A Case of Simultaneous Bilateral Putaminal Hemorrhage

Abstract

Simultaneous occurrence of multiple intracerebral hemorrhages is a rare condition. Here we report a case of simultaneous bilateral putaminal hemorrhage. A 74–year–old woman suddenly collapsed on the street. She had been medicated for hypertension for thirty years. She was receiving an angiotensin receptor blocker, a long–acting calcium antagonist and aspirin. On admission, she was comatose (Glasgow Coma Scale E1V1M2). The size of her right pupil was 4.0 mm, the left pupil was 5.0 mm. Computed tomography of her brain identfied hematomas in bilateral putamen. The right putaminal hemorrhage was 7×4×7cm, and the left hemorrhage was 5×2×4cm. As the hematomas were large and her neurological condition was severe, no surgical intervention was attempted. She died on the sixth day after admission. An autopsy of her brain was performed with the permission of her family. However, her brain was severely autolytic; therefore, pathological findings were difficult to detect. We identified 27 cases of simultaneous bilateral putaminal hemorrhage in the literature. We summarized these cases and ours. The mean age was 56.75 years old. Nineteen cases had a history of hypertension. Twenty–five cases were comatose or semi–comatose at onset. Fifteen cases (55.6%) died. Many of surviving cases were severely disability. Multiple intracerebral hemorrhages occur in patients with hypertension, coagulation defects, neoplasm, multiple small aneurysms, or angiopathies. However, the underlying mechanism for simultaneous bilateral putaminal hemorrhages is not clear.