Validity of Diagnostic Categories Based on Computed Tomography Findings for Acute Lobar Cerebral Hematoma in Patients with a Ruptured Cerebral Aneurysm Compared with That of Patients with Hypertensive Lobar Cerebral Hematoma

ABSTRACT

PURPOSE: The rupture of a cerebral aneurysm generally presents as a subarachnoid hemorrhage (SAH) and less often involves a lobar cerebral hematoma (LCH). Also, compared with a hypertensive LCH, an aneurysmal LCH is an unfavorable factor for a favorable outcome. Thus, the earlier we detect an aneurysmal LCH, the more favorable the outcome we can expect. We designed this study to use diagnostic categories to compare aneurysmal LCHs with hypertensive LCHs based on computed tomography (CT) findings. METHODS: From Mar. 2003 to Feb. 2004, patients with LCH who visited the emergency department of Kyung Hee University Hospital were divided into two groups. One was the aneurysmal LCH group (29 patients), and the other was the hypertensive LCH group (155 patients). Based on CT findings, we retrospectively compared the two groups by using the following six diagnostic categories 1) location of hematoma, 2) presence of an aneurysm on enhanced CT findings, 3) disruption of the cerebral cortex, 4) connection of the hematoma to the main cerebral artery, 5) a hematoma involved with a SAH or an intraventricular hemorrhage (IVH), and 6) heterogeneity of a hematoma in Hounsfield unit. RESULTS: The patterns of aneurysmal LCHs and hypertensive LCHs were specific. Statistically, frontal, corpus callosal, and temporal hematomas may result from ruptured aneurysms, but systemic hypertension may cause thalamic, pontine, cerebellar, and subcortical hematomas. The other diagnostic categories, except for heterogeneity of the hematoma, were statistically more specific for the aneurysmal LCH group than they were for the hypertensive LCH group. CONCLUSION: Based on CT findings, we can make a diagnosis of whether the hematoma in a cerebral parenchyma is due to a ruptured aneurysm or not. Moreover, enhanced CT gives more valuable information for a differential diagnosis. Thus, we propose that enhanced CT be carried out for all non-traumatic LCH patients.