascular Malformations / Q000453:epidemiology / Q000473:pathology*; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D002544:Cerebral Infarction / Q000453:epidemiology / Q000473:pathology*; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D055815:Young Adult