Illustrated correlation of brain C.T. scan findings in clinical assessment of spontaneous intracerebral haematoma in patients with positive risk factors

Background: Spontaneous intracerebral hemorrhage [SICH] is defined as non-traumatic bleeding into the parenchyma of the brain that may extend into the head computed tomography scan is the standard diagnostic tool

Objective: Find out the most important risk factor for SICH and Illustrate the correlation between the sites of hemorrhage detected by CT scan images and patients presentations

Patients and Methods: A prospective study between May 2010 and May 2012; this study was done in the CT unit in AL-Imamain Kadhimmain medical city, Baghdad, The study included 224 consecutive patients with the diagnosis of primary SICH. All the patients had primary spontaneous intracerebral hemorrhage clinically diagnosed plus CT findings that showed evidence of intra-cerebral hemorrhage. Statistical analysis was done using SPSS 15

Results: This study included 224 patients, 128 males and 96 females. Forty two patients lie in the age group of 50-59 years, 66 between 60-69 years, 48 between 70-79 years, 52 patients are seventy years old and older and only 16 are below fifty years of age. Regarding the site of bleeding 160 patients [71.4%] had bleeding in deep seated areas of the brain and 64 patients [28.6%] had bleeding in a superficial location. Regarding the deep seated hemorrhage basal ganglia was in 96 [42.8%] of the patients, followed by Thalamus in 48 [21.4%], and cerebellum in 16 [7.2%] of the patients. In the superficial sites of hemorrhage parietal lobe was in 40 patients [17.8%], then parieto-occipital hemorrhage was in 16 [7.2%] patients and 8 patients [3.6%] had temporal lobe hemorrhage. Hypertension was the most common risk factors, found in 75% of patients, followed by antigcoagulant use in 57.2% of patients. A history of diabetes mellitus was positive in 39.3% of the patients, 39.3% of them were smokers, and 25% patients had no history of any risk factors. A statistically significant difference between deep and superficial bleeding is seen in correlation with hypertension and smoking [P value is 0.00001 and 0.002 respectively] The focal neurological signs, found in 66 patients, facial palsy in 48 patients, loss of consciousness in 40 patients, 32 patients had both focal neurological signs and loss of consciousness as a presentation, 22 of them presented with speech difficulty, 8patients presented with ataxia and 8 with dementia. Significant relationship was found between the site of hemorrhage and patients' presentation [P value 0.001]. 120 patients had intra-ventricular extension of hemorrhage in their CT films, 120 patients had pressure effect of the hemorrhage, and 104 were complicated by edema

Conclusion: Males are more affected than females by spontaneous intra-cerebral hemorrhage which tends to occur more commonly in a deep seated area of the brain. Hypertension is the most important risk factor. There is great correlation between patients' presentations and the site of hemorrhage. Patients 50 years and older are more liable for spontaneous intra-cerebral hemorrhage

Intradural Spinal Lipoma without dysraphism

Intradural lipomas are rare tumors of the spinal canal. The aim of this paper is to report four cases of an unusually late presentation of a young male with this tumor

Correlation of CT scan findings of the brain with patient's age, sex and Glasgow coma scale score in mild head injury

Most patients admitted to the emergency department with head injury sustained minor head injury, which is defined as a presenting Glasgow Coma Scale [GCS] score of 13-15, with or without a brief history of loss of consciousness or posttraumatic amnesia after blunt trauma to the head. CT is routinely used to assess all patients with acute head injury and a CT scan is regarded positive if it reveals an acute traumatic intracranial lesion that requires either intervention or observation. To study the incidence of positive CT scan and the different CT findings and to correlate these positive scans with patient's sex, age, and the presenting GCS score. Prospective study was done at March 2008 to June 2010 in Al-Kadhimiyia Teaching Hospital, Iraq including 254 patients suffering mild head injury [186 male and 68 female]. The patients were initially assessed by a neurosurgeon in the emergency department and had a presenting GCS score of 13-15. Emergency CT was performed in all patients within the first 6 hours of trauma. A CT scan was considered positive if it reveals one or more of the following findings: soft tissue swelling and sub-galial hematoma, fractures, brain contusion, brain swelling and edema, epidural hematoma, subdural hematoma, and intra-cerebral hematoma. Male: Female ratio was 2.71. Normal CT scans were observed in 72% of patients, the remaining 28% had positive CT scan. Incidence of positive CT in males in higher than in females [P<0.05]. 62%. of patients with positive CT scan were older than 40 years. Regarding serious injuries, 5.6% showed intra-cerebral hematoma, 7% showed epidural hematoma, and 4.2% showed subdural hematoma. The incidence of positive CT scan in mild head injury is more common in males and in older patients. Soft tissue swelling and sub-galial hematoma were the commonest CT findings in patients with mild head trauma